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Early acid–base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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).

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Acknowledgments

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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Authors and Affiliations

  1. ANZICS CTG, Level 3, 10 Ievers St, Carlton, VIC, 3053, Australia

    Rinaldo Bellomo, Miklos Lipcsey, Paolo Calzavacca, Michael Haase, Anjia Haase-Fielitz, Elisa Licari, Augustine Tee, Louise Cole, Alan Cass, Simon Finfer, Martin Gallagher, Joanne Lee, Serigne Lo, Colin McArthur, Shay McGuinness, John Myburgh & Carlos Scheinkestel

Authors
  1. Rinaldo Bellomo
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  2. Miklos Lipcsey
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  3. Paolo Calzavacca
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  4. Michael Haase
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  5. Anjia Haase-Fielitz
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  6. Elisa Licari
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  7. Augustine Tee
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  8. Louise Cole
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  9. Alan Cass
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  10. Simon Finfer
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  11. Martin Gallagher
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  12. Joanne Lee
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  13. Serigne Lo
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  14. Colin McArthur
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  15. Shay McGuinness
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  16. John Myburgh
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  17. Carlos Scheinkestel
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Consortia

The RENAL Study Investigators and The ANZICS Clinical Trials Group

Corresponding author

Correspondence to Rinaldo Bellomo.

Additional information

The randomized evaluation of normal versus augmented level (RENAL) Replacement Therapy Study is a collaboration of the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG) and the George Institute for International Health.

The names and affiliations of the RENAL Replacement Therapy Study investigators are listed in the Appendix.

Appendix

Appendix

Writing committee (in alphabetical order): Rinaldo Bellomo (chair), Alan Cass, Louise Cole, Simon Finfer, Martin Gallagher, Serigne N. Lo, Colin McArthur, Shay McGuinness, John Myburgh, Robyn Norton, Carlos Scheinkestel, and Steve Su.

Management committee: (in alphabetical order): Rinaldo Bellomo (chair), David Ali, Alan Cass, Louise Cole, Simon Finfer, Martin Gallagher, Donna Goldsmith, Joanne Lee, John Myburgh, Robyn Norton, and Carlos Scheinkestel.

Steering committee: Rinaldo Bellomo (chair), Ashoke Banerjee Deepak Bhonagiri, David Blythe, John Botha, John Cade, Louise Cole, Geoff Dobb, John Eddington, Simon Finfer, Arthas Flabouris, Craig French, Peter Garrett, Seton Henderson, Benno Ihle, Chris Joyce, Michael Kalkoff, Jeff Lipman, Colin McArthur, Shay McGuinness, David Milliss, Imogen Mitchell, John Morgan, John Myburgh, Priya Nair, Neil Orford, Asif Raza, Carlos Scheinkestel, Yahya Shehabi, Antony Tobin, Richard Totaro, Andrew Turner, and Christopher Wright.

Project management team (in alphabetical order): David Ali, Joanne Lee, Lorraine Little, Alana Morrison, Giovanna Regaglia, and Ravi Shukla

Data safety and monitoring committee (in alphabetical order): Colin Baigent (chair), Jonathan Emberson, David Wheeler, and Duncan Young.

Statistics committee (in alphabetical order): Laurent Billot, Severine Bompoint, Stephane Heritier, Serigne N. Lo, Avinesh Pillai, and Steve Su.

Data management and IT/programming (in alphabetical order): Sameer Pandey, Suzanne Ryan, Manuela Schmidt, Gemma Starzec, and Bala Vijayan

Site investigators and research coordinators (in alphabetical order):

Australian Capital Territory:

Canberra Hospital: Imogen Mitchell, Rebecca Ashley, Jelena Gissane, Katya Malchukova, and Jamie Ranse.

