Acute Kidney Injury, Fluid Overload, Hypoperfusion
Conditions
Keywords
Ultrasound, Renal perfusion, Fluid treatment, Venous congestion, Renal function
Brief summary
The study will examine the ability of renal ultrasound (Doppler and Contrast Enhanced Ultrasound (CEUS)) in distinguishing ICU patients who exhibit increases in glomerular filtration rate (GFR) in response to fluid loading, from those for whom fluid loading is without benefit of directly harmful.
Detailed description
The study will examine the ability of renal ultrasound (Doppler and Contrast Enhanced Ultrasound (CEUS)) in distinguishing ICU patients who exhibit increases in GFR in response to fluid loading, from those for whom fluid loading is without benefit of directly harmful. Patients available for inclusion will receive a baseline administration of Tc-99-DTPA for precise determination of GFR/renal function by blood and urine samples. Baseline values of ultrasound measures will be obtained, including renal arterial, renal venous, portal venous and hepatic venous Doppler measures and renal contrast enhanced ultrasound (CEUS) will also be recorded. After two hours, baseline values of GFR are finished. The patient is then exposed to passive leg raising and ultrasound measures are repeated, including renal arterial, renal venous, portal venous and hepatic venous Doppler measures. The participant then receives a standardised fluid bolus of 7 ml/kg (ideal body weight) Once the fluid bolus administration is complete, renal ultrasound is repeated, including renal arterial, renal venous, portal venous, hepatic venous Doppler measures and renal CEUS. Follow-up determination of GFR/renal function based on Tc-99-DTPA after fluid therapy is repeated with blood and urine samples.
Interventions
DRUGIV crystalloid fluid bolus
The participant receives IV fluid as a standardised bolus of 7 ml/kg (ideal body weight).
Sponsors
Aarhus University Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Inclusion criteria
* Patients ≥ 18 years admitted to the ICU, Aarhus University Hospital. * Patients who are assessed by their attending physician as having need for fluid therapy.
Exclusion criteria
* Insufficient ultrasound imaging of the kidneys. * Pregnancy. * Intolerance to any ultrasound contrast agent or isotopes, including intolerance for human albumin. * Prior enrolment in a conflicting research study. * Known morphological kidney disease. * Need for dialysis. * Need for extracorporeal membrane oxygenation (ECMO). * Prior participation. * Severe pulmonary hypertension (systolic pulmonary pressure \> 90 mmHg)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes in renal function in response to a standardised fluid bolus. | 6 hours | Renal function is measures as Tc-99-Diethylenetriaminepentaacetic acid (DTPA) clearance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Renal venous impedance index | 6 hours | (maximum flow velocity - minimum diastolic flow velocity) / maximum flow velocity |
| Renal venous stasis index | 6 hours | (index cardiac cycle time - venous flow time) / index cardiac cycle time |
| Renal arterial resistive index | 6 hours | (maximum flow velocity - minimum diastolic flow velocity) / maximum flow velocity |
| Portal venous pulsatility fraction | 6 hours | (maximum flow velocity - minimum diastolic flow velocity) / maximum flow velocity |
| Contrast enhanced ultrasound 1 | 6 hours | Mean transit time (mTT) |
| Renal venous flow classification | 6 hours | normal - abnormal (pulsatile/biphasic/monophasic |
| Contrast enhanced ultrasound 3 | 6 hours | Relative Blood Volume (rBV) |
| Contrast enhanced ultrasound 4 | 6 hours | Wash-in Rate (WiR) |
| Contrast enhanced ultrasound 5 | 6 hours | Quality Of Fit (QOF) |
| Continuous recordings of hemodynamic variables 1 | 6 hours | arterial pressure |
| Continuous recordings of hemodynamic variables 2 | 6 hours | Central venous pressure |
| Contrast enhanced ultrasound 2 | 6 hours | Perfusion Index (PI) |
Countries
Denmark
Outcome results
None listed