Phenotype Guided Vasoactive Medication During Kidney Transplantation
Intraoperative Circulation Phenotyping to Guide Vasoactive Medication in Kidney Transplant Recipients
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Phase 4
Contacts and Locations
Study Contact
Study Contact
- Name: Jennifer L Cutler, M.D.
- Phone Number: 310-497-4541
- Email: jennifer.cutler@cshs.org
Study Contact Backup
- Name: Leon Wang, M.D.
- Phone Number: 203-464-8236
- Email: leon.wang@cshs.org
Study Locations
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-
California
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Los Angeles, California, United States, 90048
- Cedars Sinai Medical Center
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-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Adults aged 18 years or older
- Undergoing kidney transplantation at Cedars-Sinai Medical Center
- Able to provide informed consent
Exclusion Criteria:
- Patients unable to provide informed consent
- Patients with contraindications to protocol vasoactive medications, as determined by the treating anesthesiologist
- Patients in whom required intraoperative monitoring cannot be performed
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Experimental: Phenotype-Guided Vasoactive Protocol
Recipients undergo intraoperative circulation phenotyping using pulse contour monitoring and fluid responsiveness testing.
Vasoactive support is assigned according to phenotype: vasopressin infusion for Hyperdynamic physiology, norepinephrine infusion for Mixed Physiology, calcium chloride and/or low-dose dopamine for Poor Contractility, and fluid-guided support for Normal physiology.
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Recipients undergo intraoperative circulation phenotyping using pulse contour monitoring and flow-pressure coupling testing.
Vasoactive support is assigned according to phenotype: vasopressin infusion for Hyperdynamic physiology, norepinephrine infusion for Mixed Physiology, calcium chloride and/or low-dose dopamine for Poor Contractility, and fluid-guided support for Normal physiology.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Positive Flow-Pressure Coupling Proportion in Hyperdynamic Phenotype as measured by pulse contour analysis on the Edwards Hemosphere
Time Frame: Intraoperative (from induction to end of surgery)
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Proportion of positive flow-pressure coupling responses among recipients classified intraoperatively as Hyperdynamic.
Flow-Pressure coupling is defined as demonstrating both fluid responsiveness and pressure responsiveness following a fluid responsiveness test.
Fluid responsiveness is defined as >= 10% increase in the stroke volume (ml/beat) and pressure responsiveness is defined as >= 15% in the mean arterial pressure (mmHg) 2 minutes after conclusion of the fluid responsiveness test.
Hyperdynamic phenotypes are defined as having the following hemodynamics: CI >4.0 L/min/m², SVRI <1970 dyn·s·cm-⁵/m², and dP/dt >1000 mmHg/s .
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Intraoperative (from induction to end of surgery)
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Characterization of flow-pressure coupling in Normal, Mixed Physiology, and Poor-contractility phenotypes as measured with pulse contour analysis on the Edwards Hemosphere
Time Frame: intraoperative
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Measurement of positive rate of FPC per FRT in all remaining circulatory phenotypes.
These phenotypes are defined by the following hemodynamics: • Normal phenotype: CI 2.5-4.0
L/min/m² and SVRI 1970-2390 dyn·s·cm-⁵/m² ; • Mixed physiology: CI 2.5-4.0
L/min/m², SVRI <1970 dyn·s·cm-⁵/m², and dP/dt <1000 mmHg/s and • Poor Contractility: CI <2.5 L/min/m² and dP/dt <1000 mmHg/s .
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intraoperative
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Analysis of intraoperative cardiac index (CI) measured with pulse contour analysis on the Edwards Hemosphere
Time Frame: intraoperative
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recording of CI L/min/m² as baseline, and after each FRT
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intraoperative
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Protocol Adherence
Time Frame: Intraoperative
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Proportion of intraoperative decision points consistent with the phenotype-guided protocol.
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Intraoperative
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Analysis of Intraoperative Systemic vascular resistance index (SVRI) measured with pulse contour analysis on the Edwards Hemosphere
Time Frame: intraoperative
|
Recording of SVRI dyn·s·cm-⁵/m² as baseline, and after each FRT
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intraoperative
|
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Analysis of Intraoperative mean arterial pressure (MAP) measured with pulse contour analysis on the Edwards Hemosphere
Time Frame: intraoperative
|
recording of MAP mmHg as baseline and after each FRT
|
intraoperative
|
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Analysis of Intraoperative Contractility (dP/dt) measured with pulse contour analysis on the Edwards Hemosphere.
Time Frame: intraoperative
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Recording of dP/dt mmHg/s as baseline and after each FRT
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intraoperative
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Analysis of Intraoperative EaDyn (PPV/SVV) with pulse contour analysis on the Edwards Hemosphere
Time Frame: intraoperative
|
Recording of EaDyn (PPV/SVV) as baseline and after each FRT
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intraoperative
|
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Recording of delayed graft function, defined as the need for dialysis within the first week following kidney transplantation
Time Frame: Postoperative day 0 to postoperative day 7
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Delayed graft function will be recorded as yes or no
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Postoperative day 0 to postoperative day 7
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Collaborators and Investigators
Sponsor
Sponsor
Study record dates
Study Major Dates
Study Start (Estimated)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Peptide Hormones
- Neuropeptides
- Peptides
- Amino Acids, Peptides, and Proteins
- Oligopeptides
- Nerve Tissue Proteins
- Proteins
- Organic Chemicals
- Hydrocarbons
- Hydrocarbons, Cyclic
- Hydrocarbons, Aromatic
- Amines
- Inorganic Chemicals
- Chlorine Compounds
- Catechols
- Phenols
- Benzene Derivatives
- Alcohols
- Amino Alcohols
- Ethanolamines
- Biogenic Monoamines
- Biogenic Amines
- Catecholamines
- Calcium Compounds
- Pituitary Hormones, Posterior
- Pituitary Hormones
- Chlorides
- Hydrochloric Acid
- Norepinephrine
- Vasopressins
- Dopamine
- Calcium Chloride
Other Study ID Numbers
Other Study ID Numbers
- IRB Study 4762
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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