Acute Kidney Injury
Conditions
Keywords
Acute kidney injury, Continuous renal replacement therapy, Furosemide stress test, Critical care, CRRT
Brief summary
Currently, continuous renal replacement therapy (CRRT) is the main modality for renal support in critically ill patients with hemodynamic instability. Most studies have investigated the timing of RRT initiation. However, prolonged CRRT demonstrated the association of many unexpected events, such as catheter-related complications, catheter-related blood stream infection, hypotension, hypothermia, tachycardia, and atrial fibrillation. Up to now, there is a lack of evidence regarding the timing of withholding CRRT. The furosemide stress test (FST) is a tool that is easy to use and has more availability. The investigators aimed to apply FST to evaluate renal recovery compared with standard treatment in critically ill patients undergoing CRRT.
Interventions
After taking furosemide at 1.5 mg/kg intravenously, if the urine output exceeds 200 mL within 2 hours, the patients are going to withhold CRRT. But if there is no response, the titration of furosemide to 2.5 mg/kg and 3.5 mg/kg every 6 hours is scheduled according to the urine output \>200 mL in 2 hours (not exceeding 250 mg).
Sponsors
Chiang Mai University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult 18 year of age or older * Acute kidney injury (AKI) stage 3 according to Kidney Disease Improving Global Outcomes (KDIGO) classification with oliguria (urine \<400 ml/day) * Initiate CRRT in ICU (medical ICU, surgical ICU, cardiac care unit) for at least 48 hours (time for initiation and modality of CRRT can adjust by clinician)
Exclusion criteria
* Use any inotropic drug (norepinephrine, epinephrine, dopamine, dobutamine) * Serum K \<3.5 or \>5 mmol/L * Arterial potential of Hydrogen (pH) \<7.3 * Serum bicarbonate (HCO3) \<15 mmol/L * Urine volume ≥2,300 mL/day * Previous chronic kidney disease (CKD) stage 5 or estimated glomerular filtration rate (eGFR) \<15 mL/min/1.73 m2 * Previous RRT within 14 days * Kidney transplantation * Obstructive etiology for AKI * Toxin/drug that necessitates RRT * Allergy to furosemide * Moribund with expected death within 24 hours * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Successful liberation from CRRT | 7 days | Discontinuation of CRRT without reinitiation of any RRT modality within 7 days after CRRT discontinuation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Urine output | 7 days | Urine output after each FST and during the first 7 days following randomization |
| Fluid balance | 7 days | Fluid balance after each FST and during the first 7 days following randomization |
| CRRT reinitiation | 7 days | Number of patients who need to restart CRRT |
| Total duration of RRT | Through study completion, an average of 90 days | Including first day of CRRT until last session of RRT |
| Ventilator-free day | Through study completion, an average of 90 days | Number of mechanical ventilator-free day |
| Vasoactive-free days | Through study completion, an average of 90 days | Number of vasoactive-free day |
| Day of Hospitalization | Through study completion, an average of 90 days | Length of hospital stay and ICU stay |
| Major adverse kidney events (MAKE) at 30 and 90 days | 90 days | Composite of all-cause mortality, RRT dependence, and persistent kidney dysfunction |
| Incidence of adverse events | 7 days | Number of adverse events, including catheter-related bloodstream infection, polyuria, arrhythmia, hypotensive episodes, electrolyte and acid-base disturbances, occurring within 7 days after randomization |
Countries
Thailand
Contacts
CONTACTPrit Kusirisin, MD
Outcome results
None listed