On Demand Versus Protocol-guided Renal Replacement Therapy for Management of Stage 3 Acute Kidney Injury in Patients With Cirrhosis
28 novembre 2017 aggiornato da: 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
Panoramica dello studio
Stato
Sconosciuto
Condizioni
Intervento / Trattamento
Tipo di studio
Interventistico
Iscrizione (Anticipato)
2
Fase
- Non applicabile
Contatti e Sedi
Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.
Luoghi di studio
-
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Delhi
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New Delhi, Delhi, India, 110070
- Institute of liver and Biliary Sciences
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-
Criteri di partecipazione
I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.
Criteri di ammissibilità
Età idonea allo studio
Da 18 anni a 65 anni (Adulto, Adulto più anziano)
Accetta volontari sani
No
Sessi ammissibili allo studio
Tutto
Descrizione
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.
Piano di studio
Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Nessuno (etichetta aperta)
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
|---|---|
|
Sperimentale: 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.
|
|
Comparatore attivo: 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
|
Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Lasso di tempo |
|---|---|
|
Recovery of renal functions in both groups
Lasso di tempo: day 14
|
day 14
|
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Adverse effects of dialysis in the first session in both groups
Lasso di tempo: 48 hours
|
48 hours
|
|
|
Improvement in SOFA (by 2 points) scores in both groups
Lasso di tempo: 48 hours
|
48 hours
|
|
|
Improvement in MELD ( by 2 points) scores in both groups
Lasso di tempo: 48 hours
|
48 hours
|
|
|
Improvement in APACHE ( by 2 points) scores in both groups
Lasso di tempo: 48 hours
|
48 hours
|
|
|
Change to End Stage Renal Disease with requirement of maintenance hemodialysis at least twice a week in both groups
Lasso di tempo: 4 weeks
|
4 weeks
|
|
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Improvement in renal functions in both groups
Lasso di tempo: 7 days
|
7 days
|
|
|
Mortality in both groups
Lasso di tempo: 1 month
|
1 month
|
|
|
Mortality in both groups
Lasso di tempo: 3 month
|
3 month
|
|
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Response to vasoconstrictors in patients with Hepatorenal Syndrome-Acute Kidney Injury in both groups.
Lasso di tempo: 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.
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 24 hours
|
Response as assessed by either improvement in urine output >0.5ml/kg/hour, acid-base status or renal functions.
|
24 hours
|
Collaboratori e investigatori
Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.
Studiare le date dei record
Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.
Studia le date principali
Inizio studio (Anticipato)
1 luglio 2018
Completamento primario (Anticipato)
1 luglio 2019
Completamento dello studio (Anticipato)
1 luglio 2019
Date di iscrizione allo studio
Primo inviato
17 ottobre 2016
Primo inviato che soddisfa i criteri di controllo qualità
17 ottobre 2016
Primo Inserito (Stima)
19 ottobre 2016
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
29 novembre 2017
Ultimo aggiornamento inviato che soddisfa i criteri QC
28 novembre 2017
Ultimo verificato
1 novembre 2017
Maggiori informazioni
Termini relativi a questo studio
Termini MeSH pertinenti aggiuntivi
Altri numeri di identificazione dello studio
- ILBS-AKI-Cirrhosis
Piano per i dati dei singoli partecipanti (IPD)
Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?
NO
Informazioni su farmaci e dispositivi, documenti di studio
Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti
No
Studia un dispositivo regolamentato dalla FDA degli Stati Uniti
No
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