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Journal of Nephrology

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18-07-2022 | Acute Kidney Injury | original Article

Echocardiographic parameters and hemodynamic instability at the initiation of continuous kidney replacement therapy

Authors: Panagiotis Kompotiatis, Khaled Shawwa, Jacob C. Jentzer, Brandon M. Wiley, Kianoush B. Kashani

Published in: Journal of Nephrology | Issue 1/2023

Abstract

Objective

Investigate the association of echocardiographic parameters with hemodynamic instability after initiating continuous kidney replacement therapy (CKRT) in a cohort of intensive care unit (ICU) patients requiring CKRT.

Methods

Historical cohort study of consecutive adults admitted to the ICU at a tertiary care hospital from December 2006 through November 2015 who underwent CKRT and had an echocardiogram done within seven days before CKRT initiation. The primary outcome was hypotension within one hour of CKRT initiation.

Results

We included 980 patients, 804 (82%) with acute kidney injury (AKI) and 176 (18%) with end-stage kidney disease (ESKD). Median patient age was 63 (± 14) years, and median Sequential Organ Failure Assessment (SOFA) score on the day of CKRT initiation was 12 (IQR 10–14). Multivariable analysis showed that Left (OR 2.01, 95% CI 1.04–3.86), and Right (OR 1.5, 95% CI 1.04–2.25) moderate and severe ventricular enlargement, Vasoactive-Inotropic Score (VIS) one hour before CKRT initiation (OR 1.18 per 10 units increase, 95% CI 1.09–1.28) and high bicarbonate fluid replacement (OR 2.52, 95% CI 1.01–6.2) were associated with hypotension after CKRT initiation.

Conclusion

Right and left ventricular enlargement are risk factors associated with hypotension after CKRT initiation.

Graphical abstract

Available only for authorised users

To maintain the rate of 3 mmol of citrate for each liter of blood (blood flow rate 200 ml/min or 1 L per 5 min), we use 300 ml/h of ACD-A, i.e., 36 mmol of citrate per hour. We have devised an estimated starting dose for the calcium chloride infusion that is titrated by the nephrologists depending on the labs (taking into consideration the absolute total and ionized calcium in addition to their ratio to monitor for citrate lock). To avoid electrolyte imbalances, we monitor labs three times a day, once starting CKRT and twice a day afterwards. We use a replacement solution with zero calcium and 22 mmol/L of bicarbonate as the standard solution.

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Title: Echocardiographic parameters and hemodynamic instability at the initiation of continuous kidney replacement therapy
Authors: Panagiotis Kompotiatis
Khaled Shawwa
Jacob C. Jentzer
Brandon M. Wiley
Kianoush B. Kashani
Publication date: 18-07-2022
Publisher: Springer International Publishing
Keywords: Acute Kidney Injury
Hypotension
Care
Acute Kidney Injury
Hypotension
Published in: Journal of Nephrology / Issue 1/2023
Print ISSN: 1121-8428
Electronic ISSN: 1724-6059
DOI: https://doi.org/10.1007/s40620-022-01400-2

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Abstract

Objective

Methods

Results

Conclusion

Graphical abstract

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