Health Condition 1: N184- Chronic kidney disease, stage 4 (severe) Health Condition 2: N181- Chronic kidney disease, stage 1 Health Condition 3: N182- Chronic kidney disease, stage 2 (mild) Health Condition 4: N183- Chronic kidney disease, stage 3 (moderate) Health Condition 5: N170- Acute kidney failure with tubularnecrosis Health Condition 6: N171- Acute kidney failure with acute cortical necrosis Health Condition 7: N178- Other acute kidney failure Health Condition 8: N179- Acute kidney failu
Conditions
Interventions
Intervention1: A Loop Diuretic+ A Thiazide + Acetazolamide: Inj.Furosemide 160 mg IV once +
Inj.Chlorthiazide 1000 mg IV once OR Tab. Metolazone 10 mg once+ Acetazolamide 500 mg IV/PO once
Control In
Sponsors
Department Of Emergency Medicine,AIIMS,New Delhi
Eligibility
Inclusion criteria
Inclusion criteria: 1)Serum Potassium more than 5.5 mEq/L after initial standard medical therapy. 2)Patients with preserved urine output(more than or equal to 30 mL/hour). 3)Patients with underlying CKD or AKI not on dialysis,or on Maintenance Hemodialysis but presenting in between sessions. 4)Hemodynamically stable or managable on minimal support.
Exclusion criteria
Exclusion criteria: 1)Patient or the legally authorized representative unable or unwilling to give consent. 2)Pregnant women 3)Anuria 4)Immediate life threatening ECG changes requiring emergency dialysis(sustained VT or VF unresponsive to initial stabilization) 5)Severe volume overload or pulmonary edema not manageable with diuretics. 6)Known allergy or contraindication to any of the drugs used in the sequential nephron blockade. 7)Urinary tract obstruction. 8)Patients of age less than 18 years.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| To compare the efficacy of sequential nephron blockade with emergent hemodialysis in reducing serum potassium levels in patients presenting with refractory hyperkalemia.Timepoint: From 1 to 24 hours post procedure | — |
Secondary
| Measure | Time frame |
|---|---|
| To compare the in-hospital mortality rates associated with refractory hyperkalemia in both groups. Timepoint: Till the patient is admitted in hospital.;To compare in-hospital morbidity rates(new onset or worsening cardiac arrhythmias,fluid overload or pulmonary edema,hypotension requiring intervention,electrolyte imbalance,acute worsening of renal function,need for icu admission,prolonged hospital stay) associated with refractory hyperkalemia in both groups. Timepoint: from 1 hr to 48 hrs;To evaluate the time taken to achieve potassium correction in sequential nephron blockade group. Timepoint: From 1 to 24 hrs post intervention.;To assess adverse effects(hypovolemia,hypotension,electrolyte disturbance like hyponatremia,hypocalcemia,hypomagnesemia,diuretic induced metabolic alkalosis,ototoxicity,allergic reactions to diuretics),safety(hemodynamic instability,renal function trends,requirement of rescue dialysis,life threatening events attributable to diuretics) and tolerability(completion of full sequential nephron blockade without interruption,withold or reduce diuretics due to poor response or side effects) of sequential nephron blockade compared to hemodialysis.Timepoint: From 1 to 24 hours post intervention.;To find number of patients who get crossed over from invention arm to comparative armTimepoint: within 24 hrs post intervention | — |
Countries
India
Contacts
Public ContactDr Nayer Jamshed
AIIMS,New Delhi
Outcome results
None listed