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Volume Removal Intolerance During Net Ultrafiltration in Acute Kidney Injury Patients (VINKO)

2026年7月5日 更新者：Gonzalo Ramirez Guerrero、Hospital Las Higueras

Acute kidney injury (AKI) is common in critically ill patients and is frequently associated with fluid overload, which can worsen clinical outcomes. Continuous renal replacement therapy (CRRT) allows fluid removal through net ultrafiltration (UFNET), but some patients develop hemodynamic instability or signs of poor tissue perfusion during this process.

The purpose of this prospective observational study is to evaluate tolerance to net ultrafiltration in critically ill patients with AKI receiving CRRT. The study will assess clinical, hemodynamic, ultrasound, perfusion, and biochemical parameters before and during fluid removal to identify factors associated with ultrafiltration intolerance.

The investigators hypothesize that alterations in hemodynamic, perfusion, and congestion-related parameters can identify patients at increased risk of ultrafiltration intolerance before the development of overt hypotension. The results may help improve individualized fluid removal strategies and optimize the safety of CRRT in critically ill patients.

研究概览

地位

招聘中

条件

详细说明

Fluid overload is a frequent and clinically relevant complication in critically ill patients with acute kidney injury (AKI). In this setting, continuous renal replacement therapy (CRRT) is frequently used not only for solute control but also as a strategy for controlled fluid removal through net ultrafiltration (UFNET). Although UFNET is central to de-resuscitation, the individual tolerance to fluid removal is highly variable and is not fully captured by blood pressure monitoring alone.

The concept of ultrafiltration intolerance remains poorly standardized. In clinical practice, intolerance is often recognized only after overt hemodynamic instability occurs, such as hypotension, escalation of vasoactive support, or interruption of fluid removal. However, reductions in cardiac output, impaired tissue perfusion, or worsening venous congestion may precede overt hypotension. Therefore, a multiparametric assessment may allow earlier identification of patients at risk.

This is a prospective, observational, analytical study in critically ill adult patients with AKI receiving CRRT with prescribed UFNET. The study does not assign or modify therapeutic interventions. CRRT modality, anticoagulation strategy, UFNET prescription, vasopressor management, fluid administration, and all other clinical decisions will remain under the responsibility of the treating clinical team according to routine care.

The study will characterize the physiological response to UFNET using a structured multiparametric monitoring approach. Recorded domains will include conventional macrohemodynamic variables, vasoactive support, selected advanced hemodynamic variables when available, focused cardiac ultrasound, venous congestion assessment, peripheral perfusion parameters, fluid balance variables, and selected biochemical markers. Functional hemodynamic maneuvers may be performed when feasible and clinically safe.

Data will be collected prospectively using a standardized case report form. Variables will be recorded at predefined time points before and during the early phase of UFNET, with additional off-schedule recordings if clinical signs compatible with intolerance occur. Source data will be obtained from the electronic or paper medical record, bedside monitoring systems, CRRT prescription and treatment records, laboratory results, and ultrasound assessments performed as part of clinical evaluation.

A data dictionary will define each variable, including its source, units, coding, and expected physiological range when applicable. Data quality procedures will include review of completeness, range checks, consistency checks between related variables, and verification of clinically implausible values against source records. The research team will periodically review entered data to identify missing, inconsistent, or out-of-range values.

Data will be anonymized before analysis. No directly identifiable patient information will be stored in the final analytical database. Access to the study database will be restricted to authorized study investigators. Data will be stored using password-protected institutional or investigator-controlled systems according to local confidentiality and ethical requirements.

The planned sample size is 128 participants, including an estimated analytical sample of 116 participants and an approximate 10% over-recruitment to account for incomplete data, missing assessments, or inability to definitively adjudicate the outcome. The sample size was based on an analytical case-control approach aimed at identifying factors associated with ultrafiltration intolerance.

Missing data will be evaluated before statistical analysis. Variables with substantial missingness may be excluded from inferential analyses. For variables with acceptable levels of missingness, available-case analysis will be performed. The extent and pattern of missing data will be reported.

