Renal Physiology During Continuous Renal Replacement Therapy

Sahlgrenska University Hospital

Status: Enrolling

Conditions: AKI; Renal Failure; Dialysis; Renal Blood Flow; Continuous Renal Replacement Therapy; Blood Pressure; Intensive Care

Treatments: Other: Starting at high or low blood pressure

Study type: Interventional

Funder types: Other

Identifiers

NCT04114747

Kidney and dialysis

Details and patient eligibility

About

Approximately 50% of patients in the intensive care unit (ICU) develop acute kidney injury (AKI) and more than 10% need dialysis. There is no treatment for AKI. Care is aiming for optimization of circulation and blood flow to the kidneys and avoiding nephrotoxic agents.

There is conflicting data concerning whether early or late dialysis is harmful for the kidneys. No one has examined the physiological changes in the kidney when starting dialysis and which blood pressure that leads to most optimal physiological conditions for the kidneys during dialysis. In this descriptive study of 20 ICU patients suffering from AKI we aim to investigate renal physiology when starting continuous renal replacement therapy (CRRT) and also at different target blood pressures using retrograde renal vein thermodilution technique. In parallel we will also investigate and validate this invasive method with contrast enhanced ultrasound of the kidneys.

Enrollment: 20 estimated patients

Sex: All

Ages: 18 to 90 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

AKI, according to KDIGO, stage 2 or 3 but with preserved urine production. Treated in the ICU at Sahlgrenska University Hospital Written, signed informed consent Male and female subjects ≥18 years

Exclusion criteria

Emergency need for dialysis Allergy to contrast media (used for CEUS)

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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20 participants in 2 patient groups

Starting at high blood pressure

Experimental group

Description:

Patients in this arm are randomized to have high target blood pressure at MAP 80-90 mmHg during the first recordings, thereafter they will receive low blood pressure target 60-70 mm Hg

Treatment:

Other: Starting at high or low blood pressure

Starting at low blood pressure

Experimental group

Description:

Patients in this arm are randomized to have low target blood pressure at MAP 60-70 mmHg during the first recordings, thereafter they will receive high blood pressure target 80-90 mm Hg

Treatment:

Other: Starting at high or low blood pressure