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

Title

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

Creator

Raina Rupesh; Lam Stephanie; Raheja Hershita; Krishnappa Vinod; Hothi Daljit; Davenport Andrew; Chand Deepa; Kapur Gaurav; Schaefer Franz; Sethi Sidharth Kumar; McCulloch Mignon; Bagga Arvind; Bunchman Timothy; Warady Bradley A

Publisher

Pediatric Nephrology (Berlin, Germany)

Date

2019
2019-05

Description

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.

Subject

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

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Pages

925-941

Issue

5

Volume

34

Citation

Raina Rupesh; Lam Stephanie; Raheja Hershita; Krishnappa Vinod; Hothi Daljit; Davenport Andrew; Chand Deepa; Kapur Gaurav; Schaefer Franz; Sethi Sidharth Kumar; McCulloch Mignon; Bagga Arvind; Bunchman Timothy; Warady Bradley A, “Pediatric intradialytic hypotension: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup,” NEOMED Bibliography Database, accessed May 16, 2021, https://neomed.omeka.net/items/show/6342.

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