Impact of Sodium Profiling During Haemodialysis on Haemodynamic Tolerance and Sonographic Extravascular Lung Water in Shocked Patients With Acute Kidney Injury
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 120
- 试验地点
- 1
- 主要终点
- Mean Arterial Pressure (MAP) changes during the session
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •• 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).
排除标准
- •• 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.
研究组 & 干预措施
Stepwise Sodium Profiling
stepwise sodium profiling group in which dialysate sodium was reduced in stages (150 → 145 → 140 → 135 mEq/L)
Conventional Haemodialysis
conventional IHD group with fixed dialysate sodium of 140 mEq/L
Linear Sodium Profiling
linear sodium profiling group in which dialysate sodium was Initiated at 150 mEq/L, linearly decreased to 135 mEq/L over the course of the dialysis session.
结局指标
主要结局
Mean Arterial Pressure (MAP) changes during the session
时间窗: 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
时间窗: 2 to 3 hours
Vasopressor dose changes during the session among the groups
Ultrasonagraphic IVC Diameter, Collapsibility
时间窗: 4 to 6 hours
Changes in Ultrasonagraphic IVC Diameter, Collapsibility pre and post-dialysis among the groups
Lung Ultrasound Score (LUS)
时间窗: 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
时间窗: 4 to 6 hours
Changes in Ultrasonagraphic IVC Diameter pre and post-dialysis among the groups
Ultrasonagraphic IVC Collapsibility
时间窗: 4 to 6 hours
Changes in Ultrasonagraphic IVC Collapsibility pre and post-dialysis among the groups
次要结局
- Dialysis Completion Rate(2 to 3 hours)
- Length of ICU Stay(4 to 15 days)
- Mortality(4 to 15 days)
- Laboratory findings(6 to 12 hours)
研究者
Hisham Ahmed Abdelkawy
Assistant lecture Critical Care Medicine
Fayoum University