Acute Kidney Injury
Conditions
Keywords
Acute kidney injury, renal replacement therapy, acetate free biofiltration, bicarbonate-based hemodialysis, C02 removal, intensive care unit, critical care
Brief summary
Acute kidney injury (AKI) affects up to 30% of critically ill patients and is associated with increased rates of mortality. Up to 60% of patients with AKI will ultimately require renal replacement therapy (RRT). Intermittent hemodialysis (IHD) is one of the main methods of RRT worldwide. In IHD-bicar, dialysate is composed by electrolytes, including calcium, and bicarbonate. To avoid calcium carbonate precipitation, dialysate has to be supplemented with acids (citric acid, chloride acid or acetic acid). However, IHD-bicar may be associated with hemodynamic instability or respiratory intolerance, mainly related to the CO2 release in the circulation during IHD (HCO3- \<--\> CO2 + H2O). Some recent studies showed that acetate free biofiltration (AFB-K), a technique that does not require dialysate acidification, could be associated with better hemodynamic stability and to a lower amount of CO2 delivered to the patients. AFB-K may thus improve the hemodynamic and respiratory tolerance of intermittent RRT in critically ill patients.
Detailed description
In this prospective observational study, investigators aim to characterize the hemodynamic and respiratory tolerances of HDI-bicar and AFB-K in critically ill patients requiring RRT.
Interventions
OTHERCollection of clinical and biological data during renal replacement therapy sessions
Collection of clinical and biological data during renal replacement therapy sessions. Two additional blood samples collected during and after RRT session (critically ill patients all have arterial catheter thus additional samples will not need additional puncture).
Sponsors
University Hospital, Toulouse
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients ≥ 18 years old * Invasive monitoring of blood pressure * Non opposition to the research * Admission to the intensive care unit * Need of intermittent hemodialysis
Exclusion criteria
* Sodium bicarbonate infusion * Pregnancy or breastfeeding * Juridical protection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Occurence of hemodynamic event | From admission to discharge, up to 4 hours | The occurrence of at least one of the following events will be considered a hemodynamic event : * Hypotension (decrease of systolic or mean blood pressures ≥ 15 and ≥ 10% respectively) * Tachycardia (increase of heart beating ≥ 20%) * Cardiac arrythmia (junctional tachycardia, atrial fibrillation, flutter, ventricular tachycardia or fibrillation) * Decrease of the cardiac output ≥ 15% (only in patients with invasive cardiac output monitoring) * Starting (or increase dosing) of norepinephrine ≥ 0.1 µg/kg/min |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in maximal PaCO2 | 1 hour after the beginning of dialysis , up to 4 hours | Evaluation of PaCO2 by arterial blood gas test |
| Maximum difference of tcPCO2 and etCO2 | From admission to discharge, up to 4 hours | Evaluation of TcPCO2 and etCO2 by trans-cutaneous measurement |
| Change in the strong ion difference | baseline, 4 hours | Evaluation of the strong ion difference by blood ionogram |
| Change in plasma pH | 1 hour after the beginning of dialysis session, up to 4 hours | Evaluation of plasma pH by blood ionogram |
Countries
France
Outcome results
None listed