Essential Nutrients in Critically Ill Patients With Severe AKI Treated With and Without CRRT

Observational Study Measuring Essential Nutrients in Critically Ill Patients With Severe Acute Kidney Injury Treated With and Without Continuous Haemofiltration

The aim of this study is to measure plasma levels of essential vitamins, trace elements and amino acids in critically ill patients with severe AKI. In patients who are treated with continuous renal replacement therapy, we plan to evaluate whether there are any additional losses of nutrients into the filtrate.

Study Overview

• Status: Completed
• Conditions: Acute Kidney Failure
• Intervention / Treatment: Procedure: CRRT

Detailed Description

Background: Critically ill patients with acute kidney injury (AKI) have a high risk of dying, especially if renal replacement therapy (RRT) is needed. It remains uncertain whether essential trace elements, vitamins and amino acids are lost during RRT in sufficient amounts to result in clinically significant deficiencies. At present, nutrition guidelines for patients with AKI on RRT do not account for any potential losses of micronutrients across the filter.

Hypothesis:

Critically ill patients with AKI have inadequate plasma nutrient levels. If continuous renal replacement therapy (CRRT) is required, there are additional losses of essential nutrients.

Aims:

To serially measure plasma levels of essential vitamins, trace elements and amino acids in critically ill patients with severe AKI and to evaluate whether there are any additional losses into the filtrate during CRRT

Objectives:

To perform serial measurements of plasma levels of selenium, zinc, copper, iron, vitamins B1, B6, B12, C and D, folic acid and essential amino acids in all patients with severe AKI and to measure any losses of the same nutrients in the filtrate in a cohort of patients on CRRT for >24 hours.

Patient population:

level 3 critically ill adult patients with severe AKI

Study size:

40 patients of whom 20 patients are treated with CRRT for >24 hours.

Study design:

observational non-interventional study in at least 2 large tertiary care centres in the United Kingdom

Outcomes:

Primary outcome: difference in plasma concentrations of essential trace elements and vitamins between patients with and without CRRT.

Secondary outcomes: a) concentrations of trace elements, vitamins and amino acids in filtrate in patients on CRRT; b) differences in filtrate losses between patients on CRRT ≤30ml/kg/hr versus >30ml/kg/hr.

Laboratory measurements:

Measurement of baseline plasma Selenium, Zinc, Copper, iron, Vitamins B1, B6, B12, C and D, folic acid and essential amino acids levels and repeat serial measurement of the same panel of nutrients in all patients for up to 6 days with additional concomitant measurement of nutrient levels in filtrate in cohort of patients on CRRT. In addition, daily measurement of serum electrolytes, liver profile, serum albumin and c-reactive protein.

Data collection:

Recording of the following potential confounders: type of nutrition, dose of CRRT, type of membrane.

Statistics:

Determination of the change in plasma nutrient levels over 6 days, and between baseline and 24 - 144 hours after initiation of CRRT. The estimates will be used to inform the design of an intervention study exploring the value of nutrient supplementation.

• Study Type: Observational
• Enrollment (Actual): 40

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Critically ill patients with severe acute kidney injury

Description

Inclusion Criteria:

• adult patients in the Critical Care Unit with severe AKI

Exclusion Criteria:

• pre-existing dialysis dependent renal failure
• life expectancy <48 hours
• need for total parenteral nutrition
• need for supplementation with intravenous multivitamins or trace elements
• Jehovah's witness
• patients with haemoglobin <7g/dL (unless being transfused for clinical reasons)

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
AKI without CRRT; Patients with AKI who are not treated with continuous renal replacement therapy
AKI with CRRT; Patients with AKI who are treated with continuous renal replacement therapy	Procedure: CRRT; continuous renal replacement therapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
serum levels of essential nutrients	up to 6 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
levels of essential nutrients in filtrate	concentrations of trace elements, vitamins and amino acids in filtrate in patients on CRRT	up to 6 days

Collaborators and Investigators

• Sponsor: Guy's and St Thomas' NHS Foundation Trust

Study record dates

Study Major Dates

• Study Start: August 1, 2013
• Primary Completion (Actual): November 1, 2014
• Study Completion (Actual): November 1, 2015

Study Registration Dates

• First Submitted: June 10, 2015
• First Submitted That Met QC Criteria: June 11, 2015
• First Posted (Estimate): June 12, 2015

Study Record Updates

• Last Update Posted (Estimate): May 17, 2016
• Last Update Submitted That Met QC Criteria: May 16, 2016
• Last Verified: May 1, 2016

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Kidney Diseases; Urologic Diseases; Renal Insufficiency; Acute Kidney Injury
• Other Study ID Numbers: RJ113/N062