Ultrasound-Based Clinical Profiles for Predicting the Risk of Intradialytic Hypotension in Critically Ill Patients on Intermittent Dialysis

Mohamed Hosny Abdalla; Helen Bassel  Zaghloul Rizk; Hossam El Deen  Ahmed Mowafi; Kamel Abdel Aziz Mohammed; Mohamed Gamal Elansary

doi:10.18502/aacc.v12i3.21315

Mohamed Hosny Abdalla Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Helen Bassel Zaghloul Rizk Critical Care and Intensive Care Medicine Department, Faculty of Medicine, Misr University for Science and Technology (MUST), 6th of October City, Egypt.
Hossam El Deen Ahmed Mowafi Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Kamel Abdel Aziz Mohammed Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Mohamed Gamal Elansary Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

DOI: https://doi.org/10.18502/aacc.v12i3.21315

Keywords: Intradialytic hypotension; Critically ill; Intermittent hemodialysis; IVC collapsibility index; Ultrasound

Abstract

Background: Intradialytic hypotension (IDH) is a common and serious complication of intermittent hemodialysis (IHD) in critically ill patients with acute kidney injury (AKI). Accurate pre-dialysis risk stratification remains a challenge, particularly in the ICU. This study aims to determine whether ultrasound-based cardiopulmonary profiles could predict IDH in this high-risk population.

Methods: This prospective cohort study included 100 critically ill adults undergoing IHD for AKI. All patients underwent pre-dialysis echocardiography and lung/inferior vena cava (IVC) ultrasound to assess stroke volume, cardiac output, B-lines, and IVC collapsibility index (IVC-CI). Patients were divided into two groups based on the presence or absence of IDH.

Results: IDH occurred in 35% of patients. Significant predictors of IDH included lower systolic blood pressure (124.86 ±16.02 vs. 139.92 ±22.8 mmHg, P < 0.001), higher IVC-CI [51% (13–58) vs. 27.38% (13–60), P < 0.001], sepsis (88.6% vs. 70.8%, P = 0.044), and elevated potassium (5.17 ±1.34 vs. 4.62 ±0.87 mmol/L, P = 0.015). Multivariate analysis identified IVC-CI (OR = 1.097, P < 0.001) and SBP (OR = 0.942, P = 0.001) as independent predictors. IVC-CI >49.5% predicted IDH with 68.6% sensitivity and 87.7% specificity (AUC = 0.757, 95% CI: 0.652–0.862).

Conclusion: Ultrasound-derived IVC-CI is a valuable, noninvasive tool for predicting IDH in critically ill patients receiving IHD. Incorporating sonographic profiles into routine pre-dialysis evaluation may enhance risk stratification and improve dialysis safety.