BackgroundIntradialytic hypotension, a complication of intermittent hemodialysis, decreases the efficacy of dialysis and increases long-term mortality. This study was aimed to determine whether different predialysis ultrasound cardiopulmonary profiles could predict intradialytic hypotension.MethodsThis prospective observational single-center study was performed in 248 critically ill patients with acute kidney injury undergoing intermittent hemodialysis. Immediately before hemodialysis, vena cava collapsibility was measured by vena cava ultrasound and pulmonary congestion by lung ultrasound. Factors predicting intradialytic hypotension were identified by multiple logistic regression analysis.ResultsIntradialytic hypotension was observed in 31.9% (n = 79) of the patients, interruption of dialysis because of intradialytic hypotension occurred in 6.8% (n = 31) of the sessions, and overall 28-day mortality was 20.1% (n = 50). Patients were classified in four ultrasound profiles: (A) 108 with B lines > 14 and vena cava collapsibility > 11.5 mm m−2, (B) 38 with B lines < 14 and vena cava collapsibility ≤ 11.5 mm m−2, (C) 36 with B lines > 14 and vena cava collapsibility Di ≤ 11.5 mm m−2, and (D) 66 with B lines < 14 and vena cava collapsibility > 11.5 mm m−2. There was an increased risk of intradialytic hypotension in patients receiving norepinephrine (odds ratios = 15, p = 0.001) and with profiles B (odds ratios = 12, p = 0.001) and C (odds ratios = 17, p = 0.001).ConclusionIn critically ill patients on intermittent hemodialysis, the absence of hypervolemia as assessed by lung and vena cava ultrasound predisposes to intradialytic hypotension and suggests alternative techniques of hemodialysis to provide better hemodynamic stability.

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用于预测间歇透析危重患者透析中低血压风险的基于超声的临床特征：一项前瞻性观察研究

背景透析中低血压是间歇性血液透析的并发症，会降低透析效果并增加长期死亡率。本研究旨在确定不同的透析前超声心肺特征是否可以预测透析中低血压。方法这项前瞻性观察性单中心研究在 248 名接受间歇性血液透析的急性肾损伤危重患者中进行。血液透析前即刻通过腔静脉超声测量腔静脉塌陷率，通过肺部超声测量肺充血。通过多元logistic回归分析确定了预测透析中低血压的因素。 结果 31.9%（n = 79）的患者出现透析中低血压，6例因透析中低血压而中断透析。8% (n = 31) 的会话，28 天的总死亡率为 20.1% (n = 50)。患者被分为四种超声谱：（A）108 名 B 线 > 14 且腔静脉塌陷率 > 11.5 mm m-2，（B）38 名 B 线 < 14 且腔静脉塌陷率 ≤ 11.5 mm m-2，（C ) 36 条 B 线 > 14 且腔静脉塌陷率 Di ≤ 11.5 mm m-2，以及 (D) 66 条 B 线 < 14 且腔静脉塌陷率 > 11.5 mm m-2。接受去甲肾上腺素（优势比 = 15，p = 0.001）和特征 B（优势比 = 12，p = 0.001）和 C（优势比 = 17，p = 0.001）的患者发生透析中低血压的风险增加。间歇性血液透析的危重患者，