Hypotension is a common complication of intermittent renal replacement therapy. Methylene blue, an inhibitor of nitric oxide synthesis, has been suggested to improve hemodynamics during renal replacement therapy in ambulatory patients, but evidence is lacking for critically ill patients. This trial will assess whether methylene blue can improve hemodynamics and blood pressure for patients with shock requiring renal replacement therapy.
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Inclusion Criteria: * Patients over 18 years old * Acute kidney injury or acute-on-chronic kidney disease requiring intermittent renal replacement therapy hemodialysis * Systolic blood pressure lower than 100 mmHg or use of vasopressor * Signed informed consent Exclusion Criteria: * Pregnancy * Life expectancy less than 24 hours * Exclusive palliative or end-of-life care * RRT due to hypertensive crisis * Known allergy to methylene blue * Known Glucose-6-phosphate dehydrogenase (G6PD) deficiency * Prior participation in the study * Acute coronary syndrome * Chronic nitrate oral use