• Yvelynne P Kelly, Shilpa Sharma, Suraj S Mothi, Finnian R McCausland, Mallika L Mendu, Gearoid M McMahon, Paul M Palevsky, and Sushrut S Waikar.
• Division of Renal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States of America; Department of Critical Care Medicine, St. James's Hospital, James's Street, Dublin 8, Ireland. Electronic address: yvkelly@tcd.ie.
• J Crit Care. 2021 Oct 1; 65: 261-267.

PurposeWe investigated the effect of potentially modifiable continuous renal replacement therapy (CRRT)-related treatment factors on the risk of severe hypotension.Materials And MethodsWe carried out a secondary statistical analysis of the Acute Renal Failure Trial Network (ATN) trial. The primary exposures of interest were CRRT treatment dose, ultrafiltration rate, blood flow rate, ionized calcium level and type of anti-coagulation used. The primary outcome was severe hypotension, defined as vasopressor-inotropic score > 18 and calculated based on treatment doses of vasopressor and inotropic agents.ResultsOf 1124 individuals enrolled in the ATN Trial, 786 were managed with CRRT. 265/786 (33.7%) patients experienced severe hypotension during the trial. A serum ionized calcium <1.02 mmol/l was associated with a higher risk of severe hypotension compared to a serum calcium >1.02 mmol/l (hazard ratio 2.9; 95% CI 1.5-5.7). There was no significant difference in the risk of hypotension associated with other CRRT treatment factors.ConclusionsOf the CRRT treatment factors studied, hypocalcemia with a serum ionized calcium <1.02 mmol/l was associated with a significantly increased risk of treatment-associated hypotension. Further studies will be required to assess whether treatment targets for serum calcium improve the risk of hypotension during CRRT.Copyright © 2021 Elsevier Inc. All rights reserved.

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