Is Myocardial Stunning Induced by Continuous Renal Replacement Therapy a Reality in Critically Ill Patients? (MS-CRRT)

Civil Hospices of Lyon

Status: Completed

Conditions: Myocardial Stunning; Acute Kidney Injury KDIGO 3; Continuous Renal Replacement Therapy Initiated by the Clinician in Charge Without Emergency

Treatments: Other: Control group; Procedure: Continuous renal replacement therapy

Study type: Interventional

Funder types: Other

Identifiers

NCT05209230

69HCL21_1013

Details and patient eligibility

About

Myocardial stunning during chronic intermittent hemodialysis is a well-described phenomenon. Little case series of patients presenting myocardial stunning during renal replacement therapy for acute kidney injury in critically ill patients are reported, with intermittent hemodialysis and continuous renal replacement therapy. However, the small sample sizes and the absence of a control arm limit their interpretation, mainly whether the myocardial stunning may be related to cardiac loading conditions variations and whether it may impact the hemodynamic.

The investigator hypothesize that myocardial stunning induced by renal replacement therapy is frequent, independent from cardiac loading conditions and associated with peripheral hypoperfusion.

Enrollment: 42 patients

Sex: All

Ages: 18 to 90 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age > 18 years old
• Acute Kidney Injury grade 3 (KDIGO)
• Indication for renal replacement therapy for the clinician in charge

Exclusion criteria

• Emergency indication to renal replacement therapy (pH<7.15, Kaliemia > 6mmol/L, refractory pulmonary oedema)
• Poor echogenicity with speckle tracking analysis failure
• Chronic hemodialysis
• Extra corporeal membrane oxygenation, left ventricular assist device.

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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42 participants in 2 patient groups

Continuous renal replacement therapy arm

Experimental group

Description:

Echocardiographic evaluation (with 2D speckle tracking analysis of left ventricular segmental function) 1 hour before and 3 hours after the initiation of continuous renal replacement therapy (continuous veno venous hemofiltration) initiation

Treatment:

Procedure: Continuous renal replacement therapy

Control arm

Other group

Description:

Two echocardiographic evaluations (with 2D speckle tracking analysis of left ventricular segmental function) at an interval of 4 hours, before the continuous renal replacement therapy initiation.

Treatment:

Other: Control group