Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Nov 21;12(1):106.
doi: 10.1186/s40635-024-00695-8.

Predictors of intradialytic hypotension in critically ill patients undergoing kidney replacement therapy: a systematic review

Rafaella Maria C Lyrio  1 , Etienne Macedo  2 , Raghavan Murugan  3   4 , Arnaldo A da Silva  5 , Tess M Calcagno  6 , Estevão F Sampaio  7 , Rafael H Sassi  8 , Rogério da Hora Passos  9   10
Affiliations
Review

Predictors of intradialytic hypotension in critically ill patients undergoing kidney replacement therapy: a systematic review

Rafaella Maria C Lyrio et al. Intensive Care Med Exp. .

Abstract

Background: This systematic review aims to identify predictors of intradialytic hypotension (IDH) in critically ill patients undergoing kidney replacement therapy (KRT) for acute kidney injury (AKI).

Methods: A comprehensive search of PubMed was conducted from 2002 to April 2024. Studies included critically ill adults undergoing KRT for AKI, excluding pediatric patients, non-critically ill individuals, those with chronic kidney disease, and those not undergoing KRT. The primary outcome was identifying predictive tools for hypotensive episodes during KRT sessions.

Results: The review analyzed data from 8 studies involving 2873 patients. Various machine learning models were assessed for their predictive accuracy. The Extreme Gradient Boosting Machine (XGB) model was the top performer with an area under the receiver operating characteristic curve (AUROC) of 0.828 (95% CI 0.796-0.861), closely followed by the deep neural network (DNN) with an AUROC of 0.822 (95% CI 0.789-0.856). All machine learning models outperformed other predictors. The SOCRATE score, which includes cardiovascular SOFA score, index capillary refill, and lactate level, had an AUROC of 0.79 (95% CI 0.69-0.89, p < 0.0001). Peripheral perfusion index (PPI) and heart rate variability (HRV) showed AUROCs of 0.721 (95% CI 0.547-0.857) and 0.761 (95% CI 0.59-0.887), respectively. Pulmonary vascular permeability index (PVPI) and mechanical ventilation also demonstrated significant diagnostic performance. A PVPI ≥ 1.6 at the onset of intermittent hemodialysis (IHD) sessions predicted IDH associated with preload dependence with a sensitivity of 91% (95% CI 59-100%) and specificity of 53% (95% CI 42-63%).

Conclusion: This systematic review shows how combining predictive models with clinical indicators can forecast IDH in critically ill AKI patients undergoing KRT, with validation in diverse settings needed to improve accuracy and patient care strategies.

Keywords: Acute kidney injury; Critical illness; Dialysis; Hypotension; Kidney replacement therapy.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors declare that they have no competing interests. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of studies assessed in the systematic review
See this image and copyright information in PMC

References

    1. Hou C, Wang X, Li Y, Hei F (2022) The relationship between short-term mean arterial pressure variability and mortality in critically ill patients. Front Cardiovasc Med 9:870711. 10.3389/fcvm.2022.870711 - PMC - PubMed
    1. Schuurmans J, van Rossem BTB, Rellum SR et al (2024) Hypotension during intensive care stay and mortality and morbidity: a systematic review and meta-analysis. Intensive Care Med 50:516–525. 10.1007/s00134-023-07304-4 - PMC - PubMed
    1. Silversides JA, Pinto R, Kuint R et al (2014) Fluid balance, intradialytic hypotension, and outcomes in critically ill patients undergoing renal replacement therapy: a cohort study. Crit Care Lond Engl 18:624. 10.1186/s13054-014-0624-8 - PMC - PubMed
    1. Manns M, Sigler MH, Teehan BP (1997) Intradialytic renal haemodynamics–potential consequences for the management of the patient with acute renal failure. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc Eur Ren Assoc 12:870–872. 10.1093/ndt/12.5.870 - PubMed
    1. Douvris A, Zeid K, Hiremath S et al (2019) Mechanisms for hemodynamic instability related to renal replacement therapy: a narrative review. Intensive Care Med 45:1333–1346. 10.1007/s00134-019-05707-w - PMC - PubMed

LinkOut - more resources