Abstract: TH-PO0879
Assessment of Intradialytic Hypotension in Patients with Liver Cirrhosis on CRRT
Session Information
- Dialysis: Prescription, Physiology, and Treatment Optimization
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Antley, Mckinley H., Medical University of South Carolina, Charleston, South Carolina, United States
- Heintze, David, Medical University of South Carolina, Charleston, South Carolina, United States
- Okamoto, Keisuke, Nara Kenritsu Ika Daigaku, Kashihara, Nara Prefecture, Japan
- McMahon, Blaithin A., Medical University of South Carolina, Charleston, South Carolina, United States
Background
Patients with decompensated liver cirrhosis that require the use of continuous renal replacement therapy (CRRT) are highly vulnerable to hemodynamic instability due to baseline systemic vasodilation, decreased arterial volume, and impaired cardiovascular function. Liver cirrhosis patients on CRRT are particularly vulnerable to worsening shock or hypotension from even low levels of ultrafiltration or when transitioning from CRRT to prolonged intermittent renal replace therapy (PIRRT) or intermittent hemodialysis (iHD). This can result in underdialysis, delayed renal recovery and higher mortality.
Methods
A retrospective cohort study was conducted in 228 AKI patients requiring CRRT at MUSC, 82 patients had a presentation of decompensated liver cirrhosis complicated by AKI-D. Data were extracted from the electronic medical record including hourly vasopressor requirements during CRRT, and mean arterial pressure. IDH was defined as a new pressor requirement or doubling of pressors during CRRT or addition of a second pressor. Clinical outcomes including intradialytic hypotension, renal recovery and mortality were also collected. Descriptive statistical analyses were performed.
Results
A total of 228 patients were included (cirrhosis n=82; control n =146). Intradialytic hypotension (IDH) occurred more frequently in patients with cirrhosis (78.1% vs 43.3%), with the highest rates among those who did not receive orthoptic liver transplantation (83.1% vs 58.8% in OLT). The transition to PIRRT was lower in the cirrhosis cohort than in controls (42.1% vs 67.3%), while overall transition to iHD was similar between groups (7.9% vs 9.1%). Within the cirrhosis cohort, PIRRT was most frequent among patients who underwent OLT during admission compared with those who did not (82.4% vs 30.5%) and occurred more frequently post-operatively, whereas iHD transition rates were comparable (5.9% vs 8.5%). Renal recovery was substantially lower in the cirrhosis cohort compared with controls (37.0% vs 65.3%), and markedly higher among cirrhosis patients who underwent OLT compared with those who did not (94.1% vs 21.9%).
Conclusion
Intradialytic hypotension (IDH) occurs far more frequently in patients with cirrhosis than prior estimates suggest. Nephrologist and critical staff need to better recognize how vulnerable this patient population is to intradialytic hypotension.