Clinical Trials Logo
  1. Home
  2. Shock
  3. NCT05898126

Renin-guided Hemodynamic Management in Patients With Shock — RENIN  

Shock Clinical Trial

Official title:
Effect of Personalized Hemodynamic Management Based on Serum Renin Concentration on Acute Kidney Injury Progression in Patients With Shock: a Randomized Controlled Trial.

Clinical Trial Summary

Shock is a major risk factor for mortality among patients admitted to intensive care units (ICUs). Since various hemodynamic strategies uniformly delivered to patients with shock have failed to improve clinically relevant outcomes, individualized approaches for shock supported by robust evidence are required. This study will be a prospective, multicenter, parallel-group, single-blind, randomized controlled trial. The investigators will randomly assign 800 critically ill patients requiring norepinephrine infusion to the renin-guided or usual care groups. The investigators hypothesize that renin-guided hemodynamic management, compared to usual care, can reduce a composite of mortality and acute kidney injury (AKI) progression in patients requiring vasopressor support.

Clinical Trial Description

Shock is a common cause of death among patients admitted to intensive care units. Acute kidney injury (AKI) frequently occurs in patients with shock (3, 4). Maintaining adequate perfusion pressure and oxygen delivery is crucial in the hemodynamic management of shock (5