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, Anja Haase-Fielitz, Elisa Licari, Augustine Tee, Louise Cole, Alan Cass, Simon R Finfer, Martin Patrick Gallagher, Joanne Lee, Serigne Lo, Colin McArthur, Shay P McGuinness, John A Myburgh, Carlos D Scheinkestel

Research output: Contribution to journalArticleResearchpeer-review

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 ?g/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
DOIs
Publication statusPublished - 2013
Externally publishedYes

Cite this

Bellomo, Rinaldo ; Lipcsey, Miklos ; Calzavacca, Paolo ; Haase, Michael ; Haase-Fielitz, Anja ; Licari, Elisa ; Tee, Augustine ; Cole, Louise ; Cass, Alan ; Finfer, Simon R ; Gallagher, Martin Patrick ; Lee, Joanne ; Lo, Serigne ; McArthur, Colin ; McGuinness, Shay P ; Myburgh, John A ; Scheinkestel, Carlos D. / Early acid-base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis. In: Intensive Care Medicine. 2013 ; Vol. 39. pp. 429-436.
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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 ?g/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).",
author = "Rinaldo Bellomo and Miklos Lipcsey and Paolo Calzavacca and Michael Haase and Anja Haase-Fielitz and Elisa Licari and Augustine Tee and Louise Cole and Alan Cass and Finfer, {Simon R} and Gallagher, {Martin Patrick} and Joanne Lee and Serigne Lo and Colin McArthur and McGuinness, {Shay P} and Myburgh, {John A} and Scheinkestel, {Carlos D}",
year = "2013",
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language = "English",
volume = "39",
pages = "429--436",
journal = "Intensive Care Medicine",
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Early acid-base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis. / Bellomo, Rinaldo; Lipcsey, Miklos; Calzavacca, Paolo; Haase, Michael; Haase-Fielitz, Anja; Licari, Elisa; Tee, Augustine; Cole, Louise; Cass, Alan; Finfer, Simon R; Gallagher, Martin Patrick; Lee, Joanne; Lo, Serigne; McArthur, Colin; McGuinness, Shay P; Myburgh, John A; Scheinkestel, Carlos D.

In: Intensive Care Medicine, Vol. 39, 2013, p. 429-436.

Research output: Contribution to journalArticleResearchpeer-review

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, Anja

AU - Licari, Elisa

AU - Tee, Augustine

AU - Cole, Louise

AU - Cass, Alan

AU - Finfer, Simon R

AU - Gallagher, Martin Patrick

AU - Lee, Joanne

AU - Lo, Serigne

AU - McArthur, Colin

AU - McGuinness, Shay P

AU - Myburgh, John A

AU - Scheinkestel, Carlos D

PY - 2013

Y1 - 2013

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 ?g/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 ?g/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).

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