New South Wales:

Blacktown Hospital: Asif Raza, Kiran Nand, and Treena Sara. Concord Hospital: David Millis, Jeff Tan, and Helen Wong. John Hunter Hospital: Peter Harrigan, Elise Crowfoot, and Miranda Hardie. Liverpool Hospital: Deepak Bhonagiri and Sharon Micallef. Mater Calvary Hospital, Newcastle: Jorge Brieva and Melissa Lintott. Nepean Hospital: Louise Cole, Rebecca Gresham, Maria Nikas, and Leonie Weisbrodt. Prince of Wales Hospital: Yahya Shehabi, Frances Bass, Michelle Campbell, and Victoria Stockdale. Royal North Shore Hospital: Simon Finfer, Susan Ankers, Anne O’Connor, and Julie Potter. Royal Prince Alfred Hospital: Richard Totaro and Dorrilyn Rajbhandari. St George Hospital: John Myburgh, Vanessa Dhiacou, Alina Jovanovska, and Francesca Munster. St Vincent’s Hospital: Priya Nair, Jeff Breeding, and Claire Burns. Westmead Hospital: Ashoke Banerjee, Maridy Morrison, Caroline Pfeffercorn, and Anne Ritchie.

New Zealand:

Auckland City Hospital/CVICU: Shay McGuinness, Heidi Buhr, Michelle Eccleston, and Rachael Parke. Auckland City Hospital/DCCM: Colin McArthur, Jeanette Bell, and Lynette Newby. Christchurch Hospital: Seton Henderson and Jan Mehrtens. Whangarei Hospital: Michael Kalkoff and Cathy West

Queensland:

Mater Adult and Mater Private Hospital: John Morgan, Lorraine Rudder, and Joanne Sutton. Nambour General Hospital: Peter Garrett, Nicole Groves, Shona McDonald, and Jennifer Palmer. Princess Alexandra Hospital: Chris Joyce, Meg Harwood, Jean Helyar, and Benjamin Mackie. Royal Brisbane Hospital: Jeff Lipman, Robert Boots, Claire Bertenshaw, Renae Deans, Cheryl Fourie, and Melissa Lassig-Smith.

South Australia:

Royal Adelaide Hospital: Arthas Flabouris, Jason Edwards, Stephanie O’Connor, and Justine Rivett.

Tasmania:

Royal Hobart Hospital: Andrew Turner, Tanya Field, and Kathryn Marsden.

Victoria:

Austin Hospital: Rinaldo Bellomo, Claire Mathlin, Donna Goldsmith, Inga Mercer, and Kim O’Sullivan. Bendigo Hospital: John Edington, Catherine Boschert, and Julie Smith. Epworth Hospital: Benno Ihle, Michael Graan, and Samuel Ho. Frankston Hospital: John Botha, Nina Fowler, Jodi McInness, and Naomi Pratt. Geelong Hospital: Neil Orford, Tania Elderkin, Melissa Fraser, and Anne Kinmonth. Monash Medical Centre: Christopher Wright, Sue Burton, Carly Culhane, Pauline Galt, and Rebecca Rutzou. Royal Melbourne: Megan Roberston, Deborah Barge, Tania Caf, Belinda Howe, and Patzy Low. St Vincent’s Hospital Melbourne: Antony Tobin, Nicole Groves, Jennifer Holmes, and Roger Smith. The Alfred Hospital: Carlos Scheinkestel, Andrew Davies, Lynne Murray, Rachael Nevill, Shirley Vallance, Sue Varley, and Vickie White. Western Hospital: Craig French, Lorraine Little, and Heike Raunow.

Western Australia:

Fremantle Hospital: David Blythe and Anna Palermo. Royal Perth Hospital: Geoff Dobb, Melanie Boardman, Jenny Chamberlain, Andree Gould, Geraldine McEntaggart, Samantha Perryman, and Linda Thomas.

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Bellomo, R., Lipcsey, M., Calzavacca, P. et al. Early acid–base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis. Intensive Care Med 39, 429–436 (2013). https://doi.org/10.1007/s00134-012-2800-0

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