Incidence and associated factors for hypotension during continuous renal replacement therapy in critically ill patients

Aims

This work aimed to analyse retrospective data on hypotension incidence and associated factors among patients requiring continuous renal replacement therapy.

Background

The incidence and risk factors of continuous renal replacement therapy-related hypotension have not been adequately explored.

Design

The study was designed as a retrospective analysis.

Methods

Patients who required continuous renal replacement therapy in the ICU between January 2017 and June 2021 were reviewed. The multivariate logistic regression model was used to determine the associated factors of hypotension.

Results

Hypotension occurred in 242 out of 885 circuits (27.3%) among 140 patients. The logistic regression analysis identified seven factors associated with the occurrence of hypotension during CRRT: serum albumin (OR = 0.969, 95%CI: 0.934–0.999), serum calcium (OR = 0.514, 95%CI: 0.345–0.905), CO₂CP (OR = 0.933, 95%CI: 0.897–0.971), use of vasopressors (OR = 5.731, 95%CI: 4.023–8.165), hypotension before CRRT initiation (OR = 2.779, 95%CI:1.238–6.242), age (OR = 1.016, 95%CI: 1.005–1.027), and fluid removal rate (OR = 1.002, 95%CI: 1.001–1.003).

Conclusions

Hypotension frequently occurs in patients receiving continuous renal replacement therapy, especially in the early stages. Multiple factors can be associated with cardiac output or peripheral resistance changes, including excessive ultrafiltration, vasopressors, serum albumin and serum calcium levels, and carbon dioxide combining power.