Intradialytic Hypotension Across Crit-Line Profiles

2021 ANNA National Symposium

In hospitalized patients with heart failure, achieving estimated dry weight (EDW) without causing intradialytic hypotension (IDH) is challenging. One goal of dialysis treatment is to increase ultrafiltration (UF) without causing IDH.

Patients’ fluid status can be assessed using Crit-Line profiles: profile A indicates the patient’s plasma refill is greater than or the same as the UF rate of ≤–3%, and the UF rate can be increased without causing IDH; profile B is ideal, with a change of ≥–3% to ≤–6.5%; and profile C ≥6.5% indicates a rapid decrease in plasma volume. Patients in profile C are more likely to have symptomatic IDH.

During a virtual poster session at the 2021 ANNA National Symposium, Jacqueline Chandler, BA, RN, CNN, and colleagues at the Good Samaritan Regional Medical Center, Springfield, Oregon, reported results of a retrospective data analysis of the prevalence of IDH across Crit-Line profiles. The poster was titled Prevalence of Intradialytic Hypotension (IDH) across Crit-Line Profiles in the Acute Setting: A Retrospective Data Analysis.

The analysis included data on 87 hospitalized patients with end-stage kidney disease with three consecutive hemodialysis treatments. Eligible patients had data on ending profile, total fluid removed, the occurrence of IDH, and achievement of EDW. The outcomes were calculated overall and compared across patients with and without heart failure.

In the first dialysis treatments, IDH occurred in 33% of patients with heart failure and 24% of those without heart failure. In the last dialysis treatment, the percentages of patients who developed IDH in the heart failure and non-heart failure groups were 41% and 24%, respectively. Of the patients with heart failure, 54% ended with profile A in the first treatment and 50% ended with profile A in the last treatment. The majority of patients with IDH ended in profile A: 56% during the first dialysis and 51.7% during the last dialysis. At the end of the hospital admission, 60% of patients with heart failure and 46% of those without heart failure achieved EDW.

In conclusion, the authors said, “Monitoring the profile throughout the patient treatment via Crit-Line can help nurses safely increase UF goals to achieve EDW at each treatment while avoiding complications of IDH. Although 60% of heart failure patients and 46% of non-heart failure [patients] achieved EDW, the majority of the patients were in profile A indicating the need for more aggressive UF.”

Source: Chandler J, Khanna S, Mansur A. Prevalence of intradialytic hypotension (IDH) across Crit-Line profiles in the acute setting: A retrospective data analysis. Abstract of a poster presented at the virtual 2021 American Nephrology Nurses Association National Symposium, May 2-5, 2021.