Cardiac Output Changes during Renal Replacement Therapy: A Scoping Review.

Area of Science:

• Nephrology
• Cardiology
• Critical Care Medicine

Background:

• Renal replacement therapy (RRT) is linked to hypotension, but its effect on cardiac output (CO) is not well understood.
• Limited data exist on CO monitoring and changes during RRT.

Purpose of the Study:

• To review and describe current knowledge on cardiac output (CO) monitoring during renal replacement therapy (RRT).
• To characterize changes in CO during intermittent hemodialysis (IHD) and continuous RRT (CRRT).

Main Methods:

• Systematic literature search of MEDLINE, Embase, and Cochrane databases (2000-2023).
• Inclusion of studies with at least three CO measurements during IHD or CRRT.
• Descriptive analysis of findings due to inability to perform meta-analysis.

Main Results:

• 48 studies were included, with non-invasive CO monitoring techniques being most common.
• A decrease in CO was observed in 72% of patient cohorts, with 19% experiencing severe decreases (>25%).
• CO changes were not consistently concordant with blood pressure changes and correlated with increased systemic vascular resistance (SVR).

Conclusions:

• Data on CO dynamics during RRT are limited.
• Decreased CO is a common finding during RRT, sometimes severe, and may occur independently of blood pressure.
• Increased SVR is associated with CO reduction during RRT.