Acute Kidney Injury Clinical Trial
Official title:
PrEvalence of Acute and Chronic Kidney Disease Treated by Renal Replacement Therapy in the ICU Environment
A prospective international, multi-centre, prevalence study on the epidemiology of the use of renal replacement therapy for ICU patients who have acute kidney injury and chronic end stage kidney disease.
Acute kidney injury (AKI) is a common finding in intensive care unit (ICU) patients.
Approximately 30 to 65% of patients experience an episode of AKI, and 5% of ICU patients are
treated with renal replacement therapy. AKI is associated withimportant short term and
long-term morbidity as well as mortality, and therefore also with costs. Finally, there is a
close link between chronic kidney disease (CKD) and AKI. CKD patients are at greater risk
for developing AKI, and survivors of AKI treated with renal replacement therapy (AKI-RRT),
may develop chronic kidney disease (CKD) and end stage kidney disease (ESKD).
Different aspects of RRT modality may impact on outcomes, and data that have emerged over
the last decade have improved evidence and also rejected commonly accepted dogma. Initial
data suggested a better outcome when a higher dose of treatment was applied [5,6]. However,
one small and two large prospective randomised controlled trials failed to reproduce these
earlier findings. Observational data seems to suggest that continuous RRT (CRRT) modalities
are associated with better outcomes. However, relative small, randomized studies and
meta-analyses do not demonstrate such a benefit. Observational data suggests that CRRT is
associated with improved renal recovery, and also examining the data from the 2 large
randomized studies on intensity of RRT suggest that CRRT confers a benefit. Also, despite
RRT being available for over 50 years there are no clear consensus guidelines for the
initiation of RRT. A recent survey found that up to 89 different combinations of indications
are used. Recently, the Acute Kidney Injury Network and the Kidney Disease: Improving Global
Outcomes (KDIGO) group, formulated recommendations for this. Recent observational studies
indicated that commonly accepted cut offs such as serum urea concentration are probably not
that important. Furthermore, timing of initiation may have an effect on outcome. Some
studies suggest that early initiation is associated with better outcome, on the other hand
others could not demonstrate a benefit and have even demonstrated inferior outcomes.
The most recent survey in Europe showed that CRRT is the preferred modality among
intensivists, and that despite the recently published evidence treatment doses are similar
to those of a decade ago.
Data on the use of renal replacement therapy (RRT) for AKI and for CKD in ICU patients are
either on specific patient groups, such as cardiac surgery patients, based on surveys, or
dates back for at least a decade. Furthermore, these studies suffered from exclusion bias,
as patients who fulfilled criteria for initiation of RTT, but who were denied RRT, were not
considered. That this may be an important consideration is illustrated by findings from a
recent small single centre study that demonstrated similar mortality rate between RIFLE-F
patients who were and who were not treated with RRT. Therefore, the Acute Kidney Injury
Network (AKIN) recommended measuring the epidemiology of AKI.
The investigators anticipate that the evidence that has been generated on different topics
of RRT for ICU patients may have influenced current practice. Also, the investigators
anticipate regional differences in RRT practice.
;
Observational Model: Cohort, Time Perspective: Prospective
Status | Clinical Trial | Phase | |
---|---|---|---|
Recruiting |
NCT05538351 -
A Study to Support the Development of the Enhanced Fluid Assessment Tool for Patients With Acute Kidney Injury
|
||
Recruiting |
NCT06027788 -
CTSN Embolic Protection Trial
|
N/A | |
Completed |
NCT03938038 -
Guidance of Ultrasound in Intensive Care to Direct Euvolemia
|
N/A | |
Recruiting |
NCT05805709 -
A Patient-centered Trial of a Process-of-care Intervention in Hospitalized AKI Patients: the COPE-AKI Trial
|
N/A | |
Recruiting |
NCT05318196 -
Molecular Prediction of Development, Progression or Complications of Kidney, Immune or Transplantation-related Diseases
|
||
Recruiting |
NCT05897840 -
Continuous Central Venous Oxygen Saturation Measurement as a Tool to Predict Hemodynamic Instability Related to Renal Replacement Therapy in Critically Ill Patients
|
N/A | |
Recruiting |
NCT04986137 -
Fractional Excretion of Urea for the Differential Diagnosis of Acute Kidney Injury in Cirrhosis
|
||
Terminated |
NCT04293744 -
Acute Kidney Injury After Cardiac Surgery
|
N/A | |
Completed |
NCT04095143 -
Ultrasound Markers of Organ Congestion in Severe Acute Kidney Injury
|
||
Not yet recruiting |
NCT06026592 -
Detection of Plasma DNA of Renal Origin in Kidney Transplant Patients
|
||
Not yet recruiting |
NCT06064305 -
Transcriptional and Proteomic Analysis of Acute Kidney Injury
|
||
Terminated |
NCT03438877 -
Intensive Versus Regular Dosage For PD In AKI.
|
N/A | |
Terminated |
NCT03305549 -
Recovery After Dialysis-Requiring Acute Kidney Injury
|
N/A | |
Completed |
NCT05990660 -
Renal Assist Device (RAD) for Patients With Renal Insufficiency Undergoing Cardiac Surgery
|
N/A | |
Completed |
NCT04062994 -
A Clinical Decision Support Trial to Reduce Intraoperative Hypotension
|
||
Terminated |
NCT02860130 -
Clinical Evaluation of Use of Prismocitrate 18 in Patients Undergoing Acute Continuous Renal Replacement Therapy (CRRT)
|
Phase 3 | |
Completed |
NCT06000098 -
Consol Time and Acute Kidney Injury in Robotic-assisted Prostatectomy
|
||
Not yet recruiting |
NCT05548725 -
Relation Between Acute Kidney Injury and Mineral Bone Disease
|
||
Completed |
NCT02665377 -
Prevention of Akute Kidney Injury, Hearttransplant, ANP
|
Phase 3 | |
Terminated |
NCT03539861 -
Immunomodulatory Biomimetic Device to Treat Myocardial Stunning in End-stage Renal Disease Patients
|
N/A |