Acute Kidney Injury, Critically Ill, Septic Shock
Conditions
Keywords
septic shock, acute kidney injury, renal resistive index
Brief summary
Record the renal resistive index and hemodynamic parameters ( record the cardiac output and stroke volume if the patient's next to kin agree to undertake a PiCCO monitoring ) before and after resuscitation for severe sepsis or septic shock patients, to determine whether the changes of resistive index or hemodynamic parameters, especially the cardiac output can be a better parameter to predict AKI
Detailed description
* Purpose: To examine whether the resuscitation-induced changes of renal resistive index or hemodynamic parameters has the superiority as a valid tool to evaluate the renal perfusion improvement and whether the changes can better predict AKI occurrence in severe sepsis or septic shock patients. * Methods: Measure the renal resistive index and take record of hemodynamic parameters (use a PiCCO monitoring to measure cardiac output if the patient's next to kin agree to undertake such a catheter ) before and after successful resuscitation for severe sepsis or septic shock patients, followup to determine the occurrence of AKI and mortality. * Hypothesis: The changes of resistive index or cardiac output during shock resuscitation may be a better parameter to evaluate renal perfusion and predict AKI, and may have a better value to guide renal protective therapy in septic shock.
Interventions
None listed
Sponsors
Zhongda Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* ≥18 years, Sex unlimited * Arriving ICU in 6 hours and diagnosed with severe sepsis or septic shock * Physician in charge decide that an aggressive fluid resuscitation was in order
Exclusion criteria
* Pregnancy, Age \<18 years * Ongoing recovery from AKI * Known end-stage renal disease or chronic kidney disease(glomerular filtration rate \<30mL/min/1.73m2) * Known other causes of shock morbidly * conditions known to modify RRI, such as renal-artery stenosis, intra-abdominal hypertension(\>35cmH2O)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 7 days AKI occurrence | 7 days | Follow up to determine the occurrence of AKI in 7 days after inclusion. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| eGFR | until 6 hours after enrollment | eGFR when enrolled and 6 hours after enrollment.The 2012 SSC guideline for severe sepsis and septic shock recommend to achieve some six-hour resuscitation goals.So we collect 5ml blood and 2 hrs urine when enrolled(at this time, initiate large amount of fluid resuscitation,which is so called before resuscitation). At 6hrs after enrolled,collect another 5ml blood and 2 hrs urine.Glomerular filtration rate (GFR) describes the flow rate of filtered fluid through the kidney. eGFR is Creatinine-based approximations of GFR. We project to use the Urine Creatinine concentration×Urine Flow Rate/Plasma Creatinine Concentration formula to calculate the eGFR (collected two hours urine, and examine the plasma and urine creatinine in the middle of the two hours). The lowest plasma creatinine value in the 3 months preceding inclusion was taken as the baseline value, therefore use the value to calculate baseline eGFR by CKD-EPI formula. |
Countries
China
Contacts
Primary ContactXiaohua Qiu, MD
Backup ContactJingchao Luo, MD
Outcome results
None listed