Hypotension within one-hour from starting CRRT is associated with in-hospital mortality

To investigate early hemodynamic instability and its implications on adverse outcomes in patients who require continuous renal replacement therapy (CRRT).

A retrospective study of patients admitted to the intensive care unit (ICU) and underwent CRRT at Mayo Clinic, Rochester, Minnesota between December 2006 through November 2015.

Multivariate logistic regression was performed to identify predictors of in-hospital mortality and major adverse kidney events (MAKE) at 90 days. Hypotension was defined as any of the following criteria occurring during the first hour of CRRT initiation: mean arterial pressure < 60 mmHg, systolic blood pressure (SBP) <90 mmHg or a decline in SBP >40 mmHg from baseline, a positive fluid balance >500 mL or increased vasopressor requirement. The analysis included 1743 patients, 1398 with acute kidney injury (AKI). In-hospital mortality occurred in 884 patients (51%). Early hypotension occurred in 1124 patients (64.6%) and remained independently associated with in-hospital mortality (OR 1.56, 95% CI: 1.25-1.9).

Hypotension occurs frequently in patients receiving CRRT despite having a reputation as the dialysis modality with better hemodynamic tolerance. It is an independent predictor for worse outcomes. Further studies are required to understand this phenomenon.