Pediatric intradialytic hypotension: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup.

Rupesh Raina, Stephanie Lam, Hershita Raheja, Vinod Krishnappa, Daljit Hothi, Andrew Davenport, Deepa Chand, Gaurav Kapur, Franz Schaefer, Sidharth Kumar Sethi, Mignon McCulloch, Arvind Bagga, Timothy Bunchman, Bradley A Warady

Journal: Pediatric nephrology (Berlin, Germany) 2020;34(5):925-941

PMID: 30734850

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Abstract

Intradialytic hypotension (IDH) is a common adverse event resulting in premature interruption of hemodialysis, and consequently, inadequate fluid and solute removal. IDH occurs in response to the reduction in blood volume during ultrafiltration and subsequent poor compensatory mechanisms due to abnormal cardiac function or autonomic or baroreceptor failure. Pediatric patients are inherently at risk for IDH due to the added difficulty of determining and attaining an accurate dry weight. While frequent blood pressure monitoring, dialysate sodium profiling, ultrafiltration-guided blood volume monitoring, dialysate cooling, hemodiafiltration, and intradialytic mannitol and midodrine have been used to prevent IDH, they have not been extensively studied in pediatric population. Lack of large-scale studies on IDH in children makes it difficult to develop evidence-based management guidelines. Here, we aim to review IDH preventative strategies in the pediatric population and outlay recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup. Without strong evidence in the literature, our recommendations from the expert panel reflect expert opinion and serve as a valuable guide.

Address: Department of Nephrology, Cleveland Clinic Akron General and Akron Children's Hospital, Akron, OH, USA. [email protected].; Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH, USA. [email protected].; Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA.; The Children's Hospital of New Jersey, Newark Beth Israel Medical Center, Newark, NJ, USA.; Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH, USA.; Northeast Ohio Medical University, Rootstown, OH, USA.; Department of Paediatric Nephrology, Great Ormond Street Hospital, Great Ormond Street, London, UK.; UCL Centre for Nephrology, Royal Free Hospital, University College London, London, UK.; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.; Pediatric Nephrology and Hypertension, Children's Hospital of Michigan, Detroit, MI, USA.; Pediatric Nephrology Division, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany.; Pediatric Nephrology & Pediatric Kidney Transplantation, Kidney and Urology Institute, Medanta, The Medicity Hospital, Gurgaon, India.; Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.; Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.; Pediatric Nephrology & Transplantation, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, USA.; Division of Nephrology, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.

DOI: 10.1007/s00467-018-4190-1

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MeSH Terms: Age Factors, Blood Pressure, Blood Pressure Determination, Child, Consensus, Continuous Renal Replacement Therapy, Hemodiafiltration, Hemodialysis Solutions, Humans, Hypotension, Kidney Failure, Chronic, Midodrine, Renal Dialysis, Temperature