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Extracorporeal circuit temperature gradient and hemodynamic instability during continuous renal replacement therapy:
Lorna Fraire1, Téo Keraron1, Matthieu Chivot1
1Service de Médecine Intensive - Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, France.
Annals of Intensive Care
|July 19, 2026
Summary
Lowering extracorporeal circuit temperature during continuous renal replacement therapy (CRRT) reduces hemodynamic instability risk. This effect is mediated by improvements in mean arterial pressure (MAP) and cardiac output (CO).
Area of Science:
- Nephrology
- Critical Care Medicine
- Cardiovascular Physiology
Background:
- Continuous renal replacement therapy (CRRT) can influence patient hemodynamics.
- Lowering extracorporeal circuit temperature (T°CRRT) below core temperature (T°CORE) may impact hemodynamic instability risk (HIRRT) by altering cardiac output (CO) and vasomotor tone.
Purpose of the Study:
- To identify mediators in the relationship between the CRRT-to-core temperature gradient (ΔT°) and HIRRT risk.
- To explore the impact of extracorporeal cooling on hemodynamic stability during CRRT.
Main Methods:
- Ancillary analysis of a prospective study (NCT03139123) involving 42 patients with acute kidney injury receiving CRRT.
- Collected T°CRRT, T°CORE, and hemodynamic parameters 4-hourly.
- Exploratory mediation analysis of the effect of ΔT° on HIRRT, mediated through CO and mean arterial pressure (MAP).
Main Results:
- Decreasing ΔT° (extracorporeal cooling) was associated with higher heart rate, CO, and MAP, and lower norepinephrine dose.
- Univariate analysis showed a significant reduction in HIRRT risk with decreasing ΔT° (P < 0.01).
- Mediation analysis indicated that ΔT° ≤0°C decreased HIRRT probability by 7% (total effect), with indirect effects through MAP (5%) and CO (4%).
Conclusions:
- Setting CRRT circuit temperature below body temperature is associated with reduced HIRRT risk.
- Improvements in MAP and CO may mediate the protective effect of extracorporeal cooling against hemodynamic instability during CRRT.
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