Ultrafiltration Rate in Prolonged Intermittent Kidney Replacement Therapy in Critically Ill Patients: A Randomized Controlled Trial

IF 1.4 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International Pub Date : 2026-10-05 Epub Date: 2026-05-14 DOI:10.1111/hdi.70087

Vijay Kalathia, Snehal Gaikwad, Vipul Chakurkar, Sagar Kulkarni, Meetali Bidaye, Valentine Lobo

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引用次数: 0

Abstract

Background

Fluid overload is a significant risk factor for mortality in critically ill patients with acute kidney injury. Ultrafiltration during kidney replacement therapy frequently produces hypotension. The optimal ultrafiltration rate in patients on vasopressor agents undergoing prolonged intermittent kidney replacement therapy (prolonged intermittent KRT) is unknown.

Aim

This study was carried out to determine the optimal ultrafiltration rate among critically ill patients with acute kidney injury undergoing prolonged intermittent kidney replacement therapy.

Materials and Methods

We randomized patients to ultrafiltration rates of 2, 4 mL/kg/h, and a control (nephrologist's prescription) group. The mean arterial pressure, inotrope score, and vasopressor dependency index were measured before, at the mid-point, and after completing a session of prolonged intermittent KRT. Episodes of hypotension were also documented. The difference in hypotensive episodes and vasopressor dependency index between groups was the primary endpoint of the study. Exploratory analysis by stepwise logistic regression to determine the independent contribution of various factors to mortality was carried out.

Results

There was no difference between the groups at baseline. A significantly lower incidence of hypotension and premature session termination was found in the group randomized to a 4 mL/kg/h ultrafiltration rate compared with the groups prescribed 2 mL/kg/h and the control group (prescribed 2.65 mL/kg/h). The difference in pre and post mean arterial pressure and vasopressor dependency index was not significantly different between the 3 groups. Hypotension significantly increased the 30-day mortality risk and the length of stay (intensive care unit).

Conclusion

In this study, we found that the group prescribed an ultrafiltration rate of 4 mL/kg/h had the lowest number of complications in critically-ill patients undergoing prolonged intermittent KRT for acute kidney injury.

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超滤率在危重患者延长间歇肾替代治疗中的应用：一项随机对照试验。

背景：液体超载是急性肾损伤危重患者死亡的重要危险因素。超滤在肾脏替代治疗中经常产生低血压。使用血管加压药物接受长期间歇性肾替代疗法（延长间歇性肾替代疗法）的患者的最佳超滤率尚不清楚。目的：探讨急性肾损伤危重患者接受长期间歇肾替代治疗的最佳超滤率。材料和方法：我们将患者随机分为超滤率为2,4 mL/kg/h组和对照组（肾脏科医生处方）。平均动脉压、肌力评分和血管加压药物依赖指数分别在长时间间歇KRT治疗前、中点和结束后测量。低血压发作也有记录。两组之间低血压发作和血管加压药物依赖指数的差异是研究的主要终点。采用逐步逻辑回归进行探索性分析，以确定各种因素对死亡率的独立贡献。结果：两组在基线时无差异。超滤速率为4 mL/kg/h组与超滤速率为2 mL/kg/h组和对照组（超滤速率为2.65 mL/kg/h组）相比，低血压和提前终止的发生率明显降低。三组患者治疗前后平均动脉压、血管加压药物依赖指数差异无统计学意义。低血压显著增加30天死亡风险和住院时间（重症监护病房）。结论：在本研究中，我们发现超滤速率为4 mL/kg/h的重症急性肾损伤患者接受长时间间歇KRT治疗的并发症发生率最低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hemodialysis International UROLOGY & NEPHROLOGY-

CiteScore

2.50

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.