Venous Return Pressure Gradient Predicts Acute Kidney Injury Onset and Progression
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 180
- 主要终点
- Acute Kidney Injury occurrence
研究概览
简要总结
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.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 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
- •Age ≥18 years
- •Admitted to the intensive care unit (ICU) within 48 hours
- •Central venous catheter in place for continuous central venous pressure (CVP) monitoring
- •Radial artery catheter in place for hemodynamic monitoring including mean systemic filling pressure (Pmsf)
- •No acute kidney injury (AKI) at ICU admission according to KDIGO criteria
排除标准
- •Maintenance hemodialysis or continuous renal replacement therapy (CRRT) prior to ICU admission
- •Previous kidney transplantation
- •Extracorporeal membrane oxygenation (ECMO) support at ICU admission
- •Incomplete core hemodynamic data precluding calculation of venous return pressure gradient (Pmsf-CVP) or AKI assessment
结局指标
主要结局
Acute Kidney Injury occurrence
时间窗: 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.
次要结局
- Persistent Acute Kidney Injury(Within 48 hours after AKI occurrence during the ICU stay)
- AKI severity grade(At the time of maximum AKI stage during the ICU stay, up to 28 days)
- In-hospital mortality(From ICU admission to hospital discharge, up to 90 days)
- Total length of hospital stay(From hospital admission to discharge or death, up to 90 days)
- Correlation between venous return pressure gradient and serum creatinine(Within 48 hours of ICU admission)
- Correlation between venous return pressure gradient and lactate(Within 48 hours of ICU admission)
- Duration of mechanical ventilation(From intubation to first successful extubation)
- Length of ICU stay(From ICU admission to ICU discharge)
研究者
Rongan Liu
Associate Chief Physician, Intensive Care Unit
Sichuan Academy of Medical Sciences