Impact of Sodium Profiling During Haemodialysis on Haemodynamic Tolerance and Sonographic Extravascular Lung Water in Shocked Patients With Acute Kidney Injury

A prospective comparative study was conducted on 120 ICU patients with AKI and shock and indicated for acute intermittent hemodialysis, divided into three groups of 40 patients each: Group 1: conventional hemodialysis, Group 2: linear sodium profiling, and Group 3: stepwise sodium profiling. Hemodynamic parameters, vasopressor requirements, lung ultrasound scores, and IVC measurements were assessed before, during, and after dialysis to evaluate the effects of sodium profiling haemodialysis compared with conventional haemodialysis on hemodynamic tolerance and extravascular lung water in critically ill patients with AKI and shock.

Inclusion criteria

• • Adult Patients (18 years or older) who are admitted in ICU.

• AKI (either de novo or superimposed on CKD) as defined by (KDIGO 2023) criteria: an increase in serum creatinine (SCr) by ≥0.3 mg/dL within 48 hours, an increase in SCr to ≥1.5 times baseline within the prior 7 days, or a urine output of <0.5 mL/kg/h for 6 hours.
• Hemodynamic instability and they need vasopressor to maintain their mean blood pressure above 65 mmHg for ≥1-2 h before initiation of HD.
• Indicated for intermittent acute hemodialysis (IHD) per treating team (e.g., refractory hyperkalemia, severe acidosis, uremic complications, or fluid overload).

Exclusion criteria

• • Patients with hemodynamic instability who are not responsive to vasopressors and not candidate for intermittent hemodialysis.

• ESRD on regular HD.
• Patient judged unsafe for IHD as Severe uncontrolled arrhythmia, active myocardial ischemia active intracranial pathology at risk from osmotic/sodium shifts.
• Severe dysnatremia: serum Na ≤125 or ≥150 mmol/L.