I.D.E.A.L.-I.C.U. (Initiation of Dialysis EArly Versus deLayed in Intensive Care Unit)
- Conditions
- Septic ShockAcute Renal Failure (as Defined by the "Failure" Stage of the RIFLE Classification)
- Interventions
- Procedure: Renal Remplacement Therapy
- Registration Number
- NCT01682590
- Lead Sponsor
- Centre Hospitalier Universitaire Dijon
- Brief Summary
The purpose of this multicentric, randomized controlled trial is to assess whether the timing of renal replacement therapy initiation (early vs delayed) has an impact on mortality at 90 days in patients with severe acute kidney injury at the failure stage (according to RIFLE criteria) during the initial phase of septic shock.
- Detailed Description
Acute renal failure is one of the most feared complications of septic shock and occurs in 51% of patients with these conditions. Mortality at 3 months ranges from 36% to 60%. To date, these exists no consensus regarding the optimal time to initiate renal remplacement therapy (RRT). Retrospective and observational studies have suggested that early initiation of RRT could help to improve prognosis in these patients. Therefore, we aim to investigate wether early initiation of RRT (within 12 hours after a diagnosis of acute renal insufficiency at the "failure" stage according to the RIFLE Criteria), will reduce 90-day mortality as compared to deferred initiation of RRT (48 to 60 hours after diagnosis), in intensive care unit (ICU) patients with septic shock who develop acute renal failure.
Secondary objectives include: to compare the impact of the two RRT strategies on 28, 180 et 360 day mortality, duration of mechanical ventilation, duration of RRT, duration of ICU stay and duration of overall hospital stay. In addition, quality of life at 90 and 360 days will be evaluated using the EQ5D questionnaire. Tolerance of both strategies will be compared in terms of metabolic disorders, arrhythmias, pulmonary oedema by overload, hypotension, hemorrhagic complications, and dependence on RRT at hospital discharge.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 500
Adults (males or females, age >18 years) with septic shock who develop acute renal failure (as defined by the "Failure" stage of the RIFLE classification) will be eligible for inclusion.
Septic shock is defined as severe sepsis with at least 2 to 4 "SIRS" criteria and persistent hypotension despite adequate vascular filling and need vaso-active drugs.
SIRS is defined as the simultaneous presence of at least 2 of the following criteria :
- Body temperature ≥ 38°C ou ≤ 36°C
- Heart rate ≥ 90 bpm
- Respiratory rate ≥ 20/mn or PaCO2 ≤ 32 mmHg
- Leucocytes ≥ 12,000/mm3 or ≤ 4,000/mm3 or >10% immature forms.
Acute renal insufficiency is defined as the "failure" stage of the RIFLE classification, i.e. the presence of at least one of the following criteria:
- Increased creatinine x 3 times the baseline value
- Oliguria < 0.3 ml/kg/h for 12 hours
- Anuria (diuresis < 100ml) for at least 12 hours
All patients are required to provide informed consent after having been appropriately informed about the study. In case of temporary incapacity of the patient to sign, the consent form can be signed by a surrogate.
Patients presenting any of the following criteria will not be eligible for inclusion in the study:
- Patients with chronic renal at dialysis.
- Patients presenting acute renal failure of type obstructive and patients already presenting emergency criteria for immediate hemodialysis at the time of randomization (i.e. hyperkalemia >6.5 mmol/L or pH<7.15 or pulmonary oedema by fluid overload)
- Patients already had hemodialysis before their arrival in the intensive care unit
- Pregnant women.
- Moribund patients whose life expectancy is less than 24 hours
- Patients unlikely to survive to 28 days because of uncontrollable comorbidities (e.g. cardiac, pulmonary or hepatic disease at the terminal stage, hepatorenal syndrome, uncontrolled cancer, severe post-anorexic encephalopathy...)
- Patients with advance directives indicating their wish not to be resuscitated.
- Patients under legal guardianship.
- Patients participing in another interventional study that may influence the prognosis of patients.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Early initiation of RRT Renal Remplacement Therapy Start of RRT within a maximum of 12 hours after randomisation. Deferred RRT Renal Remplacement Therapy Start of RRT between 48 and 60 hours after randomisation.
- Primary Outcome Measures
Name Time Method Progression free survival 90 days To investigate whether early initiation of RRT (within 12 hours after a diagnosis of acute renal insufficiency at the "failure" stage according to the RIFLE Criteria), will reduce 90-day mortality as compared to deferred initiation of RRT (48 to 60 hours after diagnosis), in intensive care unit (ICU) patients with septic shock who develop acute renal failure.
- Secondary Outcome Measures
Name Time Method Comparison of the tolerance and evaluation quality of life 90 days Secondary objectives include: to compare the impact of the two RRT strategies on 28, 180 and 360 day mortality, duration of mechanical ventilation, duration of RRT, duration of ICU stay and duration of overall hospital stay. In addition, quality of life at 90 and 360 days will be evaluated using the EQ5D questionnaire. Tolerance of both strategies will be compared in terms of metabolic disorders, arrhythmias, pulmonary oedema by overload, hypotension, hemorrhagic complications, and dependence on RRT at hospital discharge.
Trial Locations
- Locations (27)
CHU Nîmes
🇫🇷Nîmes, France
CHU Grenoble
🇫🇷Grenoble, France
CHU Clermont-Ferrand
🇫🇷Clermont-Ferrand, France
Groupe Hospitalier de l'institut Catholique de LILLE
🇫🇷Lille, France
CHU Lapeyronie
🇫🇷Montpellier, France
CH de BOURG-EN-BRESSE
🇫🇷Bourg-en-Bresse, France
Hôpital Raymond-Poincaré GARCHES (AP-HP)
🇫🇷Garches, France
CH de LA ROCHE sur YON
🇫🇷La Roche sur Yon, France
CHG Mulhouse
🇫🇷Mulhouse, France
CHU de Strasbourg - Nouvel hôpital civil
🇫🇷Strasbourg, France
CH Sud Essonne - Site Etampes
🇫🇷Etampes, France
CHU Montpellier
🇫🇷Montpellier, France
CHU Nancy Brabois
🇫🇷Nancy, France
CHU Lyon Sud
🇫🇷Pierre-Bénite, France
HOPITAL BICHAT Claude-Bernard
🇫🇷Paris, France
CH Belfort
🇫🇷Belfort, France
CHU Besançon
🇫🇷Besançon, France
CH Avignon
🇫🇷Avignon, France
CHU Caen
🇫🇷Caen, France
CHU Dijon
🇫🇷Dijon, France
CH Dieppe
🇫🇷Dieppe, France
CHU de Lyon
🇫🇷Lyon, France
CHR d'Orléans
🇫🇷Orleans, France
CH Périgueux
🇫🇷Périgueux, France
Hôpital Cochin
🇫🇷Paris, France
CHR Metz
🇫🇷Thionville, France
CHRU Tours
🇫🇷Tours, France