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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2020

01-12-2020 | Acute Kidney Injury | Research

Bedside prediction of intradialytic hemodynamic instability in critically ill patients: the SOCRATE study

Authors: Naïke Bigé, Jean-Rémi Lavillegrand, Julien Dang, Philippe Attias, Stéphanie Deryckere, Jérémie Joffre, Vincent Dubée, Gabriel Preda, Guillaume Dumas, Geoffroy Hariri, Claire Pichereau, Jean-Luc Baudel, Bertrand Guidet, Eric Maury, Pierre-Yves Boelle, Hafid Ait-Oufella

Published in: Annals of Intensive Care | Issue 1/2020

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Abstract

Background

Despite improvements in intermittent hemodialysis management, intradialytic hemodynamic instability (IHI) remains a common issue that could account for increased mortality and delayed renal recovery. However, predictive factors of IHI remain poorly explored. The objective of this study was to evaluate the relationship between baseline macrohemodynamic, tissue hypoperfusion parameters and IHI occurrence.

Methods

Prospective observational study conducted in a 18-bed medical ICU of a tertiary teaching hospital. Cardiovascular SOFA score, index capillary refill time (CRT) and lactate level were measured just before (T0) consecutive intermittent hemodialysis sessions performed for AKI. The occurrence of IHI requiring a therapeutic intervention was recorded.

Results

Two hundred eleven sessions, corresponding to 72 (34%) first sessions and 139 (66%) later sessions, were included. As IHI mostly occurred during first sessions (43% vs 12%, P < 0.0001), following analyses were performed on the 72 first sessions. At T0, cardiovascular SOFA score ≥1 (87% vs 51%, P = 0.0021) was more frequent before IHI sessions, as well as index CRT ≥ 3 s (55% vs 15%, P = 0.0004), and hyperlactatemia > 2 mmol/L (68% vs 29%, P = 0.0018). Moreover, the occurrence of IHI increased with the number of macrohemodynamic and tissue perfusion impaired parameters, named SOCRATE score (cardiovascular SOFA, index CRT and lactATE): 10% (95% CI [3%, 30%]), 33% (95% CI [15%, 58%]), 55% (95% CI [35%, 73%]) and 80% (95% CI [55%, 93%]) for 0, 1, 2 and 3 parameters, respectively (AUC = 0.79 [0.69–0.89], P < 0.0001). These results were confirmed by analyzing the 139 later sessions included in the study.

