Effect of colloid priming on blood pressure in the first hour in critically ill patients receiving continuous renal replacement therapy_West China Medical Journal

Authors：

MAO Renli ^1,2 , LIU Xiaolan ¹ , WANG Fang ¹ , LIN Li ¹ ,  YANG Yingying ¹ , WANG Bo ³ , ZHANG Zhongwei ³ , ZHANG Ling ¹

1. Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Nephrology, Guang’an People’s Hospital, Guang’an, Sichuan 638500, P. R. China;
3. Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

YANG Yingying, Email: yingyingyangsf@163.com

Keywords：

Priming; continuous renal replacement therapy; hemodynamics; hypotension

DOI：

10.7507/1002-0179.202406125

Video：

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Objective To investigate and compare the effects of succinylated gelatin injection and saline priming on the first hour blood pressure in critically ill patients receiving continuous renal replacement therapy (CRRT). Methods Inpatients who received continuous venous-venous dialysis filtration therapy in the intensive care unit of West China Hospital of Sichuan University between January and May 2024 were selected. The patients were randomly divided into an experimental group (colloidal solution group) and a control group (crystalloid solution group) in a 1∶1 ratio. The colloidal solution group used succinylated gelatin injection as the priming solution, and used the dual connection method to draw blood to the machine. The patient’s systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate at 10 minutes before and 0, 1, 3, 5, 10, 30 and 60 minute after CRRT initiation, the name and dosage of vascular compression drugs pumped intravenously at 0, 30 and 60 minutes, and the liquid inlet and outlet in the first hour were monitored and recorded. The crystalloid solution group used normal saline as the priming solution, and the rest of the methods were the same as those of the colloidal solution group. Two groups of patients were compared for changes in blood pressure and heart rate during the first hour of CRRT, as well as the incidence of hypotension. Results A total of 208 patients were included, with 104 cases in each group. There was no significant difference in baseline data between the two groups (P>0.05). At 3 minutes after CRRT, the systolic blood pressure of the crystalloid solution group was lower than that of the colloidal solution group [(122.56±23.82) vs. (129.43±25.46) mm Hg (1 mm Hg=0.133 kPa); t=?2.005, P=0.046]. There was no statistically significant difference in diastolic blood pressure, mean arterial pressure, or heart rate between the two groups at different time points (P>0.05). The intra group comparison results showed that the systolic blood pressure of the crystalloid solution group decreased compared to before at 1, 3, 5, and 10 minutes after CRRT (P<0.05), while the diastolic blood pressure and mean arterial pressure decreased compared to before at 3, 5, and 10 minutes after the start of CRRT (P<0.05); there was no statistically significant difference in blood pressure of the colloidal solution group among different time points after the start of CRRT (P>0.05). The heart rate of the crystalloid solution group was higher at 10 minutes after the start of CRRT than at 3 minutes after CRRT (P=0.045); 60 minutes after the start of CRRT, the heart rate in the colloidal solution group was lower than that 0 minutes after CRRT (P=0.032); there was no statistically significant difference between the two groups at other time points within each group (P>0.05). On the first hour of CRRT, there was a statistically significant difference in the incidence of hypotension between the two groups [33 cases (31.7%) vs. 18 cases (17.3%); χ²=5.845, P=0.016]. Conclusions The use of colloidal solution pre-flushing is more advantageous to improving the decrease in blood pressure in the first hour of CRRT in severe patients than crystalloid solution group pre-flushing. And it can reduce the incidence of hypotension in the first hour of CRRT in severe patients.

