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Pediatric intradialytic hypotension: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT)

Rupesh Raina1,2, Stephanie Lam3, Hershita Raheja4

  • 1Department of Nephrology, Cleveland Clinic Akron General and Akron Children's Hospital, Akron, OH, USA. rraina@akronchildrens.org.

Pediatric Nephrology (Berlin, Germany)
|February 9, 2019
PubMed

Insights

Intradialytic hypotension (IDH) is a frequent complication of hemodialysis in children, often leading to treatment interruption. This review examines IDH prevention strategies and offers expert recommendations for pediatric patients.

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Renal Replacement Therapy

Background:

  • Intradialytic hypotension (IDH) is a common adverse event in hemodialysis, causing premature treatment cessation and inadequate fluid/solute removal.
  • Pediatric patients face unique challenges in managing IDH due to difficulties in achieving accurate dry weight.
  • IDH stems from reduced blood volume during ultrafiltration and impaired compensatory mechanisms.

Framework:

  • This review synthesizes current knowledge on IDH prevention strategies applicable to pediatric hemodialysis.
  • It critically evaluates existing methods such as blood pressure monitoring, dialysate manipulation, and pharmacological interventions.
  • The Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup provides expert-driven recommendations.

Implementation:

  • Strategies reviewed include frequent blood pressure monitoring, dialysate sodium profiling, blood volume monitoring, dialysate cooling, hemodiafiltration, and intradialytic mannitol/midodrine.
  • The focus is on the limited evidence and application of these strategies in the pediatric population.
  • Expert opinion guides the recommendations due to a lack of large-scale pediatric studies.

Implications:

  • The findings aim to guide clinical practice and improve the management of IDH in children undergoing hemodialysis.
  • Developing evidence-based guidelines for pediatric IDH management is crucial for optimizing treatment outcomes.
  • These recommendations serve as a valuable interim guide for clinicians managing pediatric patients at risk for IDH.

Keywords:
Blood pressure monitoringBlood volume monitoringChildrenDialysate coolingIntradialytic hypotensionMannitolMidodrineSodium profiling

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