Conclusions

The SOCRATE score based on 3 easy-to-use bedside parameters correlates with the risk of IHI. By improving risk stratification of IHI, this score could help clinicians to manage intermittent hemodialysis initiation in critically ill AKI patients.
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Literature
1.
Clec’h C, Gonzalez F, Lautrette A, Nguile-Makao M, Garrouste-Orgeas M, Jamali S, et al. Multiple-center evaluation of mortality associated with acute kidney injury in critically ill patients: a competing risks analysis. Crit Care. 2011;15:R128.PubMedCrossRefPubMedCentral
2.
Nisula S, Kaukonen K-M, Vaara ST, Korhonen A-M, Poukkanen M, Karlsson S, et al. Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med. 2013;39:420–8.PubMedCrossRef
3.
Hoste EAJ, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41:1411–23.PubMedCrossRef
4.
Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Pons B, Boulet E, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med. 2016;375:122–33.PubMedCrossRef
5.
Schortgen F, Soubrier N, Delclaux C, Thuong M, Girou E, Brun-Buisson C, et al. Hemodynamic tolerance of intermittent hemodialysis in critically ill patients: usefulness of practice guidelines. Am J Respir Crit Care Med. 2000;162:197–202.PubMedCrossRef
6.
Vinsonneau C, Allain-Launay E, Blayau C, Darmon M, Ducheyron D, Gaillot T, et al. Renal replacement therapy in adult and pediatric intensive care: recommendations by an expert panel from the French Intensive Care Society (SRLF) with the French Society of Anesthesia Intensive Care (SFAR) French Group for Pediatric Intensive Care Emergencies (GFRUP) the French Dialysis Society (SFD). Ann Intensive Care. 2015;5:58.PubMedCrossRefPubMedCentral
7.
du Cheyron D, Terzi N, Seguin A, Valette X, Prevost F, Ramakers M, et al. Use of online blood volume and blood temperature monitoring during haemodialysis in critically ill patients with acute kidney injury: a single-centre randomized controlled trial. Nephrol Dial Transplant. 2013;28:430–7.PubMedCrossRef
8.
Chimot L, Gacouin A, Nardi N, Gros A, Mascle S, Marqué S, et al. Can we predict poor hemodynamic tolerance of intermittent hemodialysis with echocardiography in intensive care patients? J Ultrasound Med. 2014;33:2145–50.PubMedCrossRef
9.
Monnet X, Cipriani F, Camous L, Sentenac P, Dres M, Krastinova E, et al. The passive leg raising test to guide fluid removal in critically ill patients. Ann Intensive Care. 2016;6:46.PubMedCrossRefPubMedCentral
10.
Bitker L, Bayle F, Yonis H, Gobert F, Leray V, Taponnier R, et al. Prevalence and risk factors of hypotension associated with preload-dependence during intermittent hemodialysis in critically ill patients. Crit Care. 2016;20:44.PubMedCrossRefPubMedCentral
11.
Douvris A, Malhi G, Hiremath S, McIntyre L, Silver SA, Bagshaw SM, et al. Interventions to prevent hemodynamic instability during renal replacement therapy in critically ill patients: a systematic review. Crit Care. 2018;22:41.PubMedCrossRefPubMedCentral
12.
Douvris A, Zeid K, Hiremath S, Bagshaw SM, Wald R, Beaubien-Souligny W, et al. Mechanisms for hemodynamic instability related to renal replacement therapy: a narrative review. Intensive Care Med. 2019;45:1333–46.PubMedCrossRefPubMedCentral
13.
Barbar SD, Clere-Jehl R, Bourredjem A, Hernu R, Montini F, Bruyère R, et al. Timing of renal-replacement therapy in patients with acute kidney injury and sepsis. N Engl J Med. 2018;379:1431–42.PubMedCrossRef
14.
Zarbock A, Kellum JA, Schmidt C, Van Aken H, Wempe C, Pavenstädt H, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the ELAIN randomized clinical trial. JAMA. 2016;315:2190–9.PubMedCrossRef
15.
Legrand M, Darmon M, Joannidis M, Payen D. Management of renal replacement therapy in ICU patients: an international survey. Intensive Care Med. 2013;39:101–8.PubMedCrossRef
16.
Daugirdas JT. Pathophysiology of dialysis hypotension: an update. Am J Kidney Dis. 2001;38:S11–7.PubMedCrossRef
17.
Meyer C, Heiss C, Drexhage C, Kehmeier ES, Balzer J, Mühlfeld A, et al. Hemodialysis-induced release of hemoglobin limits nitric oxide bioavailability and impairs vascular function. J Am Coll Cardiol. 2010;55:454–9.PubMedCrossRef
18.
Bemelmans RHH, Boerma EC, Barendregt J, Ince C, Rommes JH, Spronk PE. Changes in the volume status of haemodialysis patients are reflected in sublingual microvascular perfusion. Nephrol Dial Transplant. 2009;24:3487–92.PubMedCrossRef
19.
Duffy MJ, Mullan BA, Craig TR, Shyamsundar M, MacSweeney RE, Thompson G, et al. Impaired endothelium-dependent vasodilatation is a novel predictor of mortality in intensive care. Crit Care Med. 2011;39:629–35.PubMedCrossRef
20.
Ait-Oufella H, Maury E, Lehoux S, Guidet B, Offenstadt G. The endothelium: physiological functions and role in microcirculatory failure during severe sepsis. Intensive Care Med. 2010;36:1286–98.PubMedCrossRef
21.
Vallet B. Endothelial cell dysfunction and abnormal tissue perfusion. Crit Care Med. 2002;30:S229–34.PubMedCrossRef
22.
Kirschenbaum LA, Astiz ME, Rackow EC, Saha DC, Lin R. Microvascular response in patients with cardiogenic shock. Crit Care Med. 2000;28:1290–4.PubMedCrossRef
23.
Trzeciak S, McCoy JV, Phillip Dellinger R, Arnold RC, Rizzuto M, Abate NL, et al. Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis. Intensive Care Med. 2008;34:2210–7.PubMedCrossRefPubMedCentral
24.
De Backer D, Ospina-Tascon G, Salgado D, Favory R, Creteur J, Vincent J-L. Monitoring the microcirculation in the critically ill patient: current methods and future approaches. Intensive Care Med. 2010;36:1813–25.PubMedCrossRef
