TY - JOUR
T1 - Pediatric intradialytic hypotension
T2 - recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup
AU - Raina, Rupesh
AU - Lam, Stephanie
AU - Raheja, Hershita
AU - Krishnappa, Vinod
AU - Hothi, Daljit
AU - Davenport, Andrew
AU - Chand, Deepa
AU - Kapur, Gaurav
AU - Schaefer, Franz
AU - Sethi, Sidharth Kumar
AU - McCulloch, Mignon
AU - Bagga, Arvind
AU - Bunchman, Timothy
AU - Warady, Bradley A.
N1 - Publisher Copyright:
© 2019, IPNA.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - 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.
AB - 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.
KW - Blood pressure monitoring
KW - Blood volume monitoring
KW - Children
KW - Dialysate cooling
KW - Intradialytic hypotension
KW - Mannitol
KW - Midodrine
KW - Sodium profiling
UR - http://www.scopus.com/inward/record.url?scp=85061318409&partnerID=8YFLogxK
U2 - 10.1007/s00467-018-4190-1
DO - 10.1007/s00467-018-4190-1
M3 - Review article
C2 - 30734850
AN - SCOPUS:85061318409
SN - 0931-041X
VL - 34
SP - 925
EP - 941
JO - Pediatric Nephrology
JF - Pediatric Nephrology
IS - 5
ER -