Dialysis Weaning in Intensive Care Units (Dialysis STOP)
- Conditions
- Acute Kidney Injury
- Interventions
- Other: Use of daily urinary urea excretion
- Registration Number
- NCT03763188
- Lead Sponsor
- Dr Alexandre Gros
- Brief Summary
Evaluation of daily urinary urea excretion, to guide Renal Replacement Therapy weaning, in Intensive Care Units.
The objective is to show that remove the dialysis catheter, once daily urinary urea excretion is greater than 1.35 mmol/kg/d, would increase more than 3 days the number without dialysis catheters, and thus without dialysis, the first 28 days after insertion.
Daily urinary urea excretion = urea (mmol/L) x diuresis (L/d) / weight (kg).
- Detailed Description
Daily urinary excretion of urea may provide a safe and reproducible renal replacement therapy withdrawal criterion, according to a recent French study (citations). A rate greater than 1.35 mmol/kg/d would predict a weaning success of 97.1% at 1 week. This criterion is influenced by the use of diuretics, and is easily accessible and achievable. Daily urinary urea excretion is representative of the recovery of renal function. The French study establishing this new withdrawal criterion was monocentric and retrospective. However, we changed our practices as soon as we became aware of them.
French multicentric (Bordeaux University Hospital, Libourne, Pau and Bayonne Hospitals) study, before and after:
* Period before: patients who were dialysed in the intensive care units of Bordeaux, Libourne, Pau and Bayonne, from November 2013 to November 2015.
* Period after: patients selected prospectively in the 4 hospitals.
When diuresis \> 100 ml/d, an urinary ionogram is realized daily. Measurement of urinary urea excretion every day. Ablation of the catheter as soon as daily urinary urinary excretion \> 1.35 mmol/kg/d.
Measurement of daily urinary excretion the following 3 days.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 260
- All patients > 18 of age, who have a Renal Replacement Therapy, in intensive care unit,
- with a diuresis > 100 ml/d.
- Patients still presenting "hard" criteria for RRT: metabolic acidosis with pH < 7.15 and PCO2 <50mmHg; acute pulmonary edema (> 5l 02 or 50% FiO2 for Sp02 > 95%) objectified by echocardiography; K> 5.5 mmol/l after treatment
- Renal transplantation
- Long-term chronic kidney injury or short-term dialysis project (arteriovenous fistula created).
- Acute Kidney Injury secondary to thrombotic microangiopathy
- Acute Kidney Injury secondary to an obstacle even if dialysed
- RRT started for toxic cause without IRA (lithium,...)
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description the group AFTER Use of daily urinary urea excretion Prospective group. Use the daily urinary urea excretion to guide the renal replacement therapy weaning.
- Primary Outcome Measures
Name Time Method the catheter free days the first 28 days after catheter insertion days
- Secondary Outcome Measures
Name Time Method Renal therapy replacement complications (hemorrhage, heparin-induced thrombocytopenia, other) the first 28 days after catheter insertion number
number of dialysis catheter laid per patients the first 28 days after catheter insertion median
new dialysis catheter and new renal replacement therapy the first 7 days after dialysis catheter ablation number
Dialysis catheters infections the first 28 days after catheter insertion number
Duration of renal replacement therapy the first 28 days after catheter insertion days
Duration of mechanical ventilation the first 28 days after catheter insertion days
Duration of ICU stay the first 28 days after catheter insertion days
Mortality at at day 28 the first 28 days after catheter insertion number
Trial Locations
- Locations (1)
Alexandre Gros
🇫🇷Bordeaux, Aquitaine, France