Hemodynamic disturbances and oliguria during continuous kidney replacement therapy in critically ill children

Abstract

Background

About 1.5% of patients admitted to the Pediatric Intensive Care Unit (PICU) will require continuous kidney replacement therapy (CKRT)/renal replacement therapy (CRRT). Mortality of these patients ranges from 30 to 60%. CKRT-related hypotension (CKRT-RHI) can occur in 19–45% of patients. Oliguria after onset of CKRT is also common, but to date has not been addressed directly in the scientific literature.

Methods

A prospective observational study was conducted to define factors involved in the hemodynamic changes that take place during the first hours of CKRT, and their relationship with urinary output.

Results

Twenty-five patients who were admitted to a single-center PICU requiring CKRT between January 1, 2014, and December 31, 2018, were included, of whom 56.3% developed CKRT-RHI. This drop in blood pressure was transient and rapidly restored to baseline, and significantly improved after the third hour of CKRT, as core temperature and heart rate decreased. Urine output significantly decreased after starting CKRT, and 72% of patients were oliguric after 6 h of therapy. Duration of CKRT was significantly longer in patients presenting with oliguria than in non-oliguric patients (28.7 vs. 7.9 days, p = 0.013).

Conclusions

The initiation of CKRT caused hemodynamic instability immediately after initial connection in most patients, but had a beneficial effect on the patient’s hemodynamic status after 3 h of therapy, presumably owing to decreases in body temperature and heart rate. Urine output significantly decreased in all patients and was not related to negative fluid balance, patient’s hemodynamic status, CKRT settings, or kidney function parameters.

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Data availability

All data generated or analyzed during the current study are available from the author on reasonable request.

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Acknowledgments

We would like to thank the following people for helping with this research project: the PICU staff including physicians, residents, nurses, nurses’ aids, and ancillary staff, as well as to our local statistics service.

Funding

This study was supported by the National Institute of Health Instituto de Salud Carlos III (FIS 17-00248) and the Research Network on Maternal and Child Health and Development (Red SAMID), RETICS funded by the PN I+D+I 2013-2016 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), ref. RD16/0022/0007).

The sponsor had no role in the design, collection, analysis or interpretation of data, in the writing of the report or in the decision to submit the article for publication.

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Authors

Contributions

All authors contributed to the study conception and design, material preparation, and data collection. Data analysis was performed by María José Santiago and Sarah N. Fernández. The first draft of the study was written by Sarah Nicole Fenrández Lafever. María José Santiago and Jesús López-Herce commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sarah N. Fernández Lafever.

Ethics declarations

The study was approved by the Gregorio Marañon Ethics Committee and was carried out in accordance with the Code of Ethics of the World Medical Association

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The authors declare that they have no conflicts of interest.

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Informed consent was obtained from all individual participants included in the study.

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Fernández Lafever, S.N., López, J., González, R. et al. Hemodynamic disturbances and oliguria during continuous kidney replacement therapy in critically ill children. Pediatr Nephrol (2021). https://doi.org/10.1007/s00467-020-04804-z

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Keywords

  • Acute kidney injury
  • Continuous renal replacement therapy
  • Continuous kidney replacement therapy
  • Hypotension
  • Urine output
  • Pediatric Intensive Care Unit
  • Oliguria
  • Children