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Early acid–base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis

Rinaldo Bellomo| Miklos Lipcsey| Paolo Calzavacca| Michael Haase| Anjia Haase-Fielitz| Elisa Licari| Augustine Tee| Louise Cole| Alan Cass| Simon Finfer| Martin Gallagher| Joanne Lee| Serigne Lo| Colin McArthur| Shay McGuinness| John Myburgh| Carlos Scheinkestel
Original
Volume 39, Issue 3 / March , 2013

Pages 429 - 436

Abstract

Purpose

In acute kidney injury patients, metabolic acidosis is common. Its severity, duration, and associated changes in mean arterial pressure (MAP) and vasopressor therapy may be affected by the intensity of continuous renal replacement therapy (CRRT). We aimed to compare key aspects of acidosis and MAP and vasopressor therapy in patients treated with two different CRRT intensities.

Methods

We studied a nested cohort of 115 patients from two tertiary intensive care units (ICUs) within a large multicenter randomized controlled trial treated with lower intensity (LI) or higher intensity (HI) CRRT.

Results

Levels of metabolic acidosis at randomization were similar [base excess (BE) of −8 ± 8 vs. −8 ± 7 mEq/l; p = 0.76]. Speed of BE correction did not differ between the two groups. However, the HI group had a greater increase in MAP from baseline to 24 h (7 ± 3 vs. 0 ± 3 mmHg; p < 0.01) and a greater decrease in norepinephrine dose (from 12.5 to 3.5 vs. 5 to 2.5 μg/min; p < 0.05). The correlation (r) coefficients between absolute change in MAP and norepinephrine (NE) dose versus change in BE were 0.05 and −0.37, respectively.

Conclusions

Overall, LI and HI CRRT have similar acid–base effects in patients with acidosis. However, HI was associated with greater improvements in MAP and vasopressor requirements (clinical trial no. NCT00221013).

Keywords

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