title: The bradykinin response and early hypotension at the introduction of continuous renal replacement therapy in the intensive care unit.
abstract: We assessed the relationship of certain clinical variables (including bradykinin [BK] release and dialysis membrane) to initial mean arterial pressure (MAP) reduction in 47 patients requiring continuous renal replacement therapy (CRRT) in an intensive care unit. The pretreatment MAP was 84 +/- 14 mm Hg for the group as a whole. The initial MAP reduction was 11.5 (7-20) mm Hg, occurring 4 to 8 min after connection. MAP reduction was 9 (6-15) mm Hg with polyacryonitrile (PAN) membranes versus 14 (5-19) mm Hg with polysulfone (PS) (not significant). There were positive correlations between MAP reduction and BK concentration at 3 (BK3; r = 0.58, p < 0.01) and 6 (BK6; r = 0.67, p < 0.001) min with PAN but not with PS. A greater reduction in MAP was seen in patients who were not receiving inotropic support (Mann-Whitney test, p < 0.01). BK3 and BK6 values for the PAN and PS groups were not significantly different. However, BK concentrations greater than 1,000 pg/ml were only seen with PAN (6 patients, MAP reduction 27 [17-31] mm Hg). There were positive (albumin) and negative (age; acute physiology, age, and chronic health evaluation score; C-reactive protein [CRP]; calcium) correlations with BK3/BK6 in the PAN and PS groups, some of which (albumin, CRP) reached statistical significance. In summary, MAP reduction at the start of CRRT correlates with BK concentration. The similarity of response with PAN and PS suggests an importance for other clinical factors. In this study, hemodynamic instability was more likely in patients with evidence of a less severe inflammatory or septic illness.
authors.affiliation: Department of Renal Medicine, St. James's University Hospital, Leeds, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Stoves
authors.forename: N P
authors.initials: NP
authors.lastname: Goode
authors.forename: R
authors.initials: R
authors.lastname: Visvanathan
authors.forename: C H
authors.initials: CH
authors.lastname: Jones
authors.forename: M
authors.initials: M
authors.lastname: Shires
authors.forename: E J
authors.initials: EJ
authors.lastname: Will
authors.forename: A M
authors.initials: AM
authors.lastname: Davison
mesh_terms: D000368:Aged; D001794:Blood Pressure; D001920:Bradykinin / Q000097:blood*; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D017583:Hemodiafiltration; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D017582:Renal Replacement Therapy
chemical_list: D008567:Membranes, Artificial; D001920:Bradykinin