Sarah N Fernández Lafever1,2,3,4, Jorge López5,6,7,8, Rafael González5,6,7,8, María J Solana5,6,7,8, Javier Urbano5,6,7,8, Jesús López-Herce5,6,7,8, Laura Butragueño5,6,7,8, María J Santiago5,6,7,8. 1. Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain. sarahlafever@gmail.com. 2. School of Medicine, Complutense University of Madrid, Madrid, Spain. sarahlafever@gmail.com. 3. Gregorio Marañón Health Research Institute, Madrid, Spain. sarahlafever@gmail.com. 4. Research Network on Maternal and Child Health and Development (Red SAMID), Madrid, Spain. sarahlafever@gmail.com. 5. Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Madrid, Spain. 6. School of Medicine, Complutense University of Madrid, Madrid, Spain. 7. Gregorio Marañón Health Research Institute, Madrid, Spain. 8. Research Network on Maternal and Child Health and Development (Red SAMID), Madrid, Spain.
Abstract
BACKGROUND: About 1.5% of patients admitted to the Pediatric Intensive Care Unit (PICU) will require continuous kidney replacement therapy (CKRT)/renal replacement therapy (CRRT). Mortality of these patients ranges from 30 to 60%. CKRT-related hypotension (CKRT-RHI) can occur in 19-45% of patients. Oliguria after onset of CKRT is also common, but to date has not been addressed directly in the scientific literature. METHODS: A prospective observational study was conducted to define factors involved in the hemodynamic changes that take place during the first hours of CKRT, and their relationship with urinary output. RESULTS: Twenty-five patients who were admitted to a single-center PICU requiring CKRT between January 1, 2014, and December 31, 2018, were included, of whom 56.3% developed CKRT-RHI. This drop in blood pressure was transient and rapidly restored to baseline, and significantly improved after the third hour of CKRT, as core temperature and heart rate decreased. Urine output significantly decreased after starting CKRT, and 72% of patients were oliguric after 6 h of therapy. Duration of CKRT was significantly longer in patients presenting with oliguria than in non-oliguric patients (28.7 vs. 7.9 days, p = 0.013). CONCLUSIONS: The initiation of CKRT caused hemodynamic instability immediately after initial connection in most patients, but had a beneficial effect on the patient's hemodynamic status after 3 h of therapy, presumably owing to decreases in body temperature and heart rate. Urine output significantly decreased in all patients and was not related to negative fluid balance, patient's hemodynamic status, CKRT settings, or kidney function parameters.
BACKGROUND: About 1.5% of patients admitted to the Pediatric Intensive Care Unit (PICU) will require continuous kidney replacement therapy (CKRT)/renal replacement therapy (CRRT). Mortality of these patients ranges from 30 to 60%. CKRT-related hypotension (CKRT-RHI) can occur in 19-45% of patients. Oliguria after onset of CKRT is also common, but to date has not been addressed directly in the scientific literature. METHODS: A prospective observational study was conducted to define factors involved in the hemodynamic changes that take place during the first hours of CKRT, and their relationship with urinary output. RESULTS: Twenty-five patients who were admitted to a single-center PICU requiring CKRT between January 1, 2014, and December 31, 2018, were included, of whom 56.3% developed CKRT-RHI. This drop in blood pressure was transient and rapidly restored to baseline, and significantly improved after the third hour of CKRT, as core temperature and heart rate decreased. Urine output significantly decreased after starting CKRT, and 72% of patients were oliguric after 6 h of therapy. Duration of CKRT was significantly longer in patients presenting with oliguria than in non-oliguric patients (28.7 vs. 7.9 days, p = 0.013). CONCLUSIONS: The initiation of CKRT caused hemodynamic instability immediately after initial connection in most patients, but had a beneficial effect on the patient's hemodynamic status after 3 h of therapy, presumably owing to decreases in body temperature and heart rate. Urine output significantly decreased in all patients and was not related to negative fluid balance, patient's hemodynamic status, CKRT settings, or kidney function parameters.
Authors: Sara Nicole Fernández; Maria José Santiago; Jesús López-Herce; Miriam García; Jimena Del Castillo; Andrés José Alcaraz; Jose María Bellón Journal: Biomed Res Int Date: 2014-08-03 Impact factor: 3.411
Authors: Sarah N Fernández; Jorge López; Rafael González; María J Solana; Javier Urbano; Alejandra Aguado; Ángel Lancharro; Jesús López-Herce; María J Santiago Journal: Pediatr Nephrol Date: 2022-03-14 Impact factor: 3.651