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Table 3 Study features and overall incidence of HIRRT

From: Interventions to prevent hemodynamic instability during renal replacement therapy in critically ill patients: a systematic review

Study

HIRRT definition

Intervention

Severity of illness scores

Pre-dialysis BP (mmHg)*

HIRRT

Intermittent hemodialysis

Lynch (2016) [21]

SBP < 80 mmHg, or 50 mmHg drop from pre-HD BP, and/or start of vasopressor during HD

Dialysate sodium modeling

SOFA:

Case: 13.0 ± 2.0

Control: 13.0 ± 3.0

Case: 119.0 ± 16.0

Control: 129.0 ± 21.0

Case: 36/242 = 14.9%

Control: 59/650 = 9.1%

Overall: 95/892 = 10.6%

du Cheyron (2013) [20]

SBP < 90 mmHg justifying Intervention

BVM and BTM

SOFA:

BVM: 7 (5–9)

BVM + BTM: 8 (4–11)

Control: 8 (5–10)

Overall: 10 (8–12)

Not reported for start of sessions but “did not differ among treatment modalities at any time”

BVM: 33/190 = 17.4%

BVM + BTM: 30/194 = 15.5%

Control: 32/188 = 17.0%

Overall: 95/572 = 16.6%

du Cheyron (2010) [19]

SBP < 90 mmHg or fall> 40 mmHg

Blood volume and Temp control

SOFA:

Case: 8.5 (6–16)Control: 8.0 (5–14)

Not reported

Case: 41/189 = 21.7%

Control: 110/383 = 28.7%

Overall: 151/572 = 26.4

Schortgen (2000) [22]

SBP drop > 10% from baseline or volume or vasopressors

“Guidelines” for HIRRT in AKI

SAPS II:“Guidelines”: 59.0 ± 24.0

Control: 50.0 ± 17.0

“Guidelines”: 121.0 ± 23.0

Control: 125.0 ± 24.0

“Guidelines”: 176/289 = 60.9%

Control: 176/248 = 71.0%

Overall: 352/537 = 65.5%

Paganini (1996) [26]

Case: volume ± vasopressors

Variable dialysate sodium and UF modeling

APACHE II:

Overall: 28.7 ± 4.7

MAP:

Case: 82.8± 16.9

Control: 86.2± 18.9

Case: 16.0%§

Control: 45.4%§

Slow low-efficiency dialysis

Albino (2014) [24]

SBP < 90 mmHg

MAP < 60 mmHg

Duration of dialysis 6 vs 10 h

SOFA:

6 h: 13.1 ± 2.4

10 h: 14.2 ± 3.0

Overall:

13.6 ± 2.7

Not reported

6 h: 63/100 = 63.0%

10 h: 53/95 = 55.8%

Overall: 116/195 = 59.5%

Lima (2012) [23]

SBP < 90 mmHg

MAP < 60 mmHg

Interventions

Lower temperature, dialysate sodium and UF profiling

SOFA:

Case: 12.0 ± 3.9Control: 11.0 ± 4.4

Case: 132.0± 25.0

Control: 124.0± 24.0

Case: 8/34 = 23.5%

Control: 16/28 = 57.1%

Overall: 24/62 = 38.7%

Continuous renal replacement therapy

Robert (2012) [25]

Therapeutic intervention for hypotension

Temperature setting:♯

A: 38 °C then 36 °C

B: 36 °C then 38 °C

SOFA:

A:12.8 ± 3.8

B: 8.0 ± 3.8

Overall: 10.6 ± 4.6

A: 118.0 ± 26.0

B: 113.0 ± 26.0

Overall: 117 ± 30

Patients requiring intervention for HIRRT:♯

Period 1:

A: 8/16 = 50.0%

B: 5/14 = 35.7%

Period 2:

A: 3/11 = 27.3%

B:4/11 = 63.6%

Eastwood (2012) [18]

Vasopressor use and/or fluid bolus at 10 and 30 min

CRRT pump speed

APACHE II:

Case: 23.1 ± 4.5Control: 25.9 ± 6.6

Overall: 24.5± 5.8

MAP:

Case: 82.5 ± 15.0

Control: 82.4 ± 15.1

Overall: 82.4 ± 15.0

No HIRRT reported

  1. *Systolic blood pressure, unless otherwise specified
  2. Incidence per session (rather than per patient), unless otherwise specified
  3. §Exact number of HIRRT events/intermittent hemodialysis sessions per group was not reported
  4. ♯Cross-over after 6 h (period 1 is first 6 h; period 2 is second 6 h)
  5. The term ‘case’ is used to refer to a group that received an intervention to limit HIRRT, irrespective of study design
  6. AKI acute kidney injury, APACHE Acute Physiology and Chronic Health Evaluation, BP blood pressure, BTM blood temperature online monitoring, BVM blood volume online monitoring, CRRT continuous renal replacement therapy, HD hemodialysis; HIRRT hemodynamic instability during renal replacement therapy, MAP mean arterial pressure, SAPS Simplified Acute Physiology Score, SBP systolic blood pressure, SOFA Sequential Organ Failure Assessment, UF ultrafiltration
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