Proactive Prescription-based Fluid Management vs Usual Care in Critically Ill Patients on Kidney Replacement Therapy

Launched by CENTRE HOSPITALIER DE L'UNIVERSITÉ DE MONTRÉAL (CHUM) · Jul 22, 2022

Keywords

ClinConnect Summary

This clinical trial is studying a new approach to managing fluids in critically ill patients who are receiving kidney replacement therapy due to acute kidney injury (AKI). The aim is to see if a structured fluid management strategy can help patients maintain a balanced fluid level, which means avoiding too much fluid buildup in the body. This is compared to the usual care that these patients currently receive.

To participate, patients must be at least 18 years old and admitted to the intensive care unit (ICU) with AKI, which can be identified by certain changes in kidney function or urine output. Participants will be monitored closely and may experience different methods of fluid management. It's important to note that certain patients, such as those expected to leave the ICU soon or those with severe health issues, may not be eligible for this trial. Overall, this study seeks to find out if better fluid management can improve outcomes for critically ill patients with kidney problems.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 1. Age ≥ 18 years
• • 2. Admitted to the ICU
• • 3. AKI during current hospitalization defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria(1) as any of the following: Increase in serum creatinine by 27 µmol/L or more within any 48-hour window, or an increase in serum creatinine to 1.5 times baseline or more within the last 7 days, or a urine output less than 0.5 mL/kg/h for 6 hours.
• • 4. Planned initiation of KRT within the following 12 hours or the receipt of KRT for AKI for ≤48 hours
• Exclusion Criteria:
• • 1. Lack of commitment to maintain kidney, pharmacologic or respiratory support at the time of screening, or probable transition to comfort care within 48 hours according to the treating physician
• • 2. Probable discharge from the ICU within the next 48 hours according to treating physician
• • 3. Severe burn injury (\>10% of body surface area)
• • 4. Severe abnormality in serum sodium (\>155 or \<120 mmol/L)
• • 5. Important ongoing fluid losses are present and/or are expected to require continued maintenance IV fluids uring the next 48 hours
• • 6. The clinical care team believes that the proposed intervention is inappropriate.