Acute Kidney Injury KDIGO 3, Continuous Renal Replacement Therapy Initiated by the Clinician in Charge Without Emergency, Myocardial Stunning
Conditions
Keywords
Acute kidney injury,, continuous renal replacement therapy, myocardial stunning, regional wall motion abnormalities, 2D speckle tracking echocardiography
Brief summary
Myocardial stunning during chronic intermittent hemodialysis is a well-described phenomenon. Little case series of patients presenting myocardial stunning during renal replacement therapy for acute kidney injury in critically ill patients are reported, with intermittent hemodialysis and continuous renal replacement therapy. However, the small sample sizes and the absence of a control arm limit their interpretation, mainly whether the myocardial stunning may be related to cardiac loading conditions variations and whether it may impact the hemodynamic. The investigator hypothesize that myocardial stunning induced by renal replacement therapy is frequent, independent from cardiac loading conditions and associated with peripheral hypoperfusion.
Interventions
PROCEDUREContinuous renal replacement therapy
Continuous renal replacement therapy (veno venous hemofiltration) without net ultrafiltration, through a dedicated central venous catheter
OTHERControl group
Continuous renal replacement therapy is differed from 6 hours to allowed 2 control echocardiographic evaluations
Sponsors
Hospices Civils de Lyon
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Age \> 18 years old * Acute Kidney Injury grade 3 (KDIGO) * Indication for renal replacement therapy for the clinician in charge
Exclusion criteria
* Emergency indication to renal replacement therapy (pH\<7.15, Kaliemia \> 6mmol/L, refractory pulmonary oedema) * Poor echogenicity with speckle tracking analysis failure * Chronic hemodialysis * Extra corporeal membrane oxygenation, left ventricular assist device.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of segment of the left ventricle with regional wall motion abnormalities | Change between the echocardiography at baseline and the echocardiography 4 hours after. | Numbers of segments of the left ventricle (by patient) with a decrease greater than 20% of the peak systolic longitudinal strain (2D speckle tracking) on the second echocardiography as compared to baseline. |
Countries
France
Outcome results
None listed