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

Document Type

Article

Publication Date

5-2019

Identifier

DOI: 10.1007/s00467-018-4190-1

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.

Journal Title

Pediatric nephrology (Berlin, Germany)

Volume

34

Issue

5

First Page

925

Last Page

941

MeSH Keywords

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

Keywords

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

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