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Original Article
- Nephrology
- Impact of intradialytic hypotension on mortality following the transition from continuous renal replacement therapy to intermittent hemodialysis
- Seong Geun Kim, Donghwan Yun, Jinwoo Lee, Yong Chul Kim, Dong Ki Kim, Kook-Hwan Oh, Kwon Wook Joo, Yon Su Kim, Seung Seok Han
- Acute Crit Care. 2023;38(1):86-94. Published online October 26, 2022
- DOI: https://doi.org/10.4266/acc.2022.00948
- 10,680 View
- 235 Download
- 7 Web of Science
- 8 Crossref
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Abstract
PDF - Background
The transition of dialysis modalities from continuous renal replacement therapy (CRRT) to intermittent hemodialysis (iHD) is frequently conducted during the recovery phase of critically ill patients with acute kidney injury. Herein, we addressed the occurrence of intradialytic hypotension (IDH) after this transition, and its association with the mortality risk.
Methods
A total of 541 patients with acute kidney injury who attempted to transition from CRRT to iHD at Seoul National University Hospital, Korea from 2010 to 2020 were retrospectively collected. IDH was defined as a discontinuation of dialysis because of hemodynamic instability plus a nadir systolic blood pressure <90 mm Hg or a decrease in systolic blood pressure ≥30 mm Hg during the first session of iHD. Odds ratios (ORs) of outcomes, such as in-hospital mortality and weaning from RRT, were measured using a logistic regression model after adjusting for multiple variables.
Results
IDH occurred in 197 patients (36%), and their mortality rate (44%) was higher than that of those without IDH (19%; OR, 2.64; 95% confidence interval [CI], 1.70–4.08). For patients exhibiting IDH, the iHD sessions delayed successful weaning from RRT (OR, 0.62; 95% CI, 0.43–0.90) compared with sessions on those without IDH. Factors such as low blood pressure, high pulse rate, low urine output, use of mechanical ventilations and vasopressors, and hypoalbuminemia were associated with IDH risk.
Conclusions
IDH occurrence following the transition from CRRT to iHD is associated with high mortality and delayed weaning from RRT. -
Citations
Citations to this article as recorded by
- Ultrafiltration Rate in Prolonged Intermittent Kidney Replacement Therapy in Critically Ill Patients: A Randomized Controlled Trial
Vijay Kalathia, Snehal Gaikwad, Vipul Chakurkar, Sagar Kulkarni, Meetali Bidaye, Valentine Lobo
Hemodialysis International.2026;[Epub] CrossRef - Quantifying Predictive Uncertainty in Hemodialysis: A Dynamic Ensemble Selection Framework Based on Interval Quality
Hsuan-Ming Lin, JrJung Lyu
Journal of Medical and Biological Engineering.2026; 46(3): 338. CrossRef - Cumulative impact of hypotension during intermittent hemodialysis on kidney recovery in critically ill patients with AKI-D
Jae Ho Kim, Joonhee Yoon, Ji-Eun Kim, Seongho Jo, Yuri Lee, Ji Won Kim, Seun Deuk Hwang, Seoung Woo Lee, Joon Ho Song, Kipyo Kim
Journal of Critical Care.2025; 85: 154944. CrossRef - A pilot feasibility study of continuous cardiac output and blood pressure monitoring during intermittent hemodialysis in patients recovering from severe acute kidney injury
Sofia Spano, Akinori Maeda, Joey Lam, Anis Chaba, Atthaphong Phongphithakchai, Yukiko Hikasa, Nuttapol Pattamin, Nuanprae Kitisin, Emily See, Peter Mount, Rinaldo Bellomo
Journal of Critical Care.2025; 88: 155086. CrossRef - A holistic framework for intradialytic hypotension prediction using generative adversarial networks-based data balancing
Hsuan-Ming Lin, JrJung Lyu
BMC Medical Informatics and Decision Making.2025;[Epub] CrossRef - Hemoglobin variability predicts mortality in acute kidney injury patients undergoing continuous renal replacement therapy: a multi-database cohort study
Yumin Huang, Ran Jiang, Kang Liu, Jinghang Li, Rongrong Sheng, Wei Xu, Huijuan Mao, Buyun Wu
Renal Failure.2025;[Epub] CrossRef - Proceedings of the University of Alabama at Birmingham Continuous Renal Replacement Therapy Academy (2023–2024)
William Beaubien-Souligny, Melissa Thompson Bastin, J. Pedro Teixeira, Jorge Cerda, Michael J. Connor, Amanda Dijanic Zeidman, Pranav S. Garimella, Luis Juncos, Arnaldo Lopez-Ruiz, Ravindra Mehta, Thiago Reis, Lilia Rizo-Topete, Samuel A. Silver, J. Ricar
Kidney360.2025; 6(10): 1798. CrossRef - The Relationship between Dialysis Adequacy and Blood Pressure and Number of Intradialytic Hypotensive Episodes in Haemodialysis Patients
Ömer Bingölbali, Semra Oğuz
Black Sea Journal of Health Science.2024; 7(5): 189. CrossRef
- Ultrafiltration Rate in Prolonged Intermittent Kidney Replacement Therapy in Critically Ill Patients: A Randomized Controlled Trial
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