{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T03:58:24Z","timestamp":1768449504366,"version":"3.49.0"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec018\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>To investigate the factors of hemodynamic instability within the first hour of continuous renal replacement therapy (CRRT) in critically ill patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec019\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>A prospective observational cohort study of patients admitted to the intensive care unit (ICU) and underwent CRRT between January 17, 2024, and December 25, 2024, was conducted. The least absolute shrinkage and selection operator (LASSO) regression was used to screen potential factors and a multivariate logistic regression model was performed to determine the independent factors of hypotension within the first hour of CRRT.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec020\">\n<jats:title>Results<\/jats:title>\n<jats:p>Hypotension occurred in 166 out of 435 patients (38.2%). Female (<jats:italic>OR<\/jats:italic>=0.53, 95%<jats:italic>CI<\/jats:italic>:0.3\u20130.89), the use of colloidal solutions (<jats:italic>OR<\/jats:italic>=0.23, 95%<jats:italic>CI<\/jats:italic>:0.12\u20130.46), platelet count (PLT) (<jats:italic>OR<\/jats:italic>=0.99, 95%<jats:italic>CI<\/jats:italic>:0.99\u20130.99), and baseline mean arterial pressure (MAP) (<jats:italic>OR<\/jats:italic>=0.95, 95%CI:0.93\u20130.96) were recognized as protective factors against hypotension within the first hour of CRRT in critically ill patients. Older age (<jats:italic>OR<\/jats:italic>=1.02, 95%<jats:italic>CI<\/jats:italic>:1.01\u20131.04), mechanical ventilation (<jats:italic>OR<\/jats:italic>=2.59, 95%<jats:italic>CI<\/jats:italic>:1.28\u20135.23), ultrafiltration rates of 101-200\u2009mL\/h (<jats:italic>OR<\/jats:italic>=2.04, 95%<jats:italic>CI<\/jats:italic>:1.11\u20133.75), international normalized ratio (INR) (<jats:italic>OR<\/jats:italic>=1.78, 95%<jats:italic>CI<\/jats:italic>:1.02\u20133.09), and high myoglobin level (<jats:italic>OR<\/jats:italic>=1.01, 95%<jats:italic>CI<\/jats:italic>:1.01\u20131.01) were identified as significant risk factors. Baseline MAP and mechanical ventilation are the most important predictors of hypotension within the first hour of CRRT in critically ill patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec021\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The incidence of hypotension within the first hour of CRRT in critically ill patients was 38.2%. Female, PLT, baseline MAP are protective factors, and age, mechanical ventilation, ultrafiltration rate of 101-200ml\/h, INR, myoglobin are risk factors for hypotension within the first hour of CRRT in critically ill patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0324235","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T17:26:26Z","timestamp":1750958786000},"page":"e0324235","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Factors associated with hypotension during the first hour of continuous renal replacement therapy in critically Ill patients: A prospective observational study"],"prefix":"10.1371","volume":"20","author":[{"given":"Mengdie","family":"Xue","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suying","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chenglin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zheyao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiyu","family":"Mao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5418-624X","authenticated-orcid":true,"given":"Jingjuan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"pone.0324235.ref001","volume-title":"Standard operating procedures for blood purification","author":"XM Chen","year":"2021"},{"issue":"6","key":"pone.0324235.ref002","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1111\/sdi.12963","article-title":"Continuous renal replacement therapy and extended indications","volume":"34","author":"C Ronco","year":"2021","journal-title":"Semin Dial"},{"issue":"3","key":"pone.0324235.ref003","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1097\/CCM.0000000000004831","article-title":"ICU-based renal replacement therapy","volume":"49","author":"R Bellomo","year":"2021","journal-title":"Crit Care Med"},{"issue":"24","key":"pone.0324235.ref004","first-page":"6036","article-title":"Effects of continuous renal replacement therapy on renal function, hemodynamics, and inflammatory factors in elderly patients with severe acute renal failure","volume":"39","author":"LX Sun","year":"2019","journal-title":"Chinese J Gerontol"},{"issue":"02","key":"pone.0324235.ref005","first-page":"50","article-title":"The effect of continuous renal replacement therapy on hemodynamics and renal function in patients with severe acute renal failure","volume":"44","author":"ZLJ Liu","year":"2016","journal-title":"Chinese J Clin Physicians"},{"issue":"13","key":"pone.0324235.ref006","first-page":"1836","article-title":"Study on risk factors and preventive nursing of hypotension