Marat Slessarev1,2, Fabio Salerno1, Ian M Ball1,3, Christopher W McIntyre1,2. 1. Department of Medicine, Western University, London, Ontario, Canada. 2. Department of Medical Biophysics, Western University, London, Ontario, Canada. 3. Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Abstract
INTRODUCTION: Intermittent renal replacement therapy induces cardiac stunning in chronic hemodialysis and acute kidney injury (AKI) patients. In chronic hemodialysis, recurrent stunning contributes to heart failure and cardiac death, with ultrafiltration and intradialytic hypotension being the principal determinants of this injury. Continuous renal replacement therapy (CRRT), with its lower ultrafiltration rates and improved hemodynamic profile, should protect against cardiac stunning in AKI. The objective of this study was to assess whether CRRT is associated with cardiac stunning in critically ill patients with AKI. METHODS: We prospectively measured cardiac function using global and segmental longitudinal left ventricular strain using transthoracic echocardiography in 11 critically ill patients who were started on CRRT for AKI. We compared measurements at 4, 8, and 24 hours to baseline immediately prior to initiation of CRRT, with each patient serving as their own control. We also recorded blood pressure, heart rate, dose of vasoactive medications and intensive care unit mortality. FINDINGS: Ten of 11 patients developed new regional cardiac stunning, with 8/11 within 4 hours of starting CRRT, despite stable hemodynamics. The number of affected left ventricular segments varied from 1 to 11 (out of 12). The stunning occurred both in patients with preserved and impaired baseline cardiac function, and 7/11 patients died in the intensive care unit. DISCUSSION: Initiation of CRRT in critically ill patients with AKI is associated with cardiac stunning despite stable hemodynamics. This mechanism may explain lack of clinical benefit of CRRT over intermittent modalities and warrants further investigation to improve cardiovascular outcomes in critically ill patients with AKI.
INTRODUCTION: Intermittent renal replacement therapy induces cardiac stunning in chronic hemodialysis and acute kidney injury (AKI) patients. In chronic hemodialysis, recurrent stunning contributes to heart failure and cardiac death, with ultrafiltration and intradialytic hypotension being the principal determinants of this injury. Continuous renal replacement therapy (CRRT), with its lower ultrafiltration rates and improved hemodynamic profile, should protect against cardiac stunning in AKI. The objective of this study was to assess whether CRRT is associated with cardiac stunning in critically illpatients with AKI. METHODS: We prospectively measured cardiac function using global and segmental longitudinal left ventricular strain using transthoracic echocardiography in 11 critically illpatients who were started on CRRT for AKI. We compared measurements at 4, 8, and 24 hours to baseline immediately prior to initiation of CRRT, with each patient serving as their own control. We also recorded blood pressure, heart rate, dose of vasoactive medications and intensive care unit mortality. FINDINGS: Ten of 11 patients developed new regional cardiac stunning, with 8/11 within 4 hours of starting CRRT, despite stable hemodynamics. The number of affected left ventricular segments varied from 1 to 11 (out of 12). The stunning occurred both in patients with preserved and impaired baseline cardiac function, and 7/11 patients died in the intensive care unit. DISCUSSION: Initiation of CRRT in critically illpatients with AKI is associated with cardiac stunning despite stable hemodynamics. This mechanism may explain lack of clinical benefit of CRRT over intermittent modalities and warrants further investigation to improve cardiovascular outcomes in critically illpatients with AKI.
Authors: Adrianna Douvris; Khalid Zeid; Swapnil Hiremath; Sean M Bagshaw; Ron Wald; William Beaubien-Souligny; Jennifer Kong; Claudio Ronco; Edward G Clark Journal: Intensive Care Med Date: 2019-08-12 Impact factor: 17.440
Authors: Sébastien Redant; Océane Barbance; Ashita Tolwani; Xavier Beretta-Piccoli; Jacques Massaut; David De Bels; Fabio S Taccone; Patrick M Honoré; Dominique Biarent Journal: Membranes (Basel) Date: 2021-03-11