Abstract: FR-PO125
Hypotensive Episodes During Continuous Kidney Replacement Therapy and Mortality
Session Information
- AKI: Outcomes, RRT
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Ramesh, Ambika, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
- Doddi, Akshith, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
- Abbasi, Aisha, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
- Sakhuja, Ankit, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
- Shawwa, Khaled, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
Background
Continuous kidney replacement therapy (CKRT) is often the preferred modality in hemodynamically unstable patients who develop acute kidney injury (AKI) and require kidney replacement therapy.
Methods
Patients with acute kidney injury (AKI) who required CKRT between 1/1/2012 and 1/1/2021 and were admitted to a tertiary academic hospital were included. We assessed the impact of hypotensive episodes on in-hospital mortality and major adverse kidney events (MAKE) at 90 days. MAKE is a composite outcome of need of kidney replacement therapy, doubling of the serum creatinine from baseline or death. Hemodynamic instability episodes were defined as mean arterial pressure (MAP) < 60 mmHg or a decrease in MAP by ≥ 10 mmHg, systolic blood pressure <90 mmHg or a decrease in SBP by ≧ 20 mHg, or increased vasopressor requirement. These were measured in 15-minute increments and the number of episodes in each hour was recorded.
Results
There were 669 patients with AKI that required CKRT during the study period. The median number of hypotensive episodes during the first 24 hours of CKRT was 51 (Interquartile range: 46-55). There were 320 (48%) who suffered in-hospital mortality. Patients who had in-hospital mortality were older ( 62 vs 58), and had higher SOFA score (11 vs 9), higher norepinephrine equivalent (NEE) requirement (0.16 vs 0.07 mcg/kg/min), more frequent hypotensive episodes (medians: 52 vs 49), higher lactate (6.2 vs 3.2 mmol/L), lower mean arterial pressure (MAP) (74 vs 79 mmHg) and were more likely to be requiring mechanical ventilation (81% vs 61%) at CKRT initiation compared to patients who did not suffer in-hospital mortality, p<0.001. After adjusting for age, baseline serum creatinine and SOFA score, lactate, MAP, mechanical ventilation and NEE at CKRT initiation, the number of hypotensive episodes during the first 24 hours was independently associated with in-hospital mortality (OR: 1.2, 95% CI: 1.11-1.35, p<0.001) and MAKE-90 (OR: 1.1, 95% CI 1.01-1.2, p-value=0.04) per 10 increase in hypotensive episodes.
Conclusion
Hypotension is a significant independent risk factor for in-hospital mortality and occurs frequently in patients receiving CKRT.
Funding
- Other NIH Support