during continuous renal replacement therapy in patients with acute kidney injury","volume":"20","author":"J Li","year":"2022","journal-title":"General Nursing"},{"issue":"11","key":"pone.0324235.ref007","first-page":"1048","article-title":"Influencing factors and the incidence of hypotension during continuous renal replacement therapy in critically ill patients","volume":"36","author":"LZZ Ling","year":"2021","journal-title":"J Nurses Training"},{"issue":"6","key":"pone.0324235.ref008","article-title":"Incidence and associated factors for hypotension during continuous renal replacement therapy in critically ill patients","volume":"30","author":"A Nie","year":"2024","journal-title":"Int J Nurs Pract"},{"key":"pone.0324235.ref009","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.jcrc.2019.07.004","article-title":"Hypotension within one-hour from starting CRRT is associated with in-hospital mortality","volume":"54","author":"K Shawwa","year":"2019","journal-title":"J Crit Care"},{"issue":"6","key":"pone.0324235.ref010","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1016\/j.kint.2021.01.018","article-title":"The time of onset of intradialytic hypotension during a hemodialysis session associates with clinical parameters and mortality","volume":"99","author":"DF Keane","year":"2021","journal-title":"Kidney Int"},{"issue":"12","key":"pone.0324235.ref011","doi-asserted-by":"crossref","first-page":"2124","DOI":"10.2215\/CJN.02680314","article-title":"Intradialytic hypotension and risk of cardiovascular disease","volume":"9","author":"BV Stef\u00e1nsson","year":"2014","journal-title":"Clin J Am Soc Nephrol"},{"issue":"8","key":"pone.0324235.ref012","doi-asserted-by":"crossref","first-page":"2511","DOI":"10.1681\/ASN.2016060704","article-title":"Relationship between hypotension and cerebral ischemia during hemodialysis","volume":"28","author":"C MacEwen","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"pone.0324235.ref013","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.jcrc.2021.07.008","article-title":"Hypocalcemia is associated with hypotension during CRRT: A secondary analysis of the Acute Renal Failure Trial Network Study","volume":"65","author":"YP Kelly","year":"2021","journal-title":"J Crit Care"},{"issue":"4","key":"pone.0324235.ref014","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1159\/000380903","article-title":"Incidence of adverse events during continuous renal replacement therapy","volume":"39","author":"A Akhoundi","year":"2015","journal-title":"Blood Purif"},{"issue":"1","key":"pone.0324235.ref015","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1186\/s13613-021-00883-9","article-title":"Prevalence and risk factors of hemodynamic instability associated with preload-dependence during continuous renal replacement therapy in a prospective observational cohort of critically ill patients","volume":"11","author":"G Chazot","year":"2021","journal-title":"Ann Intensive Care"},{"issue":"6","key":"pone.0324235.ref016","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1111\/sdi.12630","article-title":"Intradialytic hypotension in acute kidney injury requiring renal replacement therapy","volume":"30","author":"S Sharma","year":"2017","journal-title":"Semin Dial"},{"issue":"1","key":"pone.0324235.ref017","doi-asserted-by":"crossref","DOI":"10.1088\/0967-3334\/31\/1\/R01","article-title":"Arterial blood pressure measurement and pulse wave analysis--their role in enhancing cardiovascular assessment","volume":"31","author":"AP Avolio","year":"2010","journal-title":"Physiol Meas"},{"issue":"1","key":"pone.0324235.ref018","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/ALN.0000000000001432","article-title":"Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: a retrospective cohort analysis","volume":"126","author":"V Salmasi","year":"2017","journal-title":"Anesthesiology"},{"issue":"5","key":"pone.0324235.ref019","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1097\/SHK.0000000000001033","article-title":"Untreated relative hypotension measured as perfusion pressure deficit during management of shock and new-onset acute kidney injury-a literature review","volume":"49","author":"R Panwar","year":"2018","journal-title":"Shock"},{"key":"pone.0324235.ref020","author":"Chinese Nursing Association","year":"2023"},{"key":"pone.0324235.ref021","article-title":"Risk factors and predictive value of hypotension in patients with SA-AKI undergoing CRRT","volume":"1","author":"HWL Chen","year":"2024","journal-title":"Chinese Sci Technol J Database (Full-text Version)"},{"key":"pone.0324235.ref022","first-page":"024","article-title":"Factors influencing the incidence of hypotension during continuous renal replacement therapy in critically ill patients","volume":"1","author":"M Chen","year":"2022","journal-title":"Chinese Sci Technol J Database (Full-text Version)"},{"issue":"4","key":"pone.0324235.ref023","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1007\/s11255-022-03389-w","article-title":"An update review on hemodynamic instability in renal replacement therapy