Intermittent Hemodialysis for Managing Metabolic Acidosis during Resuscitation of Septic Shock: A Descriptive Study

Abstract

Objectives: Septic shock is often complicated by severe metabolic acidosis, for which renal replacement therapy may be considered. However, little is known about the use of intermittent hemodialysis to manage this condition. The aim of this study was to compare physiologic and biochemical variables and vasopressor requirements before and after intermittent hemodialysis among patients who received intermittent hemodialysis to manage metabolic acidosis during resuscitation of septic shock. Design: This retrospective, cross-sectional study was conducted between April 2014 and September 2015. Settings: The ICU of a non-university-Affiliated teaching hospital. Patients: Patients who were admitted to the ICU with septic shock and underwent intermittent hemodialysis to manage metabolic acidosis within 48 hours after the diagnosis of septic shock. Measurements and Main Results: The main outcomes were mean arterial pressure, minute ventilator volume, norepinephrine requirement, bicarbonate and pH before and after intermittent hemodialysis. Of 1,190 patients screened, 34 were included, and 33 accomplished a planned session of intermittent hemodialysis. After intermittent hemodialysis, an increased mean arterial pressure (+9.0 mm Hg; 95% CI, 6-13; p < 0.001), decreased minute ventilatory volume (-2.0 L/min; 95% CI,-3.3 to 0.8; p = 0.002), decreased norepinephrine requirement (-0.07 µg/kg/min; 95% CI,-0.12 to-0.02; p = 0.009), increased bicarbonate level (+7.2 mmol/L; 95% CI, 6.1-8.3; p < 0.001), and increased pH (+0.17; 95% CI, 0.13-0.21; p < 0.001) were observed in comparison to those before intermittent hemodialysis. Conclusions: In conclusion, intermittent hemodialysis appeared to be feasible and to stabilize hemodynamic and respiratory conditions in patients with septic shock complicated by metabolic acidosis during resuscitation.