AKI - Acute Kidney Injury
Conditions
Keywords
Venous return pressure gradient, Acute kidney injury, Mean systemic filling pressure, Central venous pressure, Intensive care
Brief summary
Acute kidney injury (AKI) is a common and serious complication in the ICU. Current diagnostic indicators (such as creatinine and urine output) exhibit significant lag, and specific hemodynamic predictive markers are lacking. The venous return pressure gradient (Pmsf-CVP), based on Guyton's theory, reflects the driving pressure for venous return; however, its value in the early warning of AKI remains unclear. This study aims to investigate the predictive value of the venous return pressure gradient for the onset and progression of AKI in ICU patients, and to clarify its effectiveness as an AKI risk warning indicator. Patients admitted to the ICU within 48 hours with risk factors for AKI (including sepsis, shock, major surgery, underlying diseases, etc.) who have radial artery catheterization and can undergo hemodynamic monitoring will be enrolled. Those undergoing maintenance dialysis/CRRT, ECMO support, or with missing core data precluding calculation of Pmsf-CVP or AKI assessment will be excluded. The venous return pressure gradient (Pmsf-CVP, mmHg) will be measured within 48 hours of ICU admission using the transient stop-flow arm arterial-venous equilibrium pressure method. The primary outcome is to evaluate the association between the venous return pressure gradient level and AKI occurrence. Secondary outcomes include correlation analyses between the venous return pressure gradient level and serum creatinine and urine output within 48 hours of ICU admission, among others.
Interventions
No study intervention. This is an observational cohort study using routine hemodynamic monitoring data (Pmsf and CVP) collected during standard clinical care.
Sponsors
Sichuan Academy of Medical Sciences
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age ≥18 years 2. Admitted to the intensive care unit (ICU) within 48 hours 3. Central venous catheter in place for continuous central venous pressure (CVP) monitoring 4. Radial artery catheter in place for hemodynamic monitoring including mean systemic filling pressure (Pmsf) 5. No acute kidney injury (AKI) at ICU admission according to KDIGO criteria
Exclusion criteria
1. Maintenance hemodialysis or continuous renal replacement therapy (CRRT) prior to ICU admission 2. Previous kidney transplantation 3. Pregnancy 4. Extracorporeal membrane oxygenation (ECMO) support at ICU admission 5. Incomplete core hemodynamic data precluding calculation of venous return pressure gradient (Pmsf-CVP) or AKI assessment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Acute Kidney Injury occurrence | Within 48 hours of ICU admission | Occurrence of acute kidney injury diagnosed according to KDIGO criteria (serum creatinine increase ≥1.5 times baseline, or ≥26 μmol/L within 48 hours, or urine output \<0.5 mL/kg/h for ≥6 hours) during the ICU stay. The association between venous return pressure gradient (Pmsf-CVP, measured within the first 48 hours of ICU admission using the Pmsf-arm method) and AKI occurrence will be assessed by multivariable logistic regression analysis, adjusting for APACHE II score, baseline serum creatinine, lactate, mean arterial pressure, sepsis, and shock. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Persistent Acute Kidney Injury | Within 48 hours after AKI occurrence during the ICU stay | Persistent AKI defined as failure of renal function to return to baseline within 48 hours after AKI occurrence during the ICU stay. The predictive value of venous return pressure gradient (Pmsf-CVP) for persistent AKI will be evaluated by ROC curve analysis. |
| AKI severity grade | At the time of maximum AKI stage during the ICU stay, up to 28 days | Maximum AKI stage (KDIGO stage 1, 2, or 3) achieved during the ICU stay. |
| In-hospital mortality | From ICU admission to hospital discharge, up to 90 days | All-cause mortality during the index hospitalization. |
| Total length of hospital stay | From hospital admission to discharge or death, up to 90 days | Number of days from hospital admission to hospital discharge or in-hospital death, whichever comes first. Patients still hospitalized at day 90 will be censored at 90 days. |
| Correlation between venous return pressure gradient and serum creatinine | Within 48 hours of ICU admission | Spearman rank correlation analysis between Pmsf-CVP (measured within 48 hours of ICU admission) and serum creatinine levels (baseline creatinine at ICU admission and peak creatinine during ICU stay). |
| Correlation between venous return pressure gradient and lactate | Within 48 hours of ICU admission | Spearman rank correlation analysis between Pmsf-CVP (measured within 48 hours of ICU admission) and lactate levels obtained from the first arterial blood gas analysis within 48 hours of ICU admission. |
| Duration of mechanical ventilation | From intubation to first successful extubation | Number of days on invasive mechanical ventilation from the time of first intubation to the first successful extubation. Reintubation within 48 hours will be counted as continuous ventilation. |
| Length of ICU stay | From ICU admission to ICU discharge | Number of days from ICU admission to ICU discharge. |
Contacts
CONTACTrongan Liu
CONTACTchunling Chen
Outcome results
None listed