Intradialytic Hypotension, Cardiac Event, Renal Insufficiency, Hospital Length of Stay
Conditions
Keywords
Hemodialysis, BIA, Acute Kidney Injury
Brief summary
This study was designed to compare the efficacy of BIA and physician adjustment to prevent intradialytic hypotension in patients with acute kidney injury who received renal replacement therapy. The investigators randomized 9 patients with acute kidney injury and volume overloaded who underwent acute hemodialysis for 45 sessions in Vajira hospital between October 2017 and February 2018. In physician adjust-group (control) estimate by physical examination and fluid balance record. Primary outcome was intradialytic hypotensive episode and secondary outcome was hemodialysis-related adverse events and other clinical outcome.
Detailed description
Background Volume overload and intradialytic hypotension are significant complications with increasing mortality rate in hemodialysis patients. Bioelectrical Impedance Analysis (BIA) has been used to estimate the optimum weight in chronic hemodialysis patient to prevent intradialytic hypotension.Volume assessment in acute kidney injury is also of great importance , however, there are currently few methods to obtain an accurate assessment of hydration status in this scenario. This study was designed to compare the efficacy of BIA and physician adjustment to prevent intradialytic hypotension in patients with acute kidney injury who received renal replacement therapy. Methods The investigators randomized 9 patients with acute kidney injury and volume overloaded who underwent acute hemodialysis for 45 sessions in Vajira hospital between October 2017 and February 2018. Volume overload was defined by BIA with value more than\>0.4. In physician adjust-group (control) estimate by physical examination and fluid balance record. Primary outcome was intradialytic hypotensive episode and secondary outcome was hemodialysis-related adverse events and other clinical outcome.
Interventions
We use Inbody S20 analysis to measure fluid status before each hemodialysis session to guide fluid removal.
PROCEDUREPhysician-guided
This intervention used physical examination as guided to adjust fluid therapy together with the chart record of intake and output per day
Sponsors
Bangkok Metropolitan Administration Medical College and Vajira Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Prospective randomized study
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with acute kidney injury with volume overload unresponsive to medication therapy =Required renal replacement therapy (RRT)
Exclusion criteria
Patients who were pregnant * Advanced malignancy * Kidney transplantation * AKI from toxins * Currently on pacemaker * Had underlying chronic kidney disease * Patients with severe cardiovascular disease such as congestive heart failure, valvular regurgition
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in blood pressure during dialysis | During hemodialysis session start from enrollment until study completion, up to 4 hours | Blood pressure less than 20 mmHg from baseline ( systolic blood pressure) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cardiac problem | Measure through study completion,for at least 3 months after randomization | Number of patients that have palpitation,cardiac arrthymia or chest pain |
| Hospital length of stay | Up to 3 months after enrollment | Total days in admission |
| Percent of renal function | at least 3 months after enrollment | eGFR |
Countries
Thailand
Outcome results
None listed