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The Capital Region of Denmark - a part of Copenhagen University Hospital
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Intracranial pressure during hemodialysis in patients with acute brain injury

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BACKGROUND: Because osmotic fluid shifts may occur over the blood-brain barrier, patients with acute brain injury are theoretically at risk of surges in intracranial pressure (ICP) during hemodialysis. However, this remains poorly investigated. We studied changes in ICP during hemodialysis in such patients.

METHODS: We performed a retrospective study of patients with acute brain injury admitted to Rigshospitalet (Copenhagen, Denmark) from 2012 to 2016 who received intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT) while undergoing ICP monitoring. Data from each patient's first dialysis session were collected. Area under the curve divided by time (AUC/t) for ICP was calculated separately before and during dialysis.

RESULTS: Thirteen patients were included. During dialysis, ICP increased from a baseline of 11.9 mm Hg (median; interquartile range 6.3-14.7) to a maximum of 21 mm Hg (18-27) (P = 0.0024), and AUC/t for ICP was greater during dialysis (15.2 (13.4-18.8) vs 11.7 mm Hg (6.4-15.1), P = 0.042). The maximum ICP increase was independent of dialysis modality, but peak values were reached earlier in patients treated with IHD (N = 4) compared to CRRT (N = 9) (75 [30-90] vs 375 min [180-420] after start of treatment, P = 0.0095). The maximum ICP increase correlated positively to the baseline plasma urea concentration (Spearman's r = 0.69, P = 0.017).

CONCLUSION: Hemodialysis is associated with increased ICP in neurocritically ill patients, and the magnitude of the increase may be related to initial plasma urea levels.

Original languageEnglish
JournalActa Anaesthesiologica Scandinavica
Volume63
Issue number4
Pages (from-to)493-499
Number of pages7
ISSN0001-5172
DOIs
Publication statusPublished - 1 Apr 2019

    Research areas

  • acute brain injury, cerebral edema, continuous renal replacement therapy, dialysis disequilibrium syndrome, hemodialysis, intracranial pressure, renal replacement therapy

ID: 55811912