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      Sodium Modeling to Reduce Intradialytic Hypotension during Haemodialysis for Acute Kidney Injury in the Intensive Care Unit

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          Abstract

          Aim

          Intradialytic hypotension often complicates haemodialysis for patients with acute kidney injury (AKI), and may impact renal recovery. Sodium modeling is sometimes used as prophylaxis against intradialytic hypotension in the chronic haemodialysis population, but there is little evidence for its use among critically ill patients with AKI.

          Methods

          A retrospective cohort with AKI requiring intermittent haemodialysis in the intensive care unit from 2001–2008 was used to study the association of prophylactic sodium modeling and multiple outcomes. Outcomes included a composite of in-hospital death or dialysis dependence at hospital discharge, as well as intradialytic hypotension, ultrafiltration goal achievement, and net ultrafiltration volume. Associations were estimated using logistic regression, mixed linear models, and generalized estimating equations adjusting for demographic and clinical characteristics.

          Results

          191 individuals who underwent 892 sessions were identified; sodium modeling was prescribed in 27.1% of the sessions. In adjusted analyses, sodium modeling was not significantly associated with intradialytic hypotension (p=0.67) or with the ultrafiltration goal achievement (p=0.06). Sodium modeling during the first dialysis session was numerically associated with lower risk for the composite of in-hospital death or dialysis dependence: adjusted OR (95% CI) 0.39 (0.15–1.02; p=0.06); however, this association did not reach statistical significance.

          Conclusion

          We did not observe statistically significant associations between sodium modeling and improved outcomes among AKI patients receiving intermittent dialysis in the intensive care unit. However, suggestive findings warrant further study.

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          Author and article information

          Journal
          9615568
          31845
          Nephrology (Carlton)
          Nephrology (Carlton)
          Nephrology (Carlton, Vic.)
          1320-5358
          1440-1797
          26 November 2015
          October 2016
          01 October 2017
          : 21
          : 10
          : 870-877
          Affiliations
          [1 ]Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, MA
          [2 ]Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Cambridge, MA
          [3 ]Division of Nephrology and Hypertension, University of North Carolina Kidney Center, Chapel Hill, NC
          [4 ]Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore
          [5 ]The Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA
          [6 ]Divsion of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA
          [7 ]DaVita Clinical Research, Minneapolis, MN
          Author notes
          Corresponding author: Katherine Lynch, 330 Brookline Ave, Libby 2, Boston, MA 02215, Phone: 617-632-9880, Fax: 617-632-9890, kelynch@ 123456bidmc.harvard.edu
          Article
          PMC4875881 PMC4875881 4875881 nihpa740491
          10.1111/nep.12677
          4875881
          26590371
          a398ec36-43db-4466-85ad-cd5a2107f617
          History
          Categories
          Article

          haemodynamics,intradialytic hypotension,haemodialysis,Acute renal failure,sodium modeling

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