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Hemodynamic instability during connection to continuous kidney replacement therapy in critically ill pediatric patients

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Abstract

Background

Emerging data suggest evidence of organ hypoperfusion during continuous kidney replacement therapy (CKRT). To facilitate kidney and global recovery, we must understand the hemodynamic risks associated with CKRT. We aimed to investigate frequency of hemodynamic instability and association with patient outcomes in pediatric CKRT.

Methods

In a single-center study of CKRT patients between September 2016 and October 2018, we collected hemodynamic data using archived high-resolution physiologic data before and after connection. Primary outcome was hypotension defined as ≥ 20% decrease in baseline mean arterial pressure (MAP) for ≥ 2 consecutive minutes in the 60 min following connection. Secondary outcomes were tachycardia (≥ 20% increase in heart rate (HR)) and hemodynamic interventions.

Results

Seventy-one patients median age 54 months (IQR 7–144), weight 16.7 kg (IQR 8–41), on hemodiafiltration had 304 filter connections, 4 (IQR 1–7) filters per patient; the median duration of CKRT was 9 days (IQR 3–20). The most common CKRT indication was AKI with fluid overload (48/71, 69%). There were 78 (27%) hypotension and 42 (14%) tachycardia events; cumulative duration of hypotension was 14 min IQR (3–31.75). Teams provided intervention in 17/304 (6%) of connections. Pediatric Logistic Organ Dysfunction 2 was the only independent predictor of hypotension (aOR 2.12 (CI 1.02–4.41)).

Conclusions

One in four and one in six pediatric CKRT filter connections were complicated by hypotension and tachycardia, respectively. Higher illness severity at CKRT initiation was independently associated with hypotension. Impact of CKRT-associated hemodynamic instability on global patient outcomes requires further targeted study.

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Acknowledgements

The authors gratefully acknowledge the support of Doctor Jorge A. CossBu, MD.

Funding

Internal funding from the Baylor College of Medicine supported this study. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript.

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Authors and Affiliations

  1. Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Sameer Thadani, Thomas Fogarty & Ayse Akcan-Arikan

  2. Department of Pediatrics, Renal Section, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Theresa Mottes, Poyyapakkam Srivaths & Ayse Akcan-Arikan

  3. Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Jack F. Price

  4. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA

    Cynthia Bell

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  1. Sameer Thadani
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Thadani, S., Fogarty, T., Mottes, T. et al. Hemodynamic instability during connection to continuous kidney replacement therapy in critically ill pediatric patients. Pediatr Nephrol 37, 2167–2177 (2022). https://doi.org/10.1007/s00467-022-05424-5

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