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