Acute Kidney Injury
Conditions
Brief summary
The aim of this study is to determine the effects of AV port reversal (AVPR) on recirculation, clearance, post-filter ionized calcium and subsequently citrate dosing.
Detailed description
Rationale: AV port reversal (AVPR) has been demonstrated to increase recirculation in venous catheters used in ICU for CVVH. The effects of this frequently used manoeuvre have not been described in the setting of CVVH using regional citrate anticoagulation. Objective: The aim of this study is to determine the effects of AVPR on recirculation, clearance, post-filter ionized calcium and subsequently citrate dosing. Study design and methods: Open trial studying the effect of AVPR in patients undergoing citrate CVVH. After measurement in standard catheter configuration, AVPR is performed after which effects on catheter recirculation, clearance, citrate dosing and post-filter ionized calcium (iCa) are monitored. Sample sites: Arterial line, arterial (pre-filter) port, postfilter port (after postdilution and calcium compensation), effluent sample. All flow rates to be noted. Study population: Twelve patients admitted to intensive care, requiring continuous renal replacement therapy (CRRT) for AKI. Patients are preferably anuric and have achieved good metabolic control under CVVH before inclusion in the study.
Interventions
OTHERAV port reversal
Reversal of the AV port at 1h Reversal of the AV port to start position at 7h
Sponsors
Ziekenhuis Oost-Limburg
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Critically ill patients requiring CRRT for AKI (RIFLE criteria) * Written informed consent from the patient or legal representative * No AV port reversal had taken place before inclusion in the study * Diuresis is minimal or the patient is anuric so that effects of changes in clearance as a consequence of diuresis are minimalized and do not influence study outcomes. * The patient has undergone CVVH for a number of days, ensuring good metabolic control, so that possible short term loss of clearance as a consequence of AV port reversal has no detrimental effects.
Exclusion criteria
* pre-existing chronic renal insufficiency requiring dialysis * chronic immunosuppression * liver cirrhosis Child-Pugh C * severe or shock-related hepatitis * Pregnancy
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| change in citrate concentration in circuit after AV port reversal | 8 hours |
| change in post-filter ionised Ca after AV port reversal | 8 hours |
| change in clearance after AV port reversal | 8 hours |
Countries
Belgium
Outcome results
None listed