Acute Kidney Injury, Septic Shock
Conditions
Keywords
Sepsis, Acute kidney injury, Mean arterial pressure, Catecholamines, Renal doppler
Brief summary
Sepsis is the most severe complication of infections. Sepsis-associated Acute kidney injury (AKI) is commonly encountered in critically ill patients and independently predicts poor outcome. Unfortunately, no drug or management strategy was able to reduce incidence of AKI. To adapt the level of mean arterial pressure according to local renal hemodynamic evaluated by renal Doppler could lead to a better renal perfusion, and then less AKI.
Detailed description
Acute Kidney Injury (AKI) is a frequent and serious complication of sepsis. Renal ischemia plays a major role in the pathophysiology of sepsis-associated AKI. There is currently no treatment to prevent or to treat AKI. It has been shown that a resistivity index (RI) greater than 0.74 of patients with septic shock could predict the occurrence of renal failure, and that increase mean arterial pressure (MAP) with norepinephrine could decrease RI. Hence, we propose to compare the frequency and the severity of the sepsis-associated AKI according to the early hemodynamic management of septic shock. Patients will be randomized in a classic group (MAP 65 mmHg) and an interventional group (MAP 85 mmHg). We can thus determine whether the level of MAP influences renal function, and whether this influence of MAP is dependent of renal perfusion assessed by renal Doppler. Participants will be followed for the duration of hospital stay, an expected average of 4 weeks. Primary endpoint: -Presence and severity of sepsis-associated AKI at day 7. Secondary endpoints: * Acute renal failure measured by Classification AKI at day 28. * Acute renal failure as measured by the RIFLE classification in the fourth to seventh day and 28th day. * Use of renal replacement therapy during hospitalization in intensive care unit * Mortality at day 28 Duration of study: Recruitment: 10 months, the patient monitoring: 28 days ± 3 days, total test duration: 11 months
Interventions
OTHERHaemodynamic management
Patients will be treated with fluid and norepinephrine to achieve and maintain a mean arterial pressure of 65 mm Hg. Then they will be randomized in two groups. In the first group (study group, n=30), mean arterial pressure will be increased to 85 mm Hg for 72 hours by increasing the dose of norepinephrine in patients.
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Any patient with septic shock may be included in the next 6 to 16h * Age \> 18 years old and \<= 80 years
Exclusion criteria
* Chronic renal failure (Baseline serum creatinine \> 120 mmol/L) * Chronic cardiac failure (Left ventricle ejection fraction \< 40%) * Pregnancy * Urinary Tract Infection * Patients with a left ventricular dysfunction ( ventricular ejection fraction \<40%)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Acute kidney injury according to RIFLE score | at 7 days |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Need for renal replacement therapy | during hospitalization | including metabolic indications (Azotemia Serum urea ≥ 36mmol/L (100 mg/dL) ; Uremic complications : encephalopathy, pericarditis, bleeding ; Hyperkalemia K+ ≥ 6 mmol/L and/or electrocardiogram abnormalities ; Hypermagnesemia ≥4 mmol/L and/or anuria/absent deep tendon reflexes ; Acidosis Serum pH ≤ 7.15), Oligo-anuria Urine output \<200mL/12 h or anuria, Fluid overload like Diuretic-resistant organ edema in the presence of acute kidney injury. |
| All cause mortality | at 28 days | All Cause mortality at 28 days, including refractory shock, refractory hypoxia, multiple organ failure, decisions to forgo life-sustaining therapies (DFLSTs) |
Countries
France
Contacts
PRINCIPAL_INVESTIGATORJacques DURANTEAU, MD,PhD
Assistance Publique - Hôpitaux de Paris
Outcome results
None listed