Jae Ho Kim , Joonhee Yoon , Ji-Eun Kim , Seongho Jo , Yuri Lee , Ji Won Kim , Seun Deuk Hwang , Seoung Woo Lee , Joon Ho Song , Kipyo Kim
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The patients underwent a median of 7 IHD sessions (interquartile range [IQR] 3–11), with an incidence of intradialytic hypotension (IDH) of 16.8 % per patient. Of these, 43.1 % were dialysis-dependent at hospital discharge. The number of IDH was a significant predictor of dialysis dependence (odds ratio [OR] 1.56; 95 % confidence interval [CI] 1.16–2.22). Patients experiencing ≥3 IDH episodes had a substantially higher risk of dialysis dependence compared to those without IDH (OR 9.41; 95 % CI 2.41–41.69). In per-session analysis, the target ultrafiltration rate was identified as an independent risk factor for IDH occurrence.</div></div><div><h3>Conclusions</h3><div>Our study revealed that IHD-related hypotension during hospitalization has a cumulative negative impact on kidney recovery in AKI-D survivors.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154944"},"PeriodicalIF":3.2000,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Cumulative impact of hypotension during intermittent hemodialysis on kidney recovery in critically ill patients with AKI-D\",\"authors\":\"Jae Ho Kim , Joonhee Yoon , Ji-Eun Kim , Seongho Jo , Yuri Lee , Ji Won Kim , Seun Deuk Hwang , Seoung Woo Lee , Joon Ho Song , Kipyo Kim\",\"doi\":\"10.1016/j.jcrc.2024.154944\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Intermittent hemodialysis (IHD) is commonly implemented in patients with AKI-D, irrespective of the initial kidney replacement therapy (KRT) modality. However, concerns remain regarding the hemodynamic instability during IHD. This study aimed to assess the association between hypotensive episodes during IHD and kidney recovery in AKI-D patients.</div></div><div><h3>Methods</h3><div>We retrospectively enrolled AKI-D survivors who received IHD in the intensive care units of a tertiary care hospital in Korea from January 2018 to February 2024.</div></div><div><h3>Results</h3><div>A total of 1791 IHD sessions from 209 AKI-D survivors were analyzed. The patients underwent a median of 7 IHD sessions (interquartile range [IQR] 3–11), with an incidence of intradialytic hypotension (IDH) of 16.8 % per patient. Of these, 43.1 % were dialysis-dependent at hospital discharge. The number of IDH was a significant predictor of dialysis dependence (odds ratio [OR] 1.56; 95 % confidence interval [CI] 1.16–2.22). Patients experiencing ≥3 IDH episodes had a substantially higher risk of dialysis dependence compared to those without IDH (OR 9.41; 95 % CI 2.41–41.69). In per-session analysis, the target ultrafiltration rate was identified as an independent risk factor for IDH occurrence.</div></div><div><h3>Conclusions</h3><div>Our study revealed that IHD-related hypotension during hospitalization has a cumulative negative impact on kidney recovery in AKI-D survivors.</div></div>\",\"PeriodicalId\":15451,\"journal\":{\"name\":\"Journal of critical care\",\"volume\":\"85 \",\"pages\":\"Article 154944\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-10-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of critical care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0883944124004313\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of critical care","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0883944124004313","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Cumulative impact of hypotension during intermittent hemodialysis on kidney recovery in critically ill patients with AKI-D
Background
Intermittent hemodialysis (IHD) is commonly implemented in patients with AKI-D, irrespective of the initial kidney replacement therapy (KRT) modality. However, concerns remain regarding the hemodynamic instability during IHD. This study aimed to assess the association between hypotensive episodes during IHD and kidney recovery in AKI-D patients.
Methods
We retrospectively enrolled AKI-D survivors who received IHD in the intensive care units of a tertiary care hospital in Korea from January 2018 to February 2024.
Results
A total of 1791 IHD sessions from 209 AKI-D survivors were analyzed. The patients underwent a median of 7 IHD sessions (interquartile range [IQR] 3–11), with an incidence of intradialytic hypotension (IDH) of 16.8 % per patient. Of these, 43.1 % were dialysis-dependent at hospital discharge. The number of IDH was a significant predictor of dialysis dependence (odds ratio [OR] 1.56; 95 % confidence interval [CI] 1.16–2.22). Patients experiencing ≥3 IDH episodes had a substantially higher risk of dialysis dependence compared to those without IDH (OR 9.41; 95 % CI 2.41–41.69). In per-session analysis, the target ultrafiltration rate was identified as an independent risk factor for IDH occurrence.
Conclusions
Our study revealed that IHD-related hypotension during hospitalization has a cumulative negative impact on kidney recovery in AKI-D survivors.
期刊介绍：
The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice.
The Journal will include articles which discuss:
All aspects of health services research in critical care
System based practice in anesthesiology, perioperative and critical care medicine
The interface between anesthesiology, critical care medicine and pain
Integrating intraoperative management in preparation for postoperative critical care management and recovery
Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients
The team approach in the OR and ICU
System-based research
Medical ethics
Technology in medicine
Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education
Residency Education.
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