P1076hemodynamic Tolerance to Intermittent Dialysis in Critically Ill Patients: The Clinical Judgment of Hipervolemia Is Able to Predicatit?

Abstract

Background and Aims Evaluation and management of fluid balance are a key challenge in caring for the critically ill requiring renal replacement therapy. As intradialytic hypotension is a common complication and can be associated ultrafiltration rate. Usually the nephrologist and critical care physician have relied in their subjective clinical judgment and clinical data to calculate ultrafiltration. The aim of this study was to assess the prediction of clinical judgment of fluid overload and other clinical and dialysis data as predictors of hemodynamic tolerance to intermittent dialysis. Method This prospective observational single-center study was performed in critically ill patients with acute kidney injury undergoing intermittent hemodialysis. Before hemodialysis, clinical judgement of Hypervolemia from nephrologists and intensivists were assessed and posterior-anterior views of chest-X-rays done within three hour before of beginning of dialysis were collected for measurement of vascular pedicle width (VPW). Factors predicting intradialytic hypotension were identified by multiple logistic regression analysis. Results 248 AKI patients requiring intermittent dialysis were considered eligible. The clinician judgement of hypervolemia was not different between hypotensive and non hypotensive sessions. Multiple logistic regression showed that the size of VPW was independently associated with the development of hypotension during IHD session. A VPW value of > 70 mm had an 86.1 % sensitivity, 55 % specificity for identifying non hypotensive sessions with an area under the curve (AUC) = 0.81, 95 % CI 0.75–0.84, p < 0.001. Conclusion Clinical judgment of hypervolemia and other clinical and demographic variables that are used by nephrologists and critical care physicians at bedside did not predict hypotensive hemodialysis sessions. The high predictive ability of VPW measurement can help physicians to avoid inductive and deductive thinking and may assist critical thinking.