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, J Lee, Serigne Lo, Colin McArthur, Shay McGuinness, John Myburgh, Carlos Scheinkestel, The RENAL Study Investigators, The ANZICS Clinical Trials Group

    Research output: Contribution to journalArticle

    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 languageEnglish
    Pages (from-to)429-436
    Number of pages8
    JournalIntensive Care Medicine
    Volume39
    Issue number3
    DOIs
    Publication statusPublished - 2013

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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., The RENAL Study Investigators, & The 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. https://doi.org/10.1007/s00134-012-2800-0