Timing of RRT in Mechanically Ventilated Patients
Conditions
Keywords
early and late RRT, AKI, Mechanical ventilation
Brief summary
This is a randomized controlled study that will be conducted on acute kidney injury (AKI) patients, who are mechanically ventilated, to assess the impact of implementation of early renal replacement therapy (RRT) compared to late RRT on patients outcome.
Detailed description
The study subjects will be randomly divided into two groups (arms). The first one will be patients who will receive early renal replacement therapy (RRT) according to predefined criteria that will be illustrated later. The other group of patients will be those who receive late RRT according to the absolute indications of emergency hemodialysis i.e. severe hyperkalemia, life-threatening acidosis, uremic encephalopathy or pericarditis in addition to intractable pulmonary edema. Appropriate randomization technique will be applied. A computer-based program will be used to perform the randomization procedure.
Interventions
PROCEDURERenal replacement therapy
Renal replacement therapy (RRT) will be initiated in the early group for patients who have stage 2 AKI according to KDIGO classification. The late group will have RRT when they develop any of the absolute indications for RRT
Sponsors
Alexandria University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All patients must be on invasive mechanical ventilation. * Patients in AKI stage 2 , according to KDIGO classification. * Recruited subjects will include either those who present with AKI on their ICU admission or those who develop AKI during their ICU stay
Exclusion criteria
* Those who are known to be in grade 5 CKD according to KDIGO classification. All other grades of CKD from 1 to 4 will be included only if they develop or present with stage 2 AKI on top of their CKD grade * Those who develop AKI due to obstructive or traumatic causes. * Patients with septic shock who are on high doses of vasopressors or inotropes (norepinephrine infusion more than 1 mcg/kg/minute, dopamine or dobutamine infusion more than 5 mcg/kg/minute). * Pregnant females
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| mortality | 28 days | ICU mortality |
| ICU length of stay | through study completion, an average of 1 year | Duration of ICU stay |
| Weaning of mechanical ventilation | through study completion, an average of 1 year | duration of mechanical ventilation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| RRT dependency | for more than three months | Persistent need for renal replacement therapy for at least two sessions per week |
| Renal functions on discharge from ICU | through study completion, an average of 1 year | creatinine level on day of discharge from ICU |
Countries
Egypt
Outcome results
None listed