Statistical analysis will include descriptive statistics, comparison between patients who develop ultrafiltration intolerance and those who do not, and exploratory modeling to identify factors independently associated with intolerance. Continuous variables will be summarized using median and interquartile range or mean and standard deviation, as appropriate. Categorical variables will be summarized as frequencies and percentages. Group comparisons will be performed using appropriate parametric or non-parametric tests according to data distribution. Multivariable logistic regression may be used to explore independent predictors, with covariate selection based on clinical relevance and number of events.

The overall objective of this study is to improve the characterization of ultrafiltration intolerance during CRRT and to generate evidence that may support individualized, physiology-guided fluid removal strategies in critically ill patients with AKI.

研究类型

观察性的

注册 (估计的)

128

联系人和位置

本节提供了进行研究的人员的详细联系信息，以及有关进行该研究的地点的信息。

学习联系方式

研究联系人备份

学习地点

  • 厄瓜多尔
      • Quito、厄瓜多尔
        • 尚未招聘
        • Hospital General Enrique Garces
        • 接触：
  • 哥伦比亚
      • Popayán、哥伦比亚
        • 招聘中
        • Hospital Universitario San José de Popayán
        • 接触：
  • 墨西哥
      • Mexico City、墨西哥
  • 巴西
      • Salvador、巴西
        • 尚未招聘
        • Hospital Cardio Pulmonar
        • 接触：
  • 意大利
      • Vicenza、意大利
  • 智利
      • Concepción、智利
        • 尚未招聘
        • Hospital Clínico Regional de Concepción
        • 接触：
      • Los Ángeles、智利
        • 尚未招聘
        • Complejo Asistencial Dr. Victor Ríos Ruiz
        • 接触：
      • Santiago、智利
        • 尚未招聘
        • Hospital Clínico Dra. Eloísa Díaz Insunza de La Florida
        • 接触：
      • Talcahuano、智利
        • 招聘中
        • Hospital Las Higueras de Talcahuano
        • 接触：
        • 接触：
        • 副研究员：
          • Rodrigo Ulloa, MD
        • 副研究员：
          • Jonathan Alarcón, MD
        • 副研究员：
          • Ricardo Ferrada, MD
  • 秘鲁
      • Lima、秘鲁

参与标准

研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。

资格标准

适合学习的年龄

  • 成人
  • 年长者

接受健康志愿者

不

取样方法

非概率样本

研究人群

Adult critically ill patients admitted to participating intensive care units with acute kidney injury requiring continuous renal replacement therapy and prescribed net ultrafiltration as part of routine clinical care.

描述

Inclusion Criteria:

  • Age ≥18 years
  • Admission to an Intensive Care Unit
  • Acute kidney injury according to KDIGO criteria
  • Prescription of continuous renal replacement therapy (CRRT) with net ultrafiltration
  • Clinical stability considered sufficient to initiate net ultrafiltration according to the treating clinical team

Exclusion Criteria:

  • Chronic kidney replacement therapy prior to ICU admission
  • Pregnancy
  • Limitation of therapeutic effort or goals-of-care decisions at admission or during the observation period
  • Inability to perform hemodynamic or perfusion assessment
  • Extracorporeal membrane oxygenation (ECMO)
  • Refusal to participate in the study

学习计划

本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。

研究是如何设计的？

设计细节

队列和干预

团体/队列
AKI Patients Receiving CRRT With Net Ultrafiltration
Adult critically ill patients with acute kidney injury receiving continuous renal replacement therapy with prescribed net ultrafiltration. Participants will be prospectively evaluated using a multiparametric monitoring strategy including clinical, hemodynamic, ultrasound, perfusion, and biochemical assessments. Patients will subsequently be classified according to the development or absence of ultrafiltration intolerance during the observation period.

