WISDOM UK: Low Dose-intensity Versus Standard Dose-intensity CRRT in Critically Ill Patients (WISDOM UK)

WISDOM UK: Low Dose-intensity Versus Standard Dose-intensity Continuous Renal Replacement Therapy in Critically Ill Patients: a Randomized Trial

Acute kidney injury is a potentially life threatening condition which affects 1 in 2 patients in the Intensive Care Unit (ICU). Patients often need dialysis treatment, also called renal replacement therapy. Renal replacement therapy is a treatment that removes toxins and excess fluid from the blood stream. It consists of having a small plastic catheter in a vein in the neck or in the groin through which blood flows through a dialysis machine and is cleansed and excess water is removed. The cleansed blood is then returned to the patient via the same catheter.

One of the major areas of uncertainty for doctors in the ICU is "What is the right intensity of renal replacement therapy for patients with acute kidney injury?" A higher intensity indeed removes more toxins but also removes other substances in the blood, including vitamins, nutrients and important medications. The current usual dose is around 25 ml/kg/hr but clinical practice in the UK is very variable and some patients routinely receive higher doses and some get lower doses. Data from large databases worldwide have suggested that a lower dose is safe and effective and may potentially allow the kidneys to recover faster but confirmation is lacking.

In this study, the investigators investigate whether renal replacement therapy at a lower intensity is as effective and safe as currently used doses. Participants will be randomised to receiving renal replacement therapy at usual or lower intensity. There will be no change to any other aspects of treatment.

The results will inform the investigators whether the study protocol is feasible and how best to design a future larger research study.

Study Overview

• Status: Recruiting
• Conditions: Dialysis; Complications; Acute Kidney Injury (Nontraumatic)
• Intervention / Treatment: Procedure: low intensity of CRRT; Procedure: usual intensity of CRRT

Detailed Description

Acute kidney injury is a potentially life threatening condition which affects 1 in 2 patients in the Intensive Care Unit (ICU). Patients often need dialysis treatment, also called renal replacement therapy. Renal replacement therapy is a treatment that removes toxins and excess fluid from the blood stream. It consists of having a small plastic catheter in a vein in the neck or in the groin through which blood flows through a dialysis machine and is cleansed and excess water is removed. The cleansed blood is then returned to the patient via the same catheter.

One of the major areas of uncertainty for doctors in the ICU is "What is the right intensity of renal replacement therapy for patients with acute kidney injury?" A higher intensity indeed removes more toxins but also removes other substances in the blood, including vitamins, nutrients and important medications. The current usual dose is around 25 ml/kg/hr but clinical practice in the UK is very variable and some patients routinely receive higher doses and some get lower doses. Data from large databases worldwide have suggested that a lower dose is safe and effective and may potentially allow the kidneys to recover faster but confirmation is lacking.

In this study, the investigators investigate whether renal replacement therapy at a lower intensity is as effective and safe as currently used doses. Participants will be randomised to receiving renal replacement therapy at usual or lower intensity. There will be no change to any other aspects of treatment.

The investigators aim to recruit 20 patients in the UK. Fully anonymised results will be shared with researchers in Canada who are conducting the same study.

• Study Type: Interventional
• Enrollment (Estimated): 20
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Marlies Ostermann, PhD; Phone Number: +442071883036; Email: m.ostermann@nhs.net
• Study Contact Backup: Name: Gillian Radcliffe; Phone Number: 00442071883036; Email: gill.radcliffe@nhs.net

Study Locations

• United Kingdom
  • Greater London
    • London, Greater London, United Kingdom, SE1 7EH
      • Recruiting
      • Guy's & St Thomas' Hospital
      • Contact: Marlies Ostermann; Phone Number: 07742514213; Email: Marlies.Ostermann@gstt.nhs.uk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• age ≥ 18 years
• patient weight ≥ 55 kg
• plan to start CRRT or within 24 hours of having started CRRT for AKI
• expected to survive and receive CRRT for a duration of ≥ 48 hours

Exclusion Criteria:

• indication for sustained higher dose-intensity CRRT
• end-stage kidney disease receiving maintenance dialysis
• previous receipt of RRT for AKI during the current hospitalization
• inability to comply with the requirements of the study protocol

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Low dose RRT; dose of CRRT 10-15ml/kg/hr	Procedure: low intensity of CRRT; usual intensity CRRT
Active Comparator: standard dose RRT; usual intensity CRRT at dose determined by clinical team	Procedure: usual intensity of CRRT; usual intensity

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
total delivered effluent rate	difference in the total delivered effluent rate per patient	7 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility endpoints	number of enrolled patients	12 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
adverse events	number of trial related adverse events per patient	14 days

Collaborators and Investigators

• Sponsor: Guy's and St Thomas' NHS Foundation Trust
• Investigators: Study Chair: Gillian Radcliffe, Guy's & St. Thomas Hospital

Study record dates

Study Major Dates

• Study Start (Actual): February 15, 2025
• Primary Completion (Estimated): January 31, 2027
• Study Completion (Estimated): March 30, 2027

Study Registration Dates

• First Submitted: February 26, 2026
• First Submitted That Met QC Criteria: February 26, 2026
• First Posted (Actual): March 3, 2026

Study Record Updates

• Last Update Posted (Actual): March 5, 2026
• Last Update Submitted That Met QC Criteria: March 3, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: acute kidney injury; dose; renal replacement therapy
• Additional Relevant MeSH Terms: Urogenital Diseases; Male Urogenital Diseases; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Renal Insufficiency; Acute Kidney Injury
• Other Study ID Numbers: WISDOM UK

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No