25.
Ekbal NJ, Dyson A, Black C, Singer M. Monitoring tissue perfusion, oxygenation, and metabolism in critically ill patients. Chest. 2013;143:1799–808.PubMedCrossRef
26.
Hariri G, Joffre J, Leblanc G, Bonsey M, Lavillegrand J-R, Urbina T, et al. Narrative review: clinical assessment of peripheral tissue perfusion in septic shock. Ann Intensive Care. 2019;9(1):37.PubMedCrossRefPubMedCentral
27.
Vincent J-L, Silva QEA, Couto L, Taccone FS. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care. 2016;20:257.PubMedCrossRefPubMedCentral
28.
Bakker J, Coffernils M, Leon M, Gris P, Vincent JL. Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock. Chest. 1991;99:956–62.PubMedCrossRef
29.
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45:486–552.PubMedCrossRef
30.
Alsma J, van Saase JLCM, Nanayakkara PWB, Schouten WEMI, Baten A, Bauer MP, et al. The Power of flash mob research: conducting a nationwide observational clinical study on capillary refill time in a single day. Chest. 2017;151:1106–13.PubMedCrossRef
31.
Jouffroy R, Saade A, Tourtier JP, Gueye P, Bloch-Laine E, Ecollan P, et al. Skin mottling score and capillary refill time to assess mortality of septic shock since pre-hospital setting. Am J Emerg Med. 2019;37:664–71.PubMedCrossRef
32.
Sansone CM, Prendin F, Giordano G, Casati P, Destrebecq A, Terzoni S. Relationship between capillary refill time at triage and abnormal clinical condition: a Prospective Study. Open Nurs J. 2017;11:84–90.PubMedCrossRefPubMedCentral
33.
Coslovsky M, Takala J, Exadaktylos AK, Martinolli L, Merz TM. A clinical prediction model to identify patients at high risk of death in the emergency department. Intensive Care Med. 2015;41:1029–36.PubMedCrossRefPubMedCentral
34.
Ait-Oufella H, Bige N, Boelle PY, Pichereau C, Alves M, Bertinchamp R, et al. Capillary refill time exploration during septic shock. Intensive Care Med. 40(7):958–64.PubMedCrossRef
35.
Hernández G, Ospina-Tascón GA, Damiani LP, Estenssoro E, Dubin A, Hurtado J, et al. Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock: the ANDROMEDA-SHOCK randomized clinical trial. JAMA. 2019;321:654–64.PubMedCrossRefPubMedCentral
36.
Jörres A, John S, Lewington A, ter Wee PM, Vanholder R, Van Biesen W, et al. A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines on Acute Kidney Injury: part 2: renal replacement therapy. Nephrol Dial Transplant. 2013;28:2940–5.PubMedCrossRef
37.
Miller ME, Hui SL, Tierney WM. Validation techniques for logistic regression models. Stat Med. 1991;10:1213–26.PubMedCrossRef
38.
VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359:7–20.CrossRef
39.
Rabindranath K, Adams J, Macleod AM, Muirhead N. Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev. 2007;3:3773.
40.
41.
Sato M, Morita H, Ema H, Yamaguchi S, Amano I. Effect of different dialyzer membranes on cutaneous microcirculation during hemodialysis. Clin Nephrol. 2006;66:426–32.PubMedCrossRef
42.
Cianciolo G, Stefoni S, Donati G, De Pascalis A, Iannelli S, Manna C, et al. Intra- and post-dialytic platelet activation and PDGF-AB release: cellulose diacetate vs polysulfone membranes. Nephrol Dial Transplant. 2001;16:1222–9.PubMedCrossRef
43.
Barak M, Nakhoul F, Katz Y. Pathophysiology and clinical implications of microbubbles during hemodialysis. Semin Dial. 2008;21:232–8.PubMedCrossRef
44.
Ospina-Tascon G, Neves AP, Occhipinti G, Donadello K, Büchele G, Simion D, et al. Effects of fluids on microvascular perfusion in patients with severe sepsis. Intensive Care Med. 2010;36:949–55.PubMedCrossRef
45.
De Backer D, Creteur J, Dubois M-J, Sakr Y, Koch M, Verdant C, et al. The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects. Crit Care Med. 2006;34:403–8.PubMedCrossRef
46.
Brunauer A, Koköfer A, Bataar O, Gradwohl-Matis I, Dankl D, Bakker J, et al. Changes in peripheral perfusion relate to visceral organ perfusion in early septic shock: a pilot study. J Crit Care. 2016;35:105–9.PubMedCrossRef
47.
Lima A, van Genderen ME, van Bommel J, Klijn E, Jansem T, Bakker J. Nitroglycerin reverts clinical manifestations of poor peripheral perfusion in patients with circulatory shock. Crit Care. 2014;18:R126.PubMedCrossRefPubMedCentral
48.
Lima A, Jansen TC, van Bommel J, Ince C, Bakker J. The prognostic value of the subjective assessment of peripheral perfusion in critically ill patients. Crit Care Med. 2009;37:934–8.PubMedCrossRef
49.
Urbina T, Bigé N, Nguyen Y, Boelle P-Y, Dubée V, Joffre J, et al. Tissue perfusion alterations correlate with mortality in patients admitted to the intensive care unit for acute pulmonary embolism: an observational study. Medicine. 2018;97:e11993.PubMedCrossRefPubMedCentral
50.
Bourcier S, Pichereau C, Boelle P-Y, Nemlaghi S, Dubée V, Lejour G, et al. Toe-to-room temperature gradient correlates with tissue perfusion and predicts outcome in selected critically ill patients with severe infections. Ann Intensive Care. 2016;6:63.PubMedCrossRefPubMedCentral
Metadata
Title
Bedside prediction of intradialytic hemodynamic instability in critically ill patients: the SOCRATE study
Authors
Naïke Bigé
Jean-Rémi Lavillegrand
Julien Dang
Philippe Attias
Stéphanie Deryckere
Jérémie Joffre
Vincent Dubée
Gabriel Preda
Guillaume Dumas
Geoffroy Hariri
Claire Pichereau
Jean-Luc Baudel
Bertrand Guidet
Eric Maury
Pierre-Yves Boelle
Hafid Ait-Oufella
Publication date
01-12-2020
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2020
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-020-00663-x

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