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

Bellomo, Rindaldo, Lipcsey, Miklos, Calzavacca, Paolo, Haase, Michael, Haase-Fielitz, Anjia, Licari, Elisa, Tee, Augustine, Cole, Louise, Cass, Alan, Finfer, Simon, Gallagher, Martin, Lee, Joanne, Lo, Serigne, McArthur, Colin, McGuinness, Shay, Myburgh, John, Scheinkestel, Carlos, RENAL Study Investigators and ANZICS Clinical Trials Group (2013). Early acid-base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis. Intensive Care Medicine,39(3):429-436.

Document type: Journal Article

IRMA ID 11035xPUB64
Title Early acid-base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis
Author Bellomo, Rindaldo
Lipcsey, Miklos
Calzavacca, Paolo
Haase, Michael
Haase-Fielitz, Anjia
Licari, Elisa
Tee, Augustine
Cole, Louise
Cass, Alan
Finfer, Simon
Gallagher, Martin
Lee, Joanne
Lo, Serigne
McArthur, Colin
McGuinness, Shay
Myburgh, John
Scheinkestel, Carlos
RENAL Study Investigators
ANZICS Clinical Trials Group
Journal Name Intensive Care Medicine
Publication Date 2013
Volume Number 39
Issue Number 3
ISSN 0342-4642   (check CDU catalogue open catalogue search in new window)
Start Page 429
End Page 436
Total Pages 8
Place of Publication Germany
Publisher Springer
HERDC Category C1 - Journal Article (DIISR)
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).
DOI http://dx.doi.org/10.1007/s00134-012-2800-0   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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Created: Thu, 07 Aug 2014, 16:57:06 CST