Acute Kidney Injury, Shock
Conditions
Keywords
Sodium Profiling, Acute Kidney Injury (AKI), Shock, Lung ultrasound, Hemodialysis
Brief summary
A study conducted to evaluate the effects of sodium profiling haemodialysis compared with conventional haemodialysis on hemodynamic tolerance and extravascular lung water in critically ill patients with AKI and shock.
Detailed description
A prospective comparative study was conducted on 120 ICU patients with AKI and shock and indicated for acute intermittent hemodialysis, divided into three groups of 40 patients each: Group 1: conventional hemodialysis, Group 2: linear sodium profiling, and Group 3: stepwise sodium profiling. Hemodynamic parameters, vasopressor requirements, lung ultrasound scores, and IVC measurements were assessed before, during, and after dialysis to evaluate the effects of sodium profiling haemodialysis compared with conventional haemodialysis on hemodynamic tolerance and extravascular lung water in critically ill patients with AKI and shock.
Interventions
None listed
Sponsors
Fayoum University
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* • Adult Patients (18 years or older) who are admitted in ICU. * AKI (either de novo or superimposed on CKD) as defined by (KDIGO 2023) criteria: an increase in serum creatinine (SCr) by ≥0.3 mg/dL within 48 hours, an increase in SCr to ≥1.5 times baseline within the prior 7 days, or a urine output of \<0.5 mL/kg/h for 6 hours. * Hemodynamic instability and they need vasopressor to maintain their mean blood pressure above 65 mmHg for ≥1-2 h before initiation of HD. * Indicated for intermittent acute hemodialysis (IHD) per treating team (e.g., refractory hyperkalemia, severe acidosis, uremic complications, or fluid overload).
Exclusion criteria
* • Patients with hemodynamic instability who are not responsive to vasopressors and not candidate for intermittent hemodialysis. * ESRD on regular HD. * Patient judged unsafe for IHD as Severe uncontrolled arrhythmia, active myocardial ischemia active intracranial pathology at risk from osmotic/sodium shifts. * Severe dysnatremia: serum Na ≤125 or ≥150 mmol/L.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean Arterial Pressure (MAP) changes during the session | 2 to 3 hours | MAP is asessed pre dialysis, during dialysis and post dialysis to detect changes among the groups |
| Vasopressor Requirement during the session | 2 to 3 hours | Vasopressor dose changes during the session among the groups |
| Lung Ultrasound Score (LUS) | 4 to 6 hours | Changes in LUS Pre and Post-dialysis among the groups A score of \>15 generally suggests mild congestion, while values \>24 are considered indicative of moderate-to-severe pulmonary oedema or significantly increased EVLW. |
| Ultrasonagraphic IVC Diameter | 4 to 6 hours | Changes in Ultrasonagraphic IVC Diameter pre and post-dialysis among the groups |
| Ultrasonagraphic IVC Collapsibility | 4 to 6 hours | Changes in Ultrasonagraphic IVC Collapsibility pre and post-dialysis among the groups |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Dialysis Completion Rate | 2 to 3 hours | the ability to complete the session without haemodynamic instability |
| Length of ICU Stay | 4 to 15 days | Length of ICU Stay among the groups |
| Mortality | 4 to 15 days | short term Mortality during ICU stay |
| Laboratory findings | 6 to 12 hours | Changes in serum sodium, Potassium, blood gases, urea and creatinine pre and post-dialysis among the groups |
Countries
Egypt
Outcome results
None listed