PURPOSE: In acute kidney injury patients, metabolic acidosis is common. Its severity, duration, and associated changes in mean arterial pressure (MAP) and vasopressor therapy may be affected by the intensity of continuous renal replacement therapy (CRRT). We aimed to compare key aspects of acidosis and MAP and vasopressor therapy in patients treated with two different CRRT intensities. METHODS: We studied a nested cohort of 115 patients from two tertiary intensive care units (ICUs) within a large multicenter randomized controlled trial treated withlower intensity (LI) or higher intensity (HI) CRRT. RESULTS:Levels of metabolic acidosis at randomization were similar [base excess (BE) of -8 ± 8 vs. -8 ± 7 mEq/l; p = 0.76]. Speed of BE correction did not differ between the two groups. However, the HI group had a greater increase in MAP from baseline to 24 h (7 ± 3 vs. 0 ± 3 mmHg; p < 0.01) and a greater decrease in norepinephrine dose (from 12.5 to 3.5 vs. 5 to 2.5 μg/min; p < 0.05). The correlation (r) coefficients between absolute change in MAP and norepinephrine (NE) dose versus change in BE were 0.05 and -0.37, respectively. CONCLUSIONS: Overall, LI and HI CRRT have similar acid-base effects in patients with acidosis. However, HI was associated with greater improvements in MAP and vasopressor requirements (clinical trial no. NCT00221013).
RCT Entities:
PURPOSE: In acute kidney injurypatients, metabolic acidosis is common. Its severity, duration, and associated changes in mean arterial pressure (MAP) and vasopressor therapy may be affected by the intensity of continuous renal replacement therapy (CRRT). We aimed to compare key aspects of acidosis and MAP and vasopressor therapy in patients treated with two different CRRT intensities. METHODS: We studied a nested cohort of 115 patients from two tertiary intensive care units (ICUs) within a large multicenter randomized controlled trial treated with lower intensity (LI) or higher intensity (HI) CRRT. RESULTS: Levels of metabolic acidosis at randomization were similar [base excess (BE) of -8 ± 8 vs. -8 ± 7 mEq/l; p = 0.76]. Speed of BE correction did not differ between the two groups. However, the HI group had a greater increase in MAP from baseline to 24 h (7 ± 3 vs. 0 ± 3 mmHg; p < 0.01) and a greater decrease in norepinephrine dose (from 12.5 to 3.5 vs. 5 to 2.5 μg/min; p < 0.05). The correlation (r) coefficients between absolute change in MAP and norepinephrine (NE) dose versus change in BE were 0.05 and -0.37, respectively. CONCLUSIONS: Overall, LI and HI CRRT have similar acid-base effects in patients with acidosis. However, HI was associated with greater improvements in MAP and vasopressor requirements (clinical trial no. NCT00221013).
Authors: Kada Klouche; Pierre Cavadore; Pierre Portales; Jacques Clot; Bernard Canaud; Jean Jacques Béraud Journal: J Nephrol Date: 2002 Mar-Apr Impact factor: 3.902
Authors: Olivier Joannes-Boyau; Patrick M Honoré; Paul Perez; Sean M Bagshaw; Hubert Grand; Jean-Luc Canivet; Antoine Dewitte; Claire Flamens; Wilfried Pujol; Anne-Sophie Grandoulier; Catherine Fleureau; Rita Jacobs; Christophe Broux; Hervé Floch; Olivier Branchard; Stephane Franck; Hadrien Rozé; Vincent Collin; Willem Boer; Joachim Calderon; Bernard Gauche; Herbert D Spapen; Gérard Janvier; Alexandre Ouattara Journal: Intensive Care Med Date: 2013-06-06 Impact factor: 17.440
Authors: Giuseppe Citerio; Jan Bakker; Matteo Bassetti; Dominique Benoit; Maurizio Cecconi; J Randall Curtis; Glenn Hernandez; Margaret Herridge; Samir Jaber; Michael Joannidis; Laurent Papazian; Mark Peters; Pierre Singer; Martin Smith; Marcio Soares; Antoni Torres; Antoine Vieillard-Baron; Jean-François Timsit; Elie Azoulay Journal: Intensive Care Med Date: 2013-12-13 Impact factor: 17.440
Authors: Kadri Tamme; Liivi Maddison; Rein Kruusat; Hans-Erik Ehrlich; Mirjam Viirelaid; Hartmut Kern; Joel Starkopf Journal: Biomed Res Int Date: 2015-04-29 Impact factor: 3.411
Authors: Edward Clark; Amber O Molnar; Olivier Joannes-Boyau; Patrick M Honoré; Lindsey Sikora; Sean M Bagshaw Journal: Crit Care Date: 2014-01-08 Impact factor: 9.097