Hemodynamic Effects of Blood Flow Variation in Continuous Renal Replacement Therapy

Inclusion Criteria:

- Age 18-89

- Acute renal failure or end-stage renal disease necessitating CRRT

- Admitted to the MICU service

- If on vasopressor/inotropic agent, norepinephrine as only intravenous pressor

- If on vasopressor/inotropic agent, at stable pressor dose for at least four hours

- If on IV fluids, stable dose of crystalloids <= 100cc/hour and is not receiving
colloids for 4 hours or more prior to initiation of CRRT

- Mean arterial pressure (MAP) >= 65

- Arterial catheter present for continuous blood pressure monitoring

- CRRT duration of 48 hours or less using NxStage System One dialysis system

- successfully tolerated CRRT for at least 4 hours without clotting or hemodynamic
instability

- no other procedures, blood products transfusion, or additional medication
administration are anticipated during the study period

Exclusion Criteria:

- listed for organ transplant

- atrial fibrillation, other irregular heart rhythm, unstable arrhythmia

- need for more than one intravenous vasopressor agent

- intravenous vasopressor/inotropic agent other than norepinephrine (ie dobutamine,
dopamine, vasopressin, epinephrine)

- therapeutic anticoagulation being administered

- known acute myocardial infarction as defined by elevated troponin along with a
documented clinical diagnosis during current hospitalization

- known acute stroke, intracerebral hemorrhage, intracranial mass effect, or elevated
intracranial pressure within the last 30 days.

- dialysis catheter malfunction and unable to maintain target blood flow rate

- fluid removal (ultrafiltration) rate > 100mL/hour