Evidence map›Paper›PMID 40935883›Full record

ArticlePediatric research2025

Intradialytic hypotension and hemodynamic phenotypes in children following continuous renal replacement therapy initiation.

Sameer Thadani, Christin Silos, Christopher Horvat, Kristin Dolan, Poyyapakkam Srivaths, Thomas Fogarty, Ayse Akcan-Arikan, Jin Chen, Javier A Neyra

Abstract read
PubMed Publisher
In one paragraph

Article in Pediatric research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Sameer ThadaniDepartment of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA. Sameer.thadani@bcm.edu.
Christin SilosDepartment of Pediatrics, Renal Division, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Christopher HorvatDepartment of Critical Care Medicine, Division of Pediatric Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Kristin DolanDepartment of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Poyyapakkam SrivathsDepartment of Pediatrics, Renal Division, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Thomas FogartyDepartment of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Ayse Akcan-ArikanDepartment of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Jin ChenDivision of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Javier A NeyraDivision of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIntradialytic hypotension (IDH) leads to inadequate organ perfusion and occurs frequently after continuous renal replacement therapy (CRRT) connection. Unsupervised learning can enhance our understanding of how clinical trajectories impact outcomes. We aim to investigate the association between IDH during CRRT connection and outcomes, while also identifying hemodynamic trajectory-based phenotypes.

methodsA single center retrospective observational study of children (<18 years) undergoing CRRT from 9/2016 to 10/2018. IDH was defined as a sustained >20% decrease in mean arterial pressure (MAP) from baseline for ≥2 consecutive minutes. IDH burden was calculated by dividing connections with IDH by total observed connections. The primary outcome was major adverse kidney events at 30 days (MAKE30). K-means clustering was used to identify MAP trajectory-based phenotypes.

results59 patients, 232 connections, and 13,920 minutes were included. Median age was 59 months (IQR 8-152). In multivariable analysis, higher IDH burden [β 4.35 (CI: 0.01-8.70)] was associated with MAKE30. Two distinct MAP trajectories phenotypes were identified, with differing incidence of MAKE30 [21 (100%) vs. 29 (76%), p < 0.01].

conclusionsIDH within the first hour of CRRT connection is associated with poor outcomes, and time-series clustering is feasible and could improve our understanding of the impact of CRRT in children. IMPACT: Repeated episodes of intradialytic hypotension within the first hour of continuous renal replacement therapy connection are associated with increased morbidity and mortality. Our findings suggest that intradialytic hypotension in the hour following CRRT connection in children is associated with poor outcomes. Unsupervised machine learning, an underutilized approach in pediatric research, identified two significantly different mean arterial pressure trajectory-based phenotypes with differing anthropometric features and outcomes. Leveraging unsupervised machine learning, we can identify trajectory-based subgroups that can provide insights into the impact of continuous renal replacement therapy in critically ill children.

Identifiers

PMID40935883

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.