Dados do Trabalho

Título

A Prospective Observational Study on Predicting the Risk of Intradialytic Hypotension in Critically Ill Patients Receiving Intermittent Dialysis

Objetivo

This study aims to evaluate the clinical utility of using the passive leg raising test (PLR) and the measurement of dynamic arterial elastance performed before the start of intermittent hemodialysis as predictors of hemodynamic instability.

Métodos

This was a prospective observational single-center study performed between January 1, 2015, and April 30, 2018, in a 30-bed medical intensive care unit. PLR and dynamic arterial elastance were evaluated as predictors of intradialytic hypotension (IDH), defined as the occurrence of a MAP below 65 mmHg during the dialysis session. Logistic regression with both categorical and continuous independent variables was used to build predictive models for the occurrence of hypotension. Statistical significance was assumed at the 5% level.

Resultados

During the period from January 2016 to March 2018, a group of 248 patients with acute kidney injury (AKI) who required intermittent hemodialysis were considered eligible for the study. IDH was observed in 31.9% of the patients, with variables such as sepsis, the use of norepinephrine, mechanical ventilation, elderly age, and high predialysis lactate level being significantly associated with IDH. Furthermore, IDH was more prevalent in patients who had preload depended as stated by the leg passive raising test and a dynamic arterial elastance of less than 1. The logistic regression model for predicting IDH showed that the use of norepinephrine and preload dependence detected by the leg passive raising test were linked to the development of IDH.

Conclusão

In critically ill patients with objective indications of emergent initiation of hemodialysis, PLR may predict IDH.