الفهرس 
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Abstract
SUMMARY
It is critical to understand that renal replacement therapy for the most severe forms of kidney disease can save lives. Fluid overload may impair the function of many organs, including the kidneys. Along with the prediction of preload unresponsiveness, which prevents administration of ineffective fluid boluses, fluid removal contributes to reducing the fluid balance. Compared to a liberal strategy of fluid administration, a conservative strategy including fluid removal prompted extubation in ARDS patients. The net fluid removal by renal replacement therapy (RRT) was shown to decrease the intra-abdominal pressure, the cardiac preload and the extravascular lung water Intradialytic hypotension (IDH) is a common and fatal hemodialysis complication
Intradialytic hypotension (IDH) occurs in approximately 10-12% of treatments and its pathogenesis is dependent on many factors, including the interaction of ultrafiltration rate (UFR), cardiac output, and arteriolar tone
COP has been reported to decrease >10% after intermittent HD and/or UF in multiple studies of stable ESRD patients with or without a propensity for (IDH).
Critically ill patients with undifferentiated hypotension have been shown to benefit from inferior vena cava ultrasound (IVC US) assessment of relative intravascular volume to guide volume management. IVC US may be a useful tool for predicting whether critically ill patients are likely to tolerate volume removal with hemodialysis (HD) and ultrafiltration
(UF)
Passive leg raising (PLR) has been used as an endogenous fluid challenge and tested for predicting the hemodynamic response to fluid in patients with acute circulatory failure. PLR has recently gained interest as a test for monitoring functional hemodynamic and assessing fluid responsiveness since it is a simple way to transiently increase cardiac preload
The present study enrolled 40 critically ill participants that were divided into two groups: group I: Consisted of 24 Patients those who did not develop intra- dialytic hypotension and group II: Consisted of 16 Patients who developed MAP less than 65 mmHg (with IDH).
Regarding our study; there was statistically insignificant difference between both groups regarding age (52.42 ± 17.5 years and 56.25 ± 18.4 years) for group I and group II respectively as well as for gender, for related comorbidities: there was statistically insignificant difference between group I and group II for DM (12.5% and 31.3%)respectively as well as HTN (29.2% and 25.0%) respectively. Moreover, we did not find statistically significant difference regarding blood pressure measurements before dialysis.
There was no statistically significant difference observed between the two groups for IVC max (p=0.838), IVC min (p=0.267), LVOT (p=0.183), and VTI1 (p=0.652) and VTI2 (p=0.967). However, the IVC collapsibility (%) was found to be significantly higher in group II (60.06 ± 10.12) compared to group I (47.01 ± 19.06) with a p-value of 0.013. There was no significant difference in heart rate (HR) between the two groups(P=0.692). There was also no significant difference in COP1 between the two groups(P=0.504). However, there was a significant difference in COP2 between the twogroups (P=0.025). The change in COP (%) was significantly higher in group II(20.86±20.83)compared to GroupI(7.25±23.45)witha P-valueof0.005.
The COP response was significantly higher in group II, with 75% of patients having a COP response greater than 12%, compared to only 29.2% in group I (p=0.004). Similarly, the IVC collapsibility response was significantly higher in group II, with 81.3% of patients having an IVC collapsibility response greater than 50%, compared to only 37.5% in group I (p=0.010).
The ROC curve of Predicted probability (COP response (>12.0%) and IVC collapsibility response (>50.0%)) with associated with intradialytic hypotension 0.775 (95% CI 0.624-0.926). The standard error was 0.077, and the asymptotic significance was 0.004, indicating that the model’s performance is statistically significant.