title: Sodium modelling to reduce intradialytic hypotension during haemodialysis for acute kidney injury in the intensive care unit.
abstract: OBJECTIVE
  Intradialytic hypotension often complicates haemodialysis for patients with acute kidney injury (AKI) and may impact renal recovery. Sodium modelling is sometimes used as prophylaxis against intradialytic hypotension in the chronic haemodialysis population, but there is little evidence for its use among critically ill patients with AKI.
  
  
  METHODS
  A retrospective cohort with AKI requiring intermittent haemodialysis in the intensive care unit from 2001 to 2008 was used to study the association of prophylactic sodium modelling and multiple outcomes. Outcomes included a composite of in-hospital death or dialysis dependence at hospital discharge, as well as intradialytic hypotension, ultrafiltration goal achievement and net ultrafiltration volume. Associations were estimated using logistic regression, mixed linear models and generalized estimating equations adjusting for demographic and clinical characteristics.
  
  
  RESULTS
  One hundred and ninety-one individuals who underwent 892 sessions were identified; sodium modelling was prescribed in 27.1% of the sessions. In adjusted analyses, sodium modelling was not significantly associated with intradialytic hypotension (P = 0.67) or with the ultrafiltration goal achievement (P = 0.06). Sodium modelling during the first dialysis session was numerically associated with lower risk for the composite of in-hospital death or dialysis dependence: adjusted odds ratio (95% confidence interval) 0.39 (0.15-1.02; P = 0.06); however, this association did not reach statistical significance.
  
  
  CONCLUSIONS
  We did not observe statistically significant associations between sodium modelling and improved outcomes among AKI patients receiving intermittent dialysis in the intensive care unit. However, suggestive findings warrant further study.
authors.affiliation: Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, MA, USA. kelynch@bidmc.harvard.edu.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Lynch
authors.affiliation: Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Cambridge, MA, USA.
authors.forename: Fatimah
authors.initials: F
authors.lastname: Ghassemi
authors.affiliation: Division of Nephrology and Hypertension, University of North Carolina Kidney Center, Chapel Hill, NC, USA.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Flythe
authors.affiliation: Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Cambridge, MA, USA.|Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore, Singapore.
authors.forename: Mengling
authors.initials: M
authors.lastname: Feng
authors.affiliation: Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Cambridge, MA, USA.|The Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA.
authors.forename: Marzyeh
authors.initials: M
authors.lastname: Ghassemi
authors.affiliation: Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Cambridge, MA, USA.
authors.forename: Leo Anthony
authors.initials: LA
authors.lastname: Celi
authors.affiliation: DaVita Clinical Research, Minneapolis, MN, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Brunelli
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy; D000328:Adult; D001795:Blood Pressure Determination / Q000379:methods; D016638:Critical Illness / Q000628:therapy; D015314:Dialysis Solutions / Q000737:chemistry / Q000494:pharmacology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010347:Patient Care Planning; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D012964:Sodium / Q000737:chemistry / Q000494:pharmacology; D014481:United States / Q000453:epidemiology
chemical_list: D015314:Dialysis Solutions; D012964:Sodium
keywords: acute renal failure; haemodialysis; haemodynamics; intradialytic hypotension; sodium modelling