Cirrhotics With Septic Shock and Acute Kidney Injury
Conditions
Brief summary
Consecutive patients with cirrhosis and septic shock with AKI who give written informed consent will be included in this prospective trial. At baseline NT-Pro BNP, urine N-GAL will be done for all patients. A baseline serum blood sample (10 ml) and urine sample will be stored. Septic shock will be defined by the presence of two or more diagnostic criteria for the systemic inflammatory response syndrome, proven or suspected infection with hypotension non-responsive to adequate fluid resuscitation assessed by no evidence of stroke volume variation on flow track and need of a vasopressor to achieve a target mean arterial pressure (MAP) of ≥ 65 mm Hg. A record of CVP, IVC diameter and B-lines on ultrasound lung would also be done. Patients with age less than 18 years, severe known cardiopulmonary disease (structural or valvular heart disease, coronary artery disease, COPD) pregnancy, chronic kidney disease on hemodialysis, patients already meeting emergency criteria for immediate hemodialysis at the time of randomization as specified in the late group, patients transferred from other hospitals who have already been on hemodialysis before their arrival in the intensive care unit, extremely moribund patients with an expected life expectancy of less than 24 hours, failure to give informed consent from family members.
Interventions
BIOLOGICALEarly SLED
withing 6 to 12 hours
BIOLOGICALLate SLED
when absolute indications will meet
Sponsors
Institute of Liver and Biliary Sciences, India
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
\- Patients with Cirrhosis with septic shock associated AKI (Acute Kidney Injury) stage 3 AKIN/KDIGO stage 2.
Exclusion criteria
* Patients with age less than 18 years * Severe known cardiopulmonary disease (structural or valvular heart disease, coronary artery disease, Coronary Obstructive Pulmonary Disease) * Pregnancy * Chronic kidney disease on hemodialysis * Patients with Hepatorenal Syndrome, post renal obstructive AKI, AKI due to suspected based on history,urinalysis and past clinical records-glomerulonephritis, interstitial nephritis or vasculitis * Patients already meeting emergency criteria for immediate hemodialysis at the time of randomization as specified in the late group (serum potassium\>6 meq/lt, metabolic acidosis ph\<7.12, acute pulmonary edema, severe volume overload with hypoxemia non-responsive to diuretic treatment) * Patients transferred from other hospitals who have already been on hemodialysis before their arrival in the intensive care unit * Extremely moribund patients with an expected life expectancy of less than 24 hours * Failure to give informed consent from family members. * Hemodynamic instability requiring very high dose of vasopressors
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Transplant free survival in both groups | 28 days |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hemodynamic stability in both groups | 48 hours | — |
| Dialysis efficiency as measured by Urea Reduction ratio in both groups | 2 days | — |
| Achievement of target ultrafiltration goals in both groups | 48 hours | — |
| Recovery in renal functions in both groups | 14 days | Recovery is defined as an increase in urine output to more than 400 ml/day |
| Duration of Intensive Care Unit stay in both groups | 28 days | — |
| Duration of mechanical ventilation in both groups | 28 days | — |
| Incidence of intradialytic hypotension in both groups | 48 hours | — |
| Improvement in SOFA, Model for End stage Liver Disease ( by 2 points) scores | 28 days | — |
| Improvement in Acute Physiology and Chronic Health Evaluation ( by 2 points) scores | 28 days | — |
| Improvement in lactic acidosis and lactate clearance at 6 initiation of dialysis in both groups | 6 hours | — |
| Improvement in lactic acidosis and lactate clearance at 24 hours after initiation of dialysis in both groups | 12 hours | — |
| Death related with renal failure in both groups | 7 day | — |
| Mortality due to renal failure related in both groups. | 7 day | — |
| Improvement in Sequential Organ Failure Assessment ( by 2 points) scores in both groups | 28 days | — |
Countries
India
Contacts
Primary ContactDr Rakhi Maiwall, MD,DM
Outcome results
None listed