Journal Article

Impact of blood volume monitoring on fluid removal during intermittent hemodialysis of critically ill children with acute kidney injury

Aicha Merouani, Wassim Kechaou, Catherine Litalien, Thierry Ducruet and Philippe Jouvet

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 26, issue 10, pages 3315-3319
Published in print October 2011 | ISSN: 0931-0509
Published online February 2011 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfq855
Impact of blood volume monitoring on fluid removal during intermittent hemodialysis of critically ill children with acute kidney injury

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Background. In chronic pediatric patients treated with intermittent hemodialysis (IHD), blood volume monitoring (BVM) is commonly used to assess and manage volume status during the dialysis session. Minimal data exists on its use during IHD in critically ill children with acute kidney injury (AKI). In these cases, fluid removal may be limited by hemodynamic instability.

Methods. We present a retrospective study conducted in our pediatric intensive care unit. For eligible patients, demographic data and IHD treatment characteristics were recorded including BVM use, ultrafiltration (UF) volume per session, hypotensive episodes and intradialysis interventions. Hypotensive episodes and UF per IHD session were compared between IHD sessions with BVM (BVM group) and IHD sessions without BVM (control group).

Results. Twenty-three AKI patients with a median age of 11 years (1.8–18) and body weight of 36 kg (10–85) received 134 IHD sessions (70 with BVM and 64 without BVM).

Hypotensive episodes occurred in 34% of all sessions with no significant difference between the BVM group and the control group: (95% CI: 22%, 44%) and 36% (95% CI: 24%, 48%), respectively, but UF per session was higher in the BVM group as compared to control (48 ± 27 mL/kg and 33 ± 26 mL/kg, respectively, P = 0.0001). The mean decrease in BVM did not exceed 13% over an entire dialysis session in patients without hypotension.

Conclusion. In conclusion, in our experience of IHD sessions in critically ill children with AKI, the use of BVM allowed a higher UF in those with BVM without influencing the frequency of hypotensive episodes. Applying specific guidelines on BVM use may decrease hypotensive episodes during IHD treatment in critically ill patients.

Keywords: fluid removal; intermittent hemodialysis; intradialytic blood volume monitoring; intradialytic hypotension; pediatric acute kidney injury

Journal Article.  2828 words.  Illustrated.

Subjects: Nephrology

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