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

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations

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.

Original languageEnglish
Pages (from-to)925-941
Number of pages17
JournalPediatric Nephrology
Volume34
Issue number5
DOIs
StatePublished - May 1 2019

Keywords

  • Blood pressure monitoring
  • Blood volume monitoring
  • Children
  • Dialysate cooling
  • Intradialytic hypotension
  • Mannitol
  • Midodrine
  • Sodium profiling

Fingerprint Dive into the research topics of 'Pediatric intradialytic hypotension: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup'. Together they form a unique fingerprint.

Cite this