2019PCRRT工作组建议_儿童透析中低血压.pdfVIP

Pediatric Nephrology /10.1007/s00467-018-4190-1 CONSENSUS CONFERENCE Pediatric intradialytic hypotension: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup Rupesh Raina 1,2 Stephanie Lam3 Hershita Raheja4 Vinod Krishnappa 2,5 Daljit Hothi6 Andrew Davenport 7 Deepa Chand8 Gaurav Kapur 9 Franz Schaefer10 Sidharth Kumar Sethi 11 Mignon McCulloch 12 Arvind Bagga 13 Timothy Bunchman 14 Bradley A. Warady 15 Received: 3 September 2018 /Revised: 23 November 2018 /Accepted: 21 December 2018 # IPNA 2019 Abstract Intradialytic hypotension (IDH) is a common adverse event resulting in premature interruption of hemodialysis, and consequent- ly, 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. Keywords Intradialytic hypotension . Children . Blood pressure monitoring . Sodium profiling . Blood volume monitoring . Dialysate cooling . Mannito