Hemodynamic and Respiratory Tolerance of Intermittent Hemodialysis in Critically Ill Patients
- Conditions
- Acute Kidney Injury
- Interventions
- Other: Collection of clinical and biological data during renal replacement therapy sessions
- Registration Number
- NCT04444765
- Lead Sponsor
- University Hospital, Toulouse
- Brief Summary
Acute kidney injury (AKI) affects up to 30% of critically ill patients and is associated with increased rates of mortality. Up to 60% of patients with AKI will ultimately require renal replacement therapy (RRT). Intermittent hemodialysis (IHD) is one of the main methods of RRT worldwide. In IHD-bicar, dialysate is composed by electrolytes, including calcium, and bicarbonate. To avoid calcium carbonate precipitation, dialysate has to be supplemented with acids (citric acid, chloride acid or acetic acid). However, IHD-bicar may be associated with hemodynamic instability or respiratory intolerance, mainly related to the CO2 release in the circulation during IHD (HCO3- \<--\> CO2 + H2O). Some recent studies showed that acetate free biofiltration (AFB-K), a technique that does not require dialysate acidification, could be associated with better hemodynamic stability and to a lower amount of CO2 delivered to the patients. AFB-K may thus improve the hemodynamic and respiratory tolerance of intermittent RRT in critically ill patients.
- Detailed Description
In this prospective observational study, investigators aim to characterize the hemodynamic and respiratory tolerances of HDI-bicar and AFB-K in critically ill patients requiring RRT.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 200
- Patients ≥ 18 years old
- Invasive monitoring of blood pressure
- Non opposition to the research
- Admission to the intensive care unit
- Need of intermittent hemodialysis
- Sodium bicarbonate infusion
- Pregnancy or breastfeeding
- Juridical protection
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Patients with bicarbonate-based intermittent dialysis Collection of clinical and biological data during renal replacement therapy sessions Dialysate is composed by electrolytes, including calcium, and bicarbonate. To avoid calcium carbonate precipitation, dialysate has to be supplemented with acids (citric acid, chloride acid or acetic acid). Patients with acetate free biofiltration dialysis Collection of clinical and biological data during renal replacement therapy sessions Acetate free biofiltration (AFB-K)is a technique that does not require dialysate acidification
- Primary Outcome Measures
Name Time Method Occurence of hemodynamic event From admission to discharge, up to 4 hours The occurrence of at least one of the following events will be considered a hemodynamic event :
* Hypotension (decrease of systolic or mean blood pressures ≥ 15 and ≥ 10% respectively)
* Tachycardia (increase of heart beating ≥ 20%)
* Cardiac arrythmia (junctional tachycardia, atrial fibrillation, flutter, ventricular tachycardia or fibrillation)
* Decrease of the cardiac output ≥ 15% (only in patients with invasive cardiac output monitoring)
* Starting (or increase dosing) of norepinephrine ≥ 0.1 µg/kg/min
- Secondary Outcome Measures
Name Time Method Change in the "strong ion difference" baseline, 4 hours Evaluation of the "strong ion difference" by blood ionogram
Change in plasma pH 1 hour after the beginning of dialysis session, up to 4 hours Evaluation of plasma pH by blood ionogram
Change in maximal PaCO2 1 hour after the beginning of dialysis , up to 4 hours Evaluation of PaCO2 by arterial blood gas test
Maximum difference of tcPCO2 and etCO2 From admission to discharge, up to 4 hours Evaluation of TcPCO2 and etCO2 by trans-cutaneous measurement
Trial Locations
- Locations (1)
Hôpital Rangueil
🇫🇷Toulouse, France