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

doi:10.1007/s00134-012-2800-0

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

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

34 Citations (Scopus)

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).

Original language	English
Pages (from-to)	429-436
Number of pages	8
Journal	Intensive Care Medicine
Volume	39
Issue number	3
DOIs	https://doi.org/10.1007/s00134-012-2800-0
Publication status	Published - 1 Mar 2013
Externally published	Yes

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Bellomo, R., Lipcsey, M., Calzavacca, P., Haase, M., Haase-Fielitz, A., Licari, E., Tee, A., Cole, L., Cass, A., Finfer, S., Gallagher, M., Lee, J., Lo, S., McArthur, C., McGuinness, S., Myburgh, J., & Scheinkestel, C. (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. https://doi.org/10.1007/s00134-012-2800-0

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

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 = "Acid-base, Acidemia, Acidosis, Alkalosis, Base excess, Bicarbonate, Continuous renal replacement therapy, Hemodialysis, Norepinephrine, Strong ion difference, pH",

author = "Rinaldo Bellomo and Miklos Lipcsey and Paolo Calzavacca and Michael Haase and Anjia Haase-Fielitz and Elisa Licari and Augustine Tee and Louise Cole and Alan Cass and Simon Finfer and Martin Gallagher and Joanne Lee and Serigne Lo and Colin McArthur and Shay McGuinness and John Myburgh and Carlos Scheinkestel",

year = "2013",

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day = "1",

doi = "10.1007/s00134-012-2800-0",

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journal = "Intensive Care Medicine",

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Bellomo, R, Lipcsey, M, Calzavacca, P, Haase, M, Haase-Fielitz, A, Licari, E, Tee, A, Cole, L, Cass, A, Finfer, S, Gallagher, M, Lee, J, Lo, S, McArthur, C, McGuinness, S, Myburgh, J & Scheinkestel, C 2013, 'Early acid-base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis', Intensive Care Medicine, vol. 39, no. 3, pp. 429-436. https://doi.org/10.1007/s00134-012-2800-0

TY - JOUR

T1 - Early acid-base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis

AU - Bellomo, Rinaldo

AU - Lipcsey, Miklos

AU - Calzavacca, Paolo

AU - Haase, Michael

AU - Haase-Fielitz, Anjia

AU - Licari, Elisa

AU - Tee, Augustine

AU - Cole, Louise

AU - Cass, Alan

AU - Finfer, Simon

AU - Gallagher, Martin

AU - Lee, Joanne

AU - Lo, Serigne

AU - McArthur, Colin

AU - McGuinness, Shay

AU - Myburgh, John

AU - Scheinkestel, Carlos

PY - 2013/3/1

Y1 - 2013/3/1

N2 - 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).

AB - 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).

KW - Acid-base

KW - Acidemia

KW - Acidosis

KW - Alkalosis

KW - Base excess

KW - Bicarbonate

KW - Continuous renal replacement therapy

KW - Hemodialysis

KW - Norepinephrine

KW - Strong ion difference

KW - pH

UR - http://www.scopus.com/inward/record.url?scp=84884211331&partnerID=8YFLogxK

U2 - 10.1007/s00134-012-2800-0

DO - 10.1007/s00134-012-2800-0

M3 - Article

SN - 0342-4642

VL - 39

SP - 429

EP - 436

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - 3

ER -

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

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