Citation： MAO Renli, LIU Xiaolan, WANG Fang, LIN Li, YANG Yingying, WANG Bo, ZHANG Zhongwei, ZHANG Ling. Effect of colloid priming on blood pressure in the first hour in critically ill patients receiving continuous renal replacement therapy. West China Medical Journal, 2025, 40(3): 425-431. doi: 10.7507/1002-0179.202406125 Copy

1.	Akhoundi A, Singh B, Vela M, et al. Incidence of adverse events during continuous renal replacement therapy. Blood Purif, 2015, 39(4): 333-339.
2.	Shingarev R, Wille K, Tolwani A. Management of complications in renal replacement therapy. Semin Dial, 2011, 24(2): 164-168.
3.	Silversides JA, Pinto R, Kuint R, et al. Fluid balance, intradialytic hypotension, and outcomes in critically ill patients undergoing renal replacement therapy: a cohort study. Crit Care, 2014, 18(6): 624.
4.	Shawwa K, Kompotiatis P, Jentzer JC, et al. Hypotension within one-hour from starting CRRT is associated with in-hospital mortality. J Crit Care, 2019, 54: 7-13.
5.	凌琳, 趙振華, 仇麗華, 等. 重癥患者連續性腎臟替代治療低血壓發生率的影響因素. 護士進修雜志, 2021, 36(11): 1048-1052.
6.	李晶. 急性腎損傷病人連續性腎臟替代治療期低血壓發生危險因素及預防護理研究. 全科護理, 2022, 20(13): 1836-1839.
7.	付平. 連續性腎臟替代治療的并發癥. 中華醫學會腎臟病學分會 2007 年學術年會論文集. 2007: 151-153.
8.	Douvris A, Malhi G, Hiremath S, et al. Interventions to prevent hemodynamic instability during renal replacement therapy in critically ill patients: a systematic review. Crit Care, 2018, 22(1): 41.
9.	Robert R, Méhaud JE, Timricht N, et al. Benefits of an early cooling phase in continuous renal replacement therapy for ICU patients. Ann Intensive Care, 2012, 2(1): 40.
10.	Rokyta R Jr, Matejovic M, Krouzecky A, et al. Effects of continuous venovenous haemofiltration-induced cooling on global haemodynamics, splanchnic oxygen and energy balance in critically ill patients. Nephrol Dial Transplant, 2004, 19(3): 623-630.
11.	Santiago MJ, López-Herce J, Urbano J, et al. Complications of continuous renal replacement therapy in critically ill children: a prospective observational evaluation study. Crit Care, 2009, 13(6): R184.
12.	Davenport A, Will EJ, Davidson AM. Improved cardiovascular stability during continuous modes of renal replacement therapy in critically ill patients with acute hepatic and renal failure. Crit Care Med, 1993, 21(3): 328-338.
13.	John S, Eckardt KU. Renal replacement therapy in the treatment of acute renal failure-intermittent and continuous. Semin Dial, 2006, 19(6): 455-464.
14.	Schneider AG, Bellomo R, Bagshaw SM, et al. Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis. Intensive Care Med, 2013, 39(6): 987-997.
