Early Deresuscitation Strategy Driven by Tissue Perfusion in Renal Replacement Therapy in Patients With Acute Renal Failure

Launched by HOSPICES CIVILS DE LYON · Apr 17, 2023

Keywords

ClinConnect Summary

This clinical trial is studying how to manage fluid overload in patients with acute kidney injury (AKI) who are receiving treatment in the Intensive Care Unit (ICU). Fluid overload happens when the body has too much fluid, which can make recovery harder and lead to serious health issues. The researchers want to compare two different approaches to fluid management: one that uses a higher rate of fluid removal (called net ultrafiltration, or UFnet) and another that uses a lower rate. The goal is to see if the higher rate helps improve patients’ overall health and recovery compared to the lower rate.

To be eligible for this trial, participants must be adults aged 65 or older who have AKI and are receiving continuous renal replacement therapy for less than a week. They should also have at least one other organ failing, like needing extra oxygen or fluids. Patients with certain conditions, like chronic kidney failure or recent serious health issues, will not be included. Participants will be monitored closely and can expect to follow a specific fluid management plan to help improve their health while they are in the ICU.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 1. Acute kidney injury treated by continuous renal replacement therapy in ICU less than 7 days,
• • 2. At least 1 organ failure during ICU in addition to AKI (mechanical ventilation or oxygen therapy or vascular filling \> 1000ml or vasopressor exposure \> 12 hours),
• • 3. Cumulative UF net less than 2000ml before inclusion,
• • 4. Norepinephrine \< 0,5 µg/kg/min,
• • 5. Absence of hypoperfusion signs,
• 6. Fluid overload defined as follows :
• • fluid overload \> 5% of base weight (based on cumulative fluid balance or a weight gain) and/or
• • Obvious oedema of the lumbar region or flanks (oedema \> 1cm bucket depth).
• Exclusion Criteria:
• • 1. Chronic renal failure hemodialyzed before admission to the ICU,
• • 2. Mechanical circulatory support (ECMO, LVAD),
• • 3. Pregnant, child -bearing age or lactating women,
• • 4. Stroke less than 30 days,
• • 5. Intestinal ischemia less than 7 days documented non-operated,
• • 6. Interventional study participation or exclusion period on going,that may interfere with the present study
• • 7. Guardianship, curatorship or safeguard of justice,
• • 8. Absence of signature of free and informed consent by the patient and/or relative,
• • 9. Patients not affiliated to a social security scheme or beneficiaries of a similar scheme