patients","volume":"55","author":"AB Yildiz","year":"2023","journal-title":"Int Urol Nephrol"},{"issue":"1","key":"pone.0324235.ref024","doi-asserted-by":"crossref","first-page":"17169","DOI":"10.1038\/s41598-021-96727-4","article-title":"Machine learning model to predict hypotension after starting continuous renal replacement therapy","volume":"11","author":"MW Kang","year":"2021","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0324235.ref025","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s40620-022-01400-2","article-title":"Echocardiographic parameters and hemodynamic instability at the initiation of continuous kidney replacement therapy","volume":"36","author":"P Kompotiatis","year":"2022","journal-title":"J Nephrol"},{"issue":"4","key":"pone.0324235.ref026","first-page":"488","article-title":"Value of some clinical parameters in predicting continuous renal replacement therapy-related hypotension","volume":"32","author":"Y Cui","year":"2020","journal-title":"Zhonghua Wei Zhong Bing Ji Jiu Yi Xue"},{"issue":"10","key":"pone.0324235.ref027","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1097\/HJH.0000000000003495","article-title":"Antihypertensive treatment in people of very old age with frailty: time for a paradigm shift?","volume":"41","author":"E Shantsila","year":"2023","journal-title":"J Hypertens"},{"issue":"2","key":"pone.0324235.ref028","doi-asserted-by":"crossref","first-page":"284","DOI":"10.3904\/kjim.2019.431","article-title":"Continuous renal replacement therapy in elderly with acute kidney injury","volume":"35","author":"KRP Medina-Liabres","year":"2020","journal-title":"Korean J Intern Med"},{"issue":"3","key":"pone.0324235.ref029","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1159\/000510996","article-title":"Prolonged intermittent renal replacement therapy for acute kidney injury in COVID-19 patients with acute respiratory distress syndrome","volume":"50","author":"JC Ramirez-Sandoval","year":"2021","journal-title":"Blood Purif"},{"issue":"3","key":"pone.0324235.ref030","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/j.ccm.2021.04.012","article-title":"Gender differences in critical illness and critical care research","volume":"42","author":"TI Lat","year":"2021","journal-title":"Clin Chest Med"},{"key":"pone.0324235.ref031","volume-title":"Report on health hazards of smoking in China 2020 [in Chinese]","author":"Chinese Center for Disease Control and Prevention","year":"2020"},{"issue":"1","key":"pone.0324235.ref032","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/s13613-024-01356-5","article-title":"Heart-Lungs interactions: the basics and clinical implications","volume":"14","author":"M Jozwiak","year":"2024","journal-title":"Ann Intensive Care"},{"issue":"3","key":"pone.0324235.ref033","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1093\/bja\/aer515","article-title":"Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy","volume":"108","author":"TE Woodcock","year":"2012","journal-title":"Br J Anaesth"},{"issue":"15","key":"pone.0324235.ref034","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1001\/jama.2020.2717","article-title":"Prevalence and outcomes of infection among patients in intensive care units in 2017","volume":"323","author":"J-L Vincent","year":"2020","journal-title":"JAMA"},{"issue":"01","key":"pone.0324235.ref035","first-page":"74","article-title":"Expert consensus on volume assessment and management of continuous renal replacement therapy","volume":"40","author":"Group CSoNE","year":"2024","journal-title":"Chinese J Nephrol"},{"issue":"12","key":"pone.0324235.ref036","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1007\/s00134-014-3525-z","article-title":"Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine","volume":"40","author":"M Cecconi","year":"2014","journal-title":"Intensive Care Med"},{"issue":"10","key":"pone.0324235.ref037","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1007\/s00134-019-05707-w","article-title":"Mechanisms for hemodynamic instability related to renal replacement therapy: a narrative review","volume":"45","author":"A Douvris","year":"2019","journal-title":"Intensive Care Med"},{"issue":"11","key":"pone.0324235.ref038","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1159\/000522258","article-title":"Impact of double-machine replacement protocol at start of continuous renal replacement therapy in vasopressor-dependent patients: a retrospective cohort study","volume":"51","author":"X Zhou","year":"2022","journal-title":"Blood Purif"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0324235","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T17:26:35Z","timestamp":1750958795000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0324235"}},"subtitle":[],"editor":[{"given":"Chiara","family":"Lazzeri","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,6,26]]},"references-count":38,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,26]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0324235","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,26]]}}}