Evaluating Adverse Effects Associated with Continuous Veno-Venous Hemodialysis in Critically Ill Patients in the Intensive Care Unit (ICU)

Background: Continuous veno-venous hemodialysis (CVVHD) is a critical intervention in managing acute kidney injury and related complications in hemodynamically unstable ICU patients. Despite its benefits, CVVHD is associated with multiple adverse effects, including metabolic disturbances, hemodynamic instability, and anticoagulation-related complications. Objectives: 1) To determine the incidence of metabolic derangements in patients on CVVHD; 2) To determine the risk factors associated with the development of metabolic derangements; 3) To determine the incidence of filter malfunction from clotting, requiring the use of anticoagulation therapy; 4) To determine the frequency of other complications associated with CVVHD; 5) To determine the risk factors associated with the development of other complications of CVVHD. Methods: We conducted a historical cohort study via retrospective chart review of adult patients (≥18 years) who received CVVHD for >24 hours in the MICU or SICU at Henry Ford St. John Hospital from 1/1/2020 to 12/31/2023. Data were collected on included demographics, comorbidities, lab values, and metabolic and anticoagulation-related complications. Data were analyzed using Student’s t-test, the chi-squared test, and repeated measures analysis of variance. Results: Seventy patients met the inclusion criteria, with a mean age of 59.0 ± 12.6 years and 71.4% (50) male. The graph shows the incidence of various derangements. There were significant changes in potassium (p<0.001), calcium (p<0.001), phosphorus (p=0.009), and blood glucose (p=0.05) levels over time. Only 12.9% of patients required parenteral anticoagulation because of filter clotting, primarily with heparin. Regional citrate protocol was not utilized in any patients requiring anticoagulation. Several characteristics were found to be significantly associated with the development of these complications. Conclusion: CVVHD is associated with a high incidence of metabolic derangements and hypothermia, necessitating vigilant monitoring and individualized management strategies. Risk factor identification may aid in early recognition and prevention of complications. Further exploration into the optimal anticoagulation strategy, including use of citrate, is warranted.