title: Microcirculatory perfusion derangements during continuous hemofiltration with fixed dose of ultrafiltration in stabilized intensive care unit patients.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a well-known complication in critically ill patients. Little is known about the timing and the ultrafiltration dose after initial resuscitation. In vivo microscopy of the microcirculation has been suggested as alternative for the assessment of volume status. Previous studies contribute to the understanding that intravascular hypovolemia is reflected by microcirculatory blood flow changes not detected by conventional methods. The aim of our study was to assess microcirculatory blood flow changes during negative fluid balance ultrafiltration in patients with oliguric AKI.
  
  
  METHODS
  Patients with oliguric AKI on renal replacement therapy were included after hemodynamic stabilization. Target was a predefined negative fluid balance; subsequently, a stepwise decrease in amount of substitution fluid was achieved. The data were recorded at baseline and after each change.
  
  
  RESULTS
  Fifteen patients were included in the study. Microcirculatory blood flow index did not change significantly between baseline and endpoint (2.90 [2.87-3.00] vs 2.90 [2.75-3.00], P=.57). During treatment, heart rate decreased from 96 (80-111) to 94 (79-110) beats per minute (P=.01), without a significant change in mean arterial blood pressure (80 [68-95 mm Hg] vs 79 [65-91 mm Hg], P=.5).
  
  
  CONCLUSIONS
  Microcirculatory blood flow is not altered by reduced substitution during renal replacement therapy.
authors.affiliation: Medical Centre Leeuwarden, ICU, Leeuwarden, The Netherlands. Electronic address: gerke52@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Veenstra
authors.affiliation: Medical Centre Leeuwarden, ICU, Leeuwarden, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Scheenstra
authors.affiliation: Medical Centre Leeuwarden, ICU, Leeuwarden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Koopmans
authors.affiliation: Medical Centre Leeuwarden, ICU, Leeuwarden, The Netherlands.
authors.forename: W P
authors.initials: WP
authors.lastname: Kingma
authors.affiliation: Medical Centre Leeuwarden, ICU, Leeuwarden, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Buter
authors.affiliation: Medical Centre Leeuwarden, ICU, Leeuwarden, The Netherlands.
authors.forename: E C
authors.initials: EC
authors.lastname: Boerma
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology* / Q000628:therapy; D000368:Aged; D062186:Arterial Pressure / Q000502:physiology; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006440:Hemofiltration / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D020896:Hypovolemia / Q000209:etiology / Q000503:physiopathology*; D007362:Intensive Care Units; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D012151:Resuscitation; D014462:Ultrafiltration / Q000009:adverse effects / Q000379:methods; D014882:Water-Electrolyte Balance / Q000502:physiology
keywords: Acute kidney failure; Microcirculatory blood flow; Negative fluid balance; Renal replacement therapy; SDF