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Sodium modelling to reduce intradialytic hypotension during haemodialysis for acute kidney injury in the intensive care unit.
Nephrology (Carlton). 2016 Oct; 21(10):870-7.N

Abstract

AIM

Intradialytic hypotension often complicates haemodialysis for patients with acute kidney injury (AKI) and may impact renal recovery. Sodium modelling is sometimes used as prophylaxis against intradialytic hypotension in the chronic haemodialysis population, but there is little evidence for its use among critically ill patients with AKI.

METHODS

A retrospective cohort with AKI requiring intermittent haemodialysis in the intensive care unit from 2001 to 2008 was used to study the association of prophylactic sodium modelling and multiple outcomes. Outcomes included a composite of in-hospital death or dialysis dependence at hospital discharge, as well as intradialytic hypotension, ultrafiltration goal achievement and net ultrafiltration volume. Associations were estimated using logistic regression, mixed linear models and generalized estimating equations adjusting for demographic and clinical characteristics.

RESULTS

One hundred and ninety-one individuals who underwent 892 sessions were identified; sodium modelling was prescribed in 27.1% of the sessions. In adjusted analyses, sodium modelling was not significantly associated with intradialytic hypotension (P = 0.67) or with the ultrafiltration goal achievement (P = 0.06). Sodium modelling during the first dialysis session was numerically associated with lower risk for the composite of in-hospital death or dialysis dependence: adjusted odds ratio (95% confidence interval) 0.39 (0.15-1.02; P = 0.06); however, this association did not reach statistical significance.

CONCLUSION

We did not observe statistically significant associations between sodium modelling and improved outcomes among AKI patients receiving intermittent dialysis in the intensive care unit. However, suggestive findings warrant further study.

Authors+Show Affiliations

Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, MA, USA. kelynch@bidmc.harvard.edu.Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Cambridge, MA, USA.Division of Nephrology and Hypertension, University of North Carolina Kidney Center, Chapel Hill, NC, USA.Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Cambridge, MA, USA. Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore, Singapore.Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Cambridge, MA, USA. The Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA.Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Cambridge, MA, USA.DaVita Clinical Research, Minneapolis, MN, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26590371

Citation

Lynch, Katherine E., et al. "Sodium Modelling to Reduce Intradialytic Hypotension During Haemodialysis for Acute Kidney Injury in the Intensive Care Unit." Nephrology (Carlton, Vic.), vol. 21, no. 10, 2016, pp. 870-7.
Lynch KE, Ghassemi F, Flythe JE, et al. Sodium modelling to reduce intradialytic hypotension during haemodialysis for acute kidney injury in the intensive care unit. Nephrology (Carlton). 2016;21(10):870-7.
Lynch, K. E., Ghassemi, F., Flythe, J. E., Feng, M., Ghassemi, M., Celi, L. A., & Brunelli, S. M. (2016). Sodium modelling to reduce intradialytic hypotension during haemodialysis for acute kidney injury in the intensive care unit. Nephrology (Carlton, Vic.), 21(10), 870-7. https://doi.org/10.1111/nep.12677
Lynch KE, et al. Sodium Modelling to Reduce Intradialytic Hypotension During Haemodialysis for Acute Kidney Injury in the Intensive Care Unit. Nephrology (Carlton). 2016;21(10):870-7. PubMed PMID: 26590371.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sodium modelling to reduce intradialytic hypotension during haemodialysis for acute kidney injury in the intensive care unit. AU - Lynch,Katherine E, AU - Ghassemi,Fatimah, AU - Flythe,Jennifer E, AU - Feng,Mengling, AU - Ghassemi,Marzyeh, AU - Celi,Leo Anthony, AU - Brunelli,Steven M, PY - 2015/09/21/received PY - 2015/11/17/revised PY - 2015/11/18/accepted PY - 2015/11/22/entrez PY - 2015/11/22/pubmed PY - 2017/3/4/medline KW - acute renal failure KW - haemodialysis KW - haemodynamics KW - intradialytic hypotension KW - sodium modelling SP - 870 EP - 7 JF - Nephrology (Carlton, Vic.) JO - Nephrology (Carlton) VL - 21 IS - 10 N2 - AIM: Intradialytic hypotension often complicates haemodialysis for patients with acute kidney injury (AKI) and may impact renal recovery. Sodium modelling is sometimes used as prophylaxis against intradialytic hypotension in the chronic haemodialysis population, but there is little evidence for its use among critically ill patients with AKI. METHODS: A retrospective cohort with AKI requiring intermittent haemodialysis in the intensive care unit from 2001 to 2008 was used to study the association of prophylactic sodium modelling and multiple outcomes. Outcomes included a composite of in-hospital death or dialysis dependence at hospital discharge, as well as intradialytic hypotension, ultrafiltration goal achievement and net ultrafiltration volume. Associations were estimated using logistic regression, mixed linear models and generalized estimating equations adjusting for demographic and clinical characteristics. RESULTS: One hundred and ninety-one individuals who underwent 892 sessions were identified; sodium modelling was prescribed in 27.1% of the sessions. In adjusted analyses, sodium modelling was not significantly associated with intradialytic hypotension (P = 0.67) or with the ultrafiltration goal achievement (P = 0.06). Sodium modelling during the first dialysis session was numerically associated with lower risk for the composite of in-hospital death or dialysis dependence: adjusted odds ratio (95% confidence interval) 0.39 (0.15-1.02; P = 0.06); however, this association did not reach statistical significance. CONCLUSION: We did not observe statistically significant associations between sodium modelling and improved outcomes among AKI patients receiving intermittent dialysis in the intensive care unit. However, suggestive findings warrant further study. SN - 1440-1797 UR - https://www.unboundmedicine.com/medline/citation/26590371/Sodium_modelling_to_reduce_intradialytic_hypotension_during_haemodialysis_for_acute_kidney_injury_in_the_intensive_care_unit_ L2 - https://doi.org/10.1111/nep.12677 DB - PRIME DP - Unbound Medicine ER -