研究衡量的是什么？

主要结果指标

结果测量
措施说明
大体时间
Development of Ultrafiltration Intolerance
大体时间：From UFNET initiation (T0) to 24 hours after initiation of net ultrafiltration
Proportion of patients who develop ultrafiltration intolerance according to the protocol-defined composite criteria, including hypotension, increased vasopressor requirements, worsening peripheral perfusion, tissue hypoperfusion, or reduction/interruption of ultrafiltration due to instability.
From UFNET initiation (T0) to 24 hours after initiation of net ultrafiltration

次要结果测量

结果测量
措施说明
大体时间
Incidence of Ultrafiltration Intolerance
大体时间：From UFNET initiation (T0) to 24 hours.
Percentage of participants who develop ultrafiltration intolerance during the observation period.
From UFNET initiation (T0) to 24 hours.
Net Ultrafiltration Rate (mL/kg/h)
大体时间：From UFNET initiation (T0) to 24 hours.
Prescribed and achieved net ultrafiltration rate during continuous renal replacement therapy.
From UFNET initiation (T0) to 24 hours.
Time to First Ultrafiltration Intolerance Event (hours)
大体时间：From UFNET initiation to 24 hours.
Time from UFNET initiation to the first occurrence of ultrafiltration intolerance.
From UFNET initiation to 24 hours.
Severity Category of Ultrafiltration Intolerance
大体时间：From UFNET initiation to 24 hours.
Proportion of participants classified as having mild, moderate, or severe ultrafiltration intolerance according to protocol-defined criteria. Higher categories indicate greater severity of intolerance.
From UFNET initiation to 24 hours.
Agreement Between Hypotension-Based and Hypoperfusion-Based Definitions of Ultrafiltration Intolerance
大体时间：From UFNET initiation to 24 hours.
Agreement between intolerance defined by hypotension criteria and intolerance defined by tissue hypoperfusion criteria, assessed using Cohen's kappa coefficient.
From UFNET initiation to 24 hours.
Cumulative Fluid Balance (mL)
大体时间：24 hours after UFNET initiation
Cumulative fluid balance achieved during the first 24 hours following UFNET initiation.
24 hours after UFNET initiation
Achieved Net Ultrafiltration Volume (mL)
大体时间：24 hours after UFNET initiation
Total net ultrafiltration volume achieved during the observation period.
24 hours after UFNET initiation
Proportion of Participants Achieving Renal Recovery
大体时间：Up to 90 days after UFNET initiation
Percentage of participants who recover kidney function sufficiently to discontinue kidney replacement therapy according to the treating clinical team.
Up to 90 days after UFNET initiation
Ventilator-Free Days
大体时间：Up to 28 days after UFNET initiation
Number of days alive and free from invasive mechanical ventilation.
Up to 28 days after UFNET initiation
Intensive Care Unit Mortality
大体时间：From UFNET initiation up to 90 days or ICU discharge, whichever occurs first
Percentage of participants who die during intensive care unit admission.
From UFNET initiation up to 90 days or ICU discharge, whichever occurs first
Hospital Mortality
大体时间：From UFNET initiation until hospital discharge, assessed up to 180 days
Percentage of participants who die during hospital admission.
From UFNET initiation until hospital discharge, assessed up to 180 days

合作者和调查者

在这里您可以找到参与这项研究的人员和组织。

赞助

Hospital Las Higueras

调查人员

  • 首席研究员：Gonzalo Ramírez-Guerrero, MD、Hospital Las Higueras de Talcahuano

出版物和有用的链接

负责输入研究信息的人员自愿提供这些出版物。这些可能与研究有关。

一般刊物

研究记录日期

这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。

研究主要日期

学习开始 (实际的)

2026年7月6日

初级完成 (估计的)

2027年12月1日

研究完成 (估计的)

2027年12月1日

研究注册日期

首次提交

2026年6月1日

首先提交符合 QC 标准的

2026年6月9日

首次发布 (实际的)

2026年6月11日

研究记录更新

最后更新发布 (实际的)

2026年7月8日

上次提交的符合 QC 标准的更新

2026年7月5日

最后验证

2026年7月1日

更多信息

与本研究相关的术语

关键字

其他相关的 MeSH 术语

其他研究编号

  • CEC-SST-15-2026

计划个人参与者数据 (IPD)

计划共享个人参与者数据 (IPD)？

未定

IPD 计划说明

The investigators have not yet determined whether individual participant data (IPD) will be shared. Any future decision regarding data sharing will be made in accordance with institutional policies, ethical approvals, participant confidentiality requirements, and applicable regulations.

药物和器械信息、研究文件

研究美国 FDA 监管的药品

不

研究美国 FDA 监管的设备产品

不

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