Incidence and associated factors for hypotension during continuous renal replacement therapy in critically ill patients

AimsThis work aimed to analyse retrospective data on hypotension incidence and associated factors among patients requiring continuous renal replacement therapy.BackgroundThe incidence and risk factors of continuous renal replacement therapy-related hypotension have not been adequately explored.DesignThe study was designed as a retrospective analysis.MethodsPatients who required continuous renal replacement therapy in the ICU between January 2017 and June 2021 were reviewed. The multivariate logistic regression model was used to determine the associated factors of hypotension.ResultsHypotension occurred in 242 out of 885 circuits (27.3%) among 140 patients. The logistic regression analysis identified seven factors associated with the occurrence of hypotension during CRRT: serum albumin (OR = 0.969, 95%CI: 0.934-0.999), serum calcium (OR = 0.514, 95%CI: 0.345-0.905), CO2CP (OR = 0.933, 95%CI: 0.897-0.971), use of vasopressors (OR = 5.731, 95%CI: 4.023-8.165), hypotension before CRRT initiation (OR = 2.779, 95%CI:1.238-6.242), age (OR = 1.016, 95%CI: 1.005-1.027), and fluid removal rate (OR = 1.002, 95%CI: 1.001-1.003).ConclusionsHypotension frequently occurs in patients receiving continuous renal replacement therapy, especially in the early stages. Multiple factors can be associated with cardiac output or peripheral resistance changes, including excessive ultrafiltration, vasopressors, serum albumin and serum calcium levels, and carbon dioxide combining power. What is already known about this topic Continuous renal replacement therapy (CRRT) has been widely used in intensive care units for patients with acute kidney injury sepsis, acute pancreatitis, severe electrolyte and metabolic disturbances. Hypotension during CRRT has been reported as one of the most common adverse events. The incidence and risk factors of CRRT-associated hypotension have not been adequately explored.What this paper adds? Despite its reputation as the dialysis modality with better haemodynamic tolerance, hypotension frequently occurs in patients receiving CRRT, and at any time during the treatment, especially in the early stage. Multiple factors leading to cardiac output or peripheral resistance changes can be linked with hypotension during CRRT include excessive ultrafiltration, vasopressor use, serum albumin and serum calcium level, and carbon dioxide combining power.The implications of this paper: It might not always be an appropriate response to lower the ultrafiltration rate for preventing hypotension during CRRT. There remains a lack of evidence in critically ill patients for CRRT-related interventions to limit the occurrence of hypotension.