Predicting Hypotension During Dialysis in the ICU

Currently, decisions regarding volume management for dialysis sessions in the ICU are made
in large part on the nephrologists'/intensivists' overall gestalt. This gestalt is based
upon a combination of commonly used measures of circulatory function, the physical exam,
fluid balance, estimates of dialysis dry weight, and monitoring changes in relative blood
volume status using devices such as the Crit-Line™ III, and central venous pressures.
However, these tools perform poorly in predicting the circulatory system's overall response
to dialysis. Consequently, episodes of dangerously low blood pressure are still frequently
encountered. Better techniques to predict the circulatory system's response to dialysis are
much needed. The intent of this study is to test newer metrics of circulatory system
function for their ability to predict low blood pressure episodes during dialysis. This is
important because it may enable the design of newer treatment strategies created to prevent
low blood pressure episodes during dialysis and improve patient outcomes. The investigators
overall hypothesis is that newer measures of vascular volume and dynamic indices of fluid
responsiveness, previously found to better reflect cardiac preload state than currently used
parameters, will better predict low blood pressure episodes during dialysis than current
methods.