On Demand Versus Protocol-guided Renal Replacement Therapy for Management of Stage 3 Acute Kidney Injury in Patients With Cirrhosis
28. november 2017 opdateret af: Institute of Liver and Biliary Sciences, India
On Demand Versus Protocol-guided Renal Replacement Therapy for Management of Stage 3 Acute Kidney Injury in Patients With Cirrhosis -A Prospective Randomized Controlled Trial
Intervention: All patients at presentation would be assessed for the underlying cause of and will be managed by removal of all precipitants(careful review of medications, diuretics, nephrotoxic drugs,vasodilators or non-steroidal anti-inflammatory drugs). The second step would be to consider plasma volume expansion in patients with hypovolemia (the choice of fluid could either be a crystalloid or albumin or even blood as indicated) along with identification and early treatment of bacterial infections. Along with this patients with a differential diagnosis of HRS-AKI would be given terlipressin ( or noradrenaline/octreotide midodrine in case of contraindication to terlipressin). Patients with a clinical diagnosis of ATN would be randomized to the on-demand versus protocol-guided dialysis groups. Further, patients with urine output of less than 0.5ml/kg/hour for 4-6 hours despite adequate fluid resuscitation and vasoconstrictors would also be subjected to randomization.
- In the on-demand group patients would get dialysis only when patient fulfills absolute criteria requiring dialysis such as metabolic acidosis with ph<7.2, hyperkalemia, refractory fluid overload (non-responsive to diuretics) or oliguria with urine output of less than 0.5ml/kg for more than 24-48 hours from the time of randomization
- In the protocol guided group patients all patients would be considered for dialysis within 6 hours of randomization After randomization patients would receive dialysis as three sessions per week of at least 4 h with a blood flow >200 mL/min and a dialysate flow >500 mL/min in intermittent group and as 20-25 mL/kg/h of effluent, by filtration and/or diffusion in continuous form until recovery of renal functions
Studieoversigt
Status
Ukendt
Betingelser
Intervention / Behandling
Undersøgelsestype
Interventionel
Tilmelding (Forventet)
2
Fase
- Ikke anvendelig
Kontakter og lokationer
Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.
Studiesteder
-
-
Delhi
-
New Delhi, Delhi, Indien, 110070
- Institute of liver and Biliary Sciences
-
-
Deltagelseskriterier
Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.
Berettigelseskriterier
Aldre berettiget til at studere
18 år til 65 år (Voksen, Ældre voksen)
Tager imod sunde frivillige
Ingen
Køn, der er berettiget til at studere
Alle
Beskrivelse
Inclusion Criteria:
- Patients with cirrhosis (diagnosed based on clinical, biochemical,radiological or histological diagnosis) with stage 3 Acute Kidney Injury defined as an increase of serum creatinine to more than 300 fold and more than 4 mg/dl.
Exclusion Criteria:
- Patients with age less than 18 years
- Severe known cardiopulmonary disease (structural or valvular heart disease, coronary artery disease, COPD Chronic Obstructive Pulmonary Disease)
- Pregnancy
- Chronic kidney disease on hemodialysis
- Patients with post renal obstructive AKI (Acute Kidney Injury), AKI (Acute Kidney Injury) suspected due to glomerulonephritis, interstitial nephritis or vasculitis based on clinical history and urine analysis
- Patients already meeting emergency criteria for immediate hemodialysis at the time of randomization (serum potassium>6 meq/lt, metabolic acidosis ph<7.12, acute pulmonary edema, severe volume overload with hypoxemia non-responsive to diuretic treatment)
- Patients transferred from other hospitals who have already been on hemodialysis before their arrival in the intensive care unit
- Extremely moribund patients with an expected life expectancy of less than 24 hours
- Failure to give informed consent from family members.
- Hemodynamic instability requiring very high dose of vasopressors.
Studieplan
Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
|---|---|
|
Eksperimentel: Protocol Guided-RRT
In the on-demand group patients would get dialysis only when patient fulfills absolute criteria requiring dialysis such as metabolic acidosis with ph<7.2, hyperkalemia, refractory fluid overload (non-responsive to diuretics) or oliguria with urine output of less than 0.5ml/kg for more than 24-48 hours from the time of randomization.
|
In the on-demand group patients would get dialysis only when patient fulfills absolute criteria requiring dialysis such as metabolic acidosis with ph<7.2, hyperkalemia, refractory fluid overload (non-responsive to diuretics) or oliguria with urine output of less than 0.5ml/kg for more than 24-48 hours from the time of randomization.
|
|
Aktiv komparator: On Demand-RRT
In the protocol guided group patients all patients would be considered for dialysis within 6 hours of randomization After randomization patients would receive dialysis as three sessions per week of at least 4 h with a blood flow >200 mL/min and a dialysate flow >500 mL/min in intermittent group and as 20-25 mL/kg/h of effluent, by filtration and/or diffusion in continuous form until recovery of renal functions
|
Patients to be randomized to the intervention as per standard of care
|
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Tidsramme |
|---|---|
|
Recovery of renal functions in both groups
Tidsramme: day 14
|
day 14
|
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Adverse effects of dialysis in the first session in both groups
Tidsramme: 48 hours
|
48 hours
|
|
|
Improvement in SOFA (by 2 points) scores in both groups
Tidsramme: 48 hours
|
48 hours
|
|
|
Improvement in MELD ( by 2 points) scores in both groups
Tidsramme: 48 hours
|
48 hours
|
|
|
Improvement in APACHE ( by 2 points) scores in both groups
Tidsramme: 48 hours
|
48 hours
|
|
|
Change to End Stage Renal Disease with requirement of maintenance hemodialysis at least twice a week in both groups
Tidsramme: 4 weeks
|
4 weeks
|
|
|
Improvement in renal functions in both groups
Tidsramme: 7 days
|
7 days
|
|
|
Mortality in both groups
Tidsramme: 1 month
|
1 month
|
|
|
Mortality in both groups
Tidsramme: 3 month
|
3 month
|
|
|
Response to vasoconstrictors in patients with Hepatorenal Syndrome-Acute Kidney Injury in both groups.
Tidsramme: 6 hours
|
Response as assessed by either improvement in urine output >0.5ml/kg/hour, acid-base status or renal functions.
|
6 hours
|
|
Response to vasoconstrictors in patients with Hepatorenal Syndrome-Acute Kidney Injury in both groups.
Tidsramme: 12 hours
|
Response as assessed by either improvement in urine output >0.5ml/kg/hour, acid-base status or renal functions.
|
12 hours
|
|
Response to vasoconstrictors in patients with Hepatorenal Syndrome-Acute Kidney Injury
Tidsramme: 24 hours
|
Response as assessed by either improvement in urine output >0.5ml/kg/hour, acid-base status or renal functions.
|
24 hours
|
|
Response to vasoconstrictors in patients with Hepatorenal Syndrome-Acute Kidney Injury in both groups
Tidsramme: 24 hours
|
Response as assessed by either improvement in urine output >0.5ml/kg/hour, acid-base status or renal functions.
|
24 hours
|
Samarbejdspartnere og efterforskere
Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.
Datoer for undersøgelser
Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.
Studer store datoer
Studiestart (Forventet)
1. juli 2018
Primær færdiggørelse (Forventet)
1. juli 2019
Studieafslutning (Forventet)
1. juli 2019
Datoer for studieregistrering
Først indsendt
17. oktober 2016
Først indsendt, der opfyldte QC-kriterier
17. oktober 2016
Først opslået (Skøn)
19. oktober 2016
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
29. november 2017
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
28. november 2017
Sidst verificeret
1. november 2017
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- ILBS-AKI-Cirrhosis
Plan for individuelle deltagerdata (IPD)
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