Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia,
Department of Anesthesiology and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy,
Blood Purif. 2024;53(3):151-161. doi: 10.1159/000534601. Epub 2023 Oct 14.
Renal replacement therapy (RRT) is associated with hypotension. However, its impact on cardiac output (CO) is less understood. We aimed to describe current knowledge of CO monitoring and changes during RRT.
We searched MEDLINE, Embase, and Cochrane from January 1, 2000, to January 31, 2023, using Covidence for studies of intermittent hemodialysis (IHD) and continuous RRT (CRRT) with at least three CO measurements during treatment. Two independent reviewers screened citations, and a third resolved disagreements. The findings did not allow meta-analysis and are presented descriptively.
We screened 3,285 articles and included 48 (37 during IHD, nine during CRRT, and two during both). Non-invasive devices (electrical conductivity techniques and finger cuff pulse contour) were the most common CO measurement techniques (21 studies). The median baseline cardiac index in IHD studies was 3 L/min/m2 (95% CI, 2.7-3.39). Among the 88 patient cohorts studied, a decrease in CO occurred in 63 (72%). In 16 cohorts, the decrease was severe (>25%). Changes in blood pressure (BP) were not concordant in extent or direction with changes in CO. The decrease in CO correlated weakly with ultrafiltration rate (r = -0.3, p = 0.05) and strongly with changes in systemic vascular resistance (SVR) (r = -0.6, p < 0.001).
There are limited data on CO changes during RRT. However, a decrease in CO appeared common and was marked in 1 of 5 patient cohorts. Such decreases often occurred without BP changes and were associated with increased SVR.
肾脏替代治疗（RRT）与低血压有关。然而，其对心输出量（CO）的影响了解较少。我们旨在描述 CO 监测的当前知识以及在 RRT 期间的变化。
我们使用 Covidence 从 2000 年 1 月 1 日至 2023 年 1 月 31 日在 MEDLINE、Embase 和 Cochrane 上进行了搜索，纳入了至少有三次治疗期间 CO 测量值的间歇性血液透析（IHD）和连续肾脏替代治疗（CRRT）的研究。两名独立的审查员筛选引文，第三名解决分歧。由于研究结果不允许进行荟萃分析，因此以描述性方式呈现。
我们筛选了 3285 篇文章，纳入了 48 篇（37 篇 IHD，9 篇 CRRT，2 篇两者兼有）。非侵入性设备（电导率技术和手指袖脉搏轮廓）是最常用的 CO 测量技术（21 项研究）。IHD 研究中基线心指数中位数为 3 L/min/m2（95%CI，2.7-3.39）。在所研究的 88 个患者队列中，有 63 个（72%）出现 CO 下降。在 16 个队列中，下降幅度较大（>25%）。CO 的变化在程度和方向上与血压（BP）的变化不一致。CO 的下降与超滤率（r = -0.3，p = 0.05）呈弱相关，与全身血管阻力（SVR）的变化呈强相关（r = -0.6，p < 0.001）。
关于 RRT 期间 CO 变化的数据有限。然而，CO 下降似乎很常见，在 1/5 的患者队列中很明显。这种下降通常在没有血压变化的情况下发生，与 SVR 增加有关。
