AKI, Blood Pressure, Continuous Renal Replacement Therapy, Dialysis, Intensive Care, Renal Blood Flow, Renal Failure
Conditions
Brief summary
Approximately 50% of patients in the intensive care unit (ICU) develop acute kidney injury (AKI) and more than 10% need dialysis. There is no treatment for AKI. Care is aiming for optimization of circulation and blood flow to the kidneys and avoiding nephrotoxic agents. There is conflicting data concerning whether early or late dialysis is harmful for the kidneys. No one has examined the physiological changes in the kidney when starting dialysis and which blood pressure that leads to most optimal physiological conditions for the kidneys during dialysis. In this descriptive study of 20 ICU patients suffering from AKI we aim to investigate renal physiology when starting continuous renal replacement therapy (CRRT) and also at different target blood pressures using retrograde renal vein thermodilution technique. In parallel we will also investigate and validate this invasive method with contrast enhanced ultrasound of the kidneys.
Interventions
OTHERStarting at high or low blood pressure
Using norepinephrine, patients will receive high or low blood pressure to start with and after measurements cross to receive the other blood pressure target
Sponsors
Sahlgrenska University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
To describe renal physiology parameters when starting CRRT and compare renal physiology parameters when using high blood pressure target (MAP 80-90 mmHg) and low blood pressure target (MAP 60-70 mmHg).
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
AKI, according to KDIGO, stage 2 or 3 but with preserved urine production. Treated in the ICU at Sahlgrenska University Hospital Written, signed informed consent Male and female subjects ≥18 years
Exclusion criteria
Emergency need for dialysis Allergy to contrast media (used for CEUS)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Renal oxygenation and blood pressure | 6 hours | Renal oxygenation changes at different mean arterial blood pressure targets during CRRT? |
| Glomerular filtration rate (GFR) and CRRT | 6 hours | Changes in GFR when CRRT is started? |
| Renal oxygenation during CRRT | 6 hours | Renal oxygenation before CRRT and during CRRT |
| Renal blood flow and CRRT | 6 hours | Changes in renal blood flow when CRRT is started? How will renal blood flow and oxygenation change at different blood pressure targets? |
| Renal blood flow and blood pressure | 6 hours | Renal blood flow changes at different mean arterial blood pressure targets during CRRT? |
| Glomerular filtration rate (GFR) and blood pressure | 6 hours | GFR changes at different mean arterial blood pressure targets during CRRT? |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| atrial natriuretic peptide (ANP) | 6 hours | Differences in serum atrial natriuretic peptide (ANP) during CRRT |
| Contrast enhanced renal ultrasound (CEUS) | 2 hours | Validation of CEUS compared to retrograde renal vein thermodilution in measuring renal blood flow |
Countries
Sweden
Contacts
Primary ContactKristina Svennerholm, MD PhD
Backup ContactChristian Rylander, MD PhD
Outcome results
None listed