15.	Wald R, Shariff SZ, Adhikari NK, et al. The association between renal replacement therapy modality and long-term outcomes among critically ill adults with acute kidney injury: a retrospective cohort study. Crit Care Med, 2014, 42(4): 868-877.
16.	Bell M, SWING, Granath F, et al. Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure. Intensive Care Med, 2007, 33(5): 773-780.
17.	Kitchlu A, Adhikari N, Burns KE, et al. Outcomes of sustained low efficiency dialysis versus continuous renal replacement therapy in critically ill adults with acute kidney injury: a cohort study. BMC Nephrol, 2015, 16: 127.
18.	Uchino S, Bellomo R, Morimatsu H, et al. Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B. E. S. T. kidney) investigators. Intensive Care Med, 2007, 33(9): 1563-1570.
19.	Kelly YP, Sharma S, Mothi SS, et al. Hypocalcemia is associated with hypotension during CRRT: a secondary analysis of the acute renal failure trial network study. J Crit Care, 2021, 65: 261-267.
20.	Manns M, Sigler MH, Teehan BP. Intradialytic renal haemodynamics--potential consequences for the management of the patient with acute renal failure. Nephrol Dial Transplant, 1997, 12(5): 870-872.
21.	Kim IB, Fealy N, Baldwin I, et al. Circuit start during continuous renal replacement therapy in vasopressor-dependent patients: the impact of a slow blood flow protocol. Blood Purif, 2011, 32(1): 1-6.
22.	石敏. CVVHD 相關性低血壓的原因分析及護理措施. 齊齊哈爾醫學院學報, 2009, 30(1): 107-108.
23.	Sigwalt F, Bouteleux A, Dambricourt F, et al. Clinical complications of continuous renal replacement therapy. Contrib Nephrol, 2018, 194: 109-117.
24.	Lobo SM, Salgado PF, Castillo VG, et al. Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients. Crit Care Med, 2000, 28(10): 3396-3404.
25.	Pulimood TB, Park GR. Debate: albumin administration should be avoided in the critically ill. Crit Care, 2000, 4(3): 151-155.
26.	Mc Causland FR, Waikar SS. Association of predialysis calculated plasma osmolarity with intradialytic blood pressure decline. Am J Kidney Dis, 2015, 66(3): 499-506.
27.	Fernández S, Santiago MJ, González R, et al. Hemodynamic impact of the connection to continuous renal replacement therapy in critically ill children. Pediatr Nephrol, 2019, 34(1): 163-168.
28.	胡軍濤, 李超乾, 湯展宏. 琥珀酰明膠注射液快速輸注對低血容量性休克患者血清電解質及凝血功能的影響. 廣西醫科大學學報, 2013, 30(1): 55-57.
29.	Roberts JS, Bratton SL. Colloid volume expanders. Problems, pitfalls and possibilities. Drugs, 1998, 55(5): 621-630.
30.	Edwards JD, Nightingale P, Wilkins RG, et al. Hemodynamic and oxygen transport response to modified fluid gelatin in critically ill patients. Crit Care Med, 1989, 17(10): 996-998.
31.	王珊娟, 杭燕南, 龔國慶, 等. 血定安對機體血流動力學和血生化影響. 中華麻醉學雜志, 1996, 16(8): 363-365.

1. Akhoundi A, Singh B, Vela M, et al. Incidence of adverse events during continuous renal replacement therapy. Blood Purif, 2015, 39(4): 333-339.
2. Shingarev R, Wille K, Tolwani A. Management of complications in renal replacement therapy. Semin Dial, 2011, 24(2): 164-168.
3. Silversides JA, Pinto R, Kuint R, et al. Fluid balance, intradialytic hypotension, and outcomes in critically ill patients undergoing renal replacement therapy: a cohort study. Crit Care, 2014, 18(6): 624.
4. Shawwa K, Kompotiatis P, Jentzer JC, et al. Hypotension within one-hour from starting CRRT is associated with in-hospital mortality. J Crit Care, 2019, 54: 7-13.
5. 凌琳, 趙振華, 仇麗華, 等. 重癥患者連續性腎臟替代治療低血壓發生率的影響因素. 護士進修雜志, 2021, 36(11): 1048-1052.
6. 李晶. 急性腎損傷病人連續性腎臟替代治療期低血壓發生危險因素及預防護理研究. 全科護理, 2022, 20(13): 1836-1839.
7. 付平. 連續性腎臟替代治療的并發癥. 中華醫學會腎臟病學分會 2007 年學術年會論文集. 2007: 151-153.
8. Douvris A, Malhi G, Hiremath S, et al. Interventions to prevent hemodynamic instability during renal replacement therapy in critically ill patients: a systematic review. Crit Care, 2018, 22(1): 41.
9. Robert R, Méhaud JE, Timricht N, et al. Benefits of an early cooling phase in continuous renal replacement therapy for ICU patients. Ann Intensive Care, 2012, 2(1): 40.
10. Rokyta R Jr, Matejovic M, Krouzecky A, et al. Effects of continuous venovenous haemofiltration-induced cooling on global haemodynamics, splanchnic oxygen and energy balance in critically ill patients. Nephrol Dial Transplant, 2004, 19(3): 623-630.
11. Santiago MJ, López-Herce J, Urbano J, et al. Complications of continuous renal replacement therapy in critically ill children: a prospective observational evaluation study. Crit Care, 2009, 13(6): R184.
12. Davenport A, Will EJ, Davidson AM. Improved cardiovascular stability during continuous modes of renal replacement therapy in critically ill patients with acute hepatic and renal failure. Crit Care Med, 1993, 21(3): 328-338.
13. John S, Eckardt KU. Renal replacement therapy in the treatment of acute renal failure-intermittent and continuous. Semin Dial, 2006, 19(6): 455-464.
14. Schneider AG, Bellomo R, Bagshaw SM, et al. Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis. Intensive Care Med, 2013, 39(6): 987-997.
15. Wald R, Shariff SZ, Adhikari NK, et al. The association between renal replacement therapy modality and long-term outcomes among critically ill adults with acute kidney injury: a retrospective cohort study. Crit Care Med, 2014, 42(4): 868-877.
16. Bell M, SWING, Granath F, et al. Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure. Intensive Care Med, 2007, 33(5): 773-780.
17. Kitchlu A, Adhikari N, Burns KE, et al. Outcomes of sustained low efficiency dialysis versus continuous renal replacement therapy in critically ill adults with acute kidney injury: a cohort study. BMC Nephrol, 2015, 16: 127.
18. Uchino S, Bellomo R, Morimatsu H, et al. Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B. E. S. T. kidney) investigators. Intensive Care Med, 2007, 33(9): 1563-1570.
19. Kelly YP, Sharma S, Mothi SS, et al. Hypocalcemia is associated with hypotension during CRRT: a secondary analysis of the acute renal failure trial network study. J Crit Care, 2021, 65: 261-267.
20. Manns M, Sigler MH, Teehan BP. Intradialytic renal haemodynamics--potential consequences for the management of the patient with acute renal failure. Nephrol Dial Transplant, 1997, 12(5): 870-872.
21. Kim IB, Fealy N, Baldwin I, et al. Circuit start during continuous renal replacement therapy in vasopressor-dependent patients: the impact of a slow blood flow protocol. Blood Purif, 2011, 32(1): 1-6.
22. 石敏. CVVHD 相關性低血壓的原因分析及護理措施. 齊齊哈爾醫學院學報, 2009, 30(1): 107-108.
23. Sigwalt F, Bouteleux A, Dambricourt F, et al. Clinical complications of continuous renal replacement therapy. Contrib Nephrol, 2018, 194: 109-117.
24. Lobo SM, Salgado PF, Castillo VG, et al. Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients. Crit Care Med, 2000, 28(10): 3396-3404.
25. Pulimood TB, Park GR. Debate: albumin administration should be avoided in the critically ill. Crit Care, 2000, 4(3): 151-155.
26. Mc Causland FR, Waikar SS. Association of predialysis calculated plasma osmolarity with intradialytic blood pressure decline. Am J Kidney Dis, 2015, 66(3): 499-506.
27. Fernández S, Santiago MJ, González R, et al. Hemodynamic impact of the connection to continuous renal replacement therapy in critically ill children. Pediatr Nephrol, 2019, 34(1): 163-168.
28. 胡軍濤, 李超乾, 湯展宏. 琥珀酰明膠注射液快速輸注對低血容量性休克患者血清電解質及凝血功能的影響. 廣西醫科大學學報, 2013, 30(1): 55-57.
29. Roberts JS, Bratton SL. Colloid volume expanders. Problems, pitfalls and possibilities. Drugs, 1998, 55(5): 621-630.
30. Edwards JD, Nightingale P, Wilkins RG, et al. Hemodynamic and oxygen transport response to modified fluid gelatin in critically ill patients. Crit Care Med, 1989, 17(10): 996-998.
31. 王珊娟, 杭燕南, 龔國慶, 等. 血定安對機體血流動力學和血生化影響. 中華麻醉學雜志, 1996, 16(8): 363-365.

West China Medical Journal

Effect of colloid priming on blood pressure in the first hour in critically ill patients receiving continuous renal replacement therapy

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