Target value of mean arterial pressure in patients undergoing continuous renal replacement therapy due to acute kidney injury

Kim, Yaerim; Yun, Donghwan; Kwon, Soie; Jin, Kyubok; Han, Seongwoo; Oh, Kook Hwan; Joo, Kwon Wook; Kim, Yon Su; Kim, Sejoong; Han, Seung Seok

doi:10.1186/s12882-020-02227-4

Cited by 9 publications

(6 citation statements)

References 22 publications

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“…Relatively higher MAP cut-off levels were suggested for CRRT patients. A retrospective study of 2,292 AKI patients who underwent CRRT reported that MAP < 82.7 mmHg at the initiation of CRRT was associated with 1.21 (1.01-1.45)-fold higher odds of mortality 13 .…”

Section: Discussionmentioning

confidence: 99%

Influence of mean arterial pressure on the decision to terminate CRRT and in-hospital mortality: A single-center prospective study

Yoon

Jang

Kim

et al. 2023

Preprint

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Background We hypothesized that a low mean arterial pressure (MAP) at CRRT initiation would influence the early death or withdrawal of CRRT and in-hospital mortality. Methods This prospective cohort study collected data for CRRT patients seen at the Third Affiliated Hospital from January 2016 to December 2020. We collected MAP data at the initiation of CRRT, reasons for CRRT termination, and in-hospital mortality data. We divided the patients into four groups based on quartiles of the initial MAP and analyzed its influence on early death/withdrawal of CRRT. Results A total of 2,346 patients with acute kidney injury (AKI) were included in this study. The median age of the participants was 68.0 (57.0–76.0) years, and 62.4% were male. CRRT was discontinued in 49.9% of our patients after renal recovery or HD transition; in 48.8%, CRRT was terminated by death (36.6%) or withdrawal (12.2%). An initial low MAP (Q1, MAP ≤ 69 mmHg and Q2, MAP ≤ 77.1 mmHg) was associated with a 1.3-fold greater risk of death/withdrawal during CRRT. Older age, a higher SOFA score, and oliguria at the time of CRRT initiation also predicted death/withdrawal during CRRT. Conclusions In patients on CRRT, a lower MAP at CRRT initiation was closely associated with a higher probability of terminating CRRT due to death/withdrawal, and it was associated with an increased risk of in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Influence of mean arterial pressure on the decision to terminate CRRT and in-hospital mortality: A single-center prospective study

Yoon

Jang

Kim

et al. 2023

Preprint

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“…Increasing MAP from 65 mmHg to a normal level was associated with improved microcirculation in hypertensive septic shock patients [ 20 ]. Mean arterial pressure < 82 mmHg was also observed to have increased mortality in patients starting continuous renal replacement therapy [ 21 ]. The optimal MAP can be further determined in the future for emergent hemodialysis patients.…”

Section: Discussionmentioning

confidence: 99%

An Early Predictive Scoring Model for In-Hospital Cardiac Arrest of Emergent Hemodialysis Patients

Chen

Cheng

Lin

2021

JCM

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Background: Patients undergoing hemodialysis are prone to cardiac arrests. Methods: This study aimed to develop a risk score to predict in-hospital cardiac arrest (IHCA) in emergency department (ED) patients undergoing emergency hemodialysis. Patients were included if they received urgent hemodialysis within 24 h after ED arrival. The primary outcome was IHCA within three days. Predictors included three domains: comorbidity, triage information (vital signs), and initial biochemical results. The final model was generated from data collected between 2015 and 2018 and validated using data from 2019. Results: A total of 257 patients, including 52 with IHCA, were analyzed. Statistical analysis selected significant variables with higher sensitivity cutoff, and scores were assigned based on relative beta coefficient ratio: K > 5.5 mmol/L (score 1), pH < 7.35 (score 1), oxygen saturation < 85% (score 1), and mean arterial pressure < 80 mmHg (score 2). The final scoring system had an area under the curve of 0.78 (p < 0.001) in the primary group and 0.75 (p = 0.023) in the validation group. The high-risk group (defined as sum scores ≥ 3) had an IHCA risk of 47.2% and 41.7%, while the low-risk group (sum scores < 3) had 18.3% and 7%, in the primary and validation databases, respectively. Conclusions: This predictive score model for IHCA in emergent hemodialysis patients could help healthcare providers to take necessary precautions and allocate resources.

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“…The compare_categories workflow (QIIME 1.9.1) was used to perform Permutational analysis of variance (PERMANOVA) on the distance matrices to test for dissimilarities between groups. Differences in the taxa relative distribution between categories were tested using analysis of composition of microbes (ANCOM) [ 50 ]. The observation_metadata_correlation workflow (QIIME 1.9.1) was used to find Pearson correlations between specific operational taxonomic units (OTUs) and tetanus vaccine specific immunoglobulin (Ig) G level with subsequent FDR correction (Q value) in Study A, B and C. Correlations were conducted using the QIIME script observation_metadata_correlation.py.…”

Section: Methodsmentioning

confidence: 99%

Effect of gluten-free diet and antibiotics on murine gut microbiota and immune response to tetanus vaccination

et al. 2022

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The purpose of this study was to compare the effect of a gluten-free diet and/or antibiotics on tetanus vaccine induced immunoglobulin G titers and immune cell levels in BALB/c mice. The gluten-free diet was associated with a reduced anti-tetanus IgG response, and it increased the relative abundance of the anti-inflammatory Bifidobacterium significantly in some of the mice. Antibiotics also led to gut microbiota changes and lower initial vaccine titer. After a second vaccination, neither gluten-free diet nor antibiotics reduced the titers. In the spleen, the gluten-free diet significantly increased regulatory T cell (Treg) fractions, CD4+ T cell activation, and tolerogenic dendritic cell fractions and activation, which extend the downregulating effect of the Treg. Therefore, the systemic effect of the gluten-free diet seems mainly tolerogenic. Antibiotics reduced the fractions of CD4+ T and B cells in the mesenteric lymph nodes. These results suggest that vaccine response in mice is under influence of their diet, the gut microbiota and the interplay between them. However, a gluten-free diet seems to work through mechanisms different from those induced by antibiotics. Therefore, diet should be considered when testing vaccines in mice and developing vaccines for humans.

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Target value of mean arterial pressure in patients undergoing continuous renal replacement therapy due to acute kidney injury

Cited by 9 publications

References 22 publications

Influence of mean arterial pressure on the decision to terminate CRRT and in-hospital mortality: A single-center prospective study

Influence of mean arterial pressure on the decision to terminate CRRT and in-hospital mortality: A single-center prospective study

An Early Predictive Scoring Model for In-Hospital Cardiac Arrest of Emergent Hemodialysis Patients

Effect of gluten-free diet and antibiotics on murine gut microbiota and immune response to tetanus vaccination

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