Hemodynamic Effects of Variations in Net Ultrafiltration Rate During Continuous Renal Replacement Therapy.

Launched by CENTRE HOSPITALIER UNIVERSITAIRE DE NĪMES · Oct 2, 2023

Keywords

ClinConnect Summary

The NEPTUNE study is looking at how different rates of fluid removal, called Net Ultrafiltration (NUF), affect patients who are receiving continuous kidney treatment in the intensive care unit. Specifically, the study will compare three different NUF rates: 1 ml/kg/h, 2 ml/kg/h, and 3 ml/kg/h. The goal is to find out which rate leads to the least amount of problems with blood pressure and other health issues while still effectively managing the patient's fluid balance.

To be eligible for this study, patients need to be hospitalized in the intensive care unit with a specific type of kidney injury that requires this continuous treatment. They should also show signs of needing fluid removal, like recent weight gain due to excess fluid or difficulty breathing from fluid overload. Participants must be stable for a short time before starting the treatment and will need to give consent, either themselves or through a family member. This study is important because it aims to improve the way fluid balance is managed in critically ill patients, potentially leading to better outcomes.

Gender

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Eligibility criteria

• Inclusion Criteria:
• • Patients hospitalised in the intensive care unit of one of the two participating centres
• • Patients with Kidney Disease: Improving Global Outcomes 3 (KDIGO3) acute kidney injury (AKI) requiring a continuous RRT during their stay in the intensive care unit, regardless of the aetiology of the AKI
• * Need to prescribe water loss by net ultrafiltration (NUF), defined by at least one of the following sub-criteria:
• • 1. weight gain ≥ 1 kg relative to entry weight
• • 2. oligo-anuria ≥ 24 hours
• • 3. clinical impact of fluid overload as judged by the clinician: acute lung oedema clinical or at CT-scan, difficulty of weaning from mechanical ventilation.
• * Hemodynamic stability in the 2 hours preceding the start of NUF, defined by all of the following sub-criteria:
• • 1. absence of vasopressors (noradrenaline) or stability or reduction in their dosage
• • 2. no need for resuscitative fluids as judged by the clinician
• • Patient or his/her trusted support person/legal representative/family member having given free and informed consent, and having signed the consent form or patient included in an emergency situation.
• • Patient affiliated to or benefiting from a health insurance scheme.
• Exclusion Criteria:
• • Patient moribund, with life expectancy too low to benefit from treatment, or with decision to discontinue treatment
• • Patient participating in an another interventional study
• • Patient in exclusion period determined by another study
• • Patient under court protection or guardianship
• • Patient/trusted person/legal representative/family member for whom it is impossible to give informed information.
• • Pregnant, parturient or breast-feeding patient.