Early acid–base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis
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In acute kidney injury patients, metabolic acidosis is common. Its severity, duration, and associated changes in mean arterial pressure (MAP) and vasopressor therapy may be affected by the intensity of continuous renal replacement therapy (CRRT). We aimed to compare key aspects of acidosis and MAP and vasopressor therapy in patients treated with two different CRRT intensities.
We studied a nested cohort of 115 patients from two tertiary intensive care units (ICUs) within a large multicenter randomized controlled trial treated with lower intensity (LI) or higher intensity (HI) CRRT.
Levels of metabolic acidosis at randomization were similar [base excess (BE) of −8 ± 8 vs. −8 ± 7 mEq/l; p = 0.76]. Speed of BE correction did not differ between the two groups. However, the HI group had a greater increase in MAP from baseline to 24 h (7 ± 3 vs. 0 ± 3 mmHg; p < 0.01) and a greater decrease in norepinephrine dose (from 12.5 to 3.5 vs. 5 to 2.5 μg/min; p < 0.05). The correlation (r) coefficients between absolute change in MAP and norepinephrine (NE) dose versus change in BE were 0.05 and −0.37, respectively.
Overall, LI and HI CRRT have similar acid–base effects in patients with acidosis. However, HI was associated with greater improvements in MAP and vasopressor requirements (clinical trial no. NCT00221013).
KeywordsAcidosis Acid–base Acidemia Norepinephrine Alkalosis Base excess Bicarbonate pH Continuous renal replacement therapy Hemodialysis Strong ion difference
We thank the nurses of both participating ICUs (Austin Hospital and Nepean Hospital) for their assistance with the collection of samples and measurements of arterial blood gases. This study was supported by grants from the National Health and Medical Research Council (NHMRC) of Australia (grant no. 352550) and Health Research Council (HRC) of New Zealand (grant no. 06-357).
Conflicts of interest
Professor Cass was supported by a NHMRC Senior Research Fellowship. Professor Bellomo has received consulting fees from Gambro Pty Ltd. Professor Simon Finfer has received travel support to present research results at scientific meetings from Eli Lilly, Cardinal Health, and CSL Bioplasma. The George Institute for International Health, an independent not-for-profit institute affiliated with the University of Sydney, has received reimbursement for Professor Finfer’s time as a steering committee member for studies sponsored by Eli Lilly and Eisai. The George Institute has received research funding from Servier, Novartis, Eisai, Merck, Sharp & Dohme, Pfizer Australia, Fresenius Kabi Deutschland GmbH, and Sanofi Aventis.
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