On Demand Versus Protocol-guided Renal Replacement Therapy for Management of Stage 3 Acute Kidney Injury in Patients With Cirrhosis
2017년 11월 28일 업데이트: 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
연구 개요
상태
알려지지 않은
연구 유형
중재적
등록 (예상)
2
단계
- 해당 없음
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연구 장소
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Delhi
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New Delhi, Delhi, 인도, 110070
- Institute of Liver and Biliary Sciences
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참여기준
연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.
자격 기준
공부할 수 있는 나이
18년 (성인, 고령자)
건강한 자원 봉사자를 받아들입니다
아니
연구 대상 성별
모두
설명
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.
공부 계획
이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 치료
- 할당: 무작위
- 중재 모델: 병렬 할당
- 마스킹: 없음(오픈 라벨)
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
|---|---|
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실험적: 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.
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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.
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활성 비교기: 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
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Patients to be randomized to the intervention as per standard of care
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연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
기간 |
|---|---|
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Recovery of renal functions in both groups
기간: day 14
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day 14
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2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
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Adverse effects of dialysis in the first session in both groups
기간: 48 hours
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48 hours
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Improvement in SOFA (by 2 points) scores in both groups
기간: 48 hours
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48 hours
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Improvement in MELD ( by 2 points) scores in both groups
기간: 48 hours
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48 hours
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Improvement in APACHE ( by 2 points) scores in both groups
기간: 48 hours
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48 hours
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Change to End Stage Renal Disease with requirement of maintenance hemodialysis at least twice a week in both groups
기간: 4 weeks
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4 weeks
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Improvement in renal functions in both groups
기간: 7 days
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7 days
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Mortality in both groups
기간: 1 month
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1 month
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Mortality in both groups
기간: 3 month
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3 month
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Response to vasoconstrictors in patients with Hepatorenal Syndrome-Acute Kidney Injury in both groups.
기간: 6 hours
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Response as assessed by either improvement in urine output >0.5ml/kg/hour, acid-base status or renal functions.
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6 hours
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Response to vasoconstrictors in patients with Hepatorenal Syndrome-Acute Kidney Injury in both groups.
기간: 12 hours
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Response as assessed by either improvement in urine output >0.5ml/kg/hour, acid-base status or renal functions.
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12 hours
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Response to vasoconstrictors in patients with Hepatorenal Syndrome-Acute Kidney Injury
기간: 24 hours
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Response as assessed by either improvement in urine output >0.5ml/kg/hour, acid-base status or renal functions.
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24 hours
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Response to vasoconstrictors in patients with Hepatorenal Syndrome-Acute Kidney Injury in both groups
기간: 24 hours
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Response as assessed by either improvement in urine output >0.5ml/kg/hour, acid-base status or renal functions.
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24 hours
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연구 기록 날짜
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연구 주요 날짜
연구 시작 (예상)
2018년 7월 1일
기본 완료 (예상)
2019년 7월 1일
연구 완료 (예상)
2019년 7월 1일
연구 등록 날짜
최초 제출
2016년 10월 17일
QC 기준을 충족하는 최초 제출
2016년 10월 17일
처음 게시됨 (추정)
2016년 10월 19일
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
2017년 11월 29일
QC 기준을 충족하는 마지막 업데이트 제출
2017년 11월 28일
마지막으로 확인됨
2017년 11월 1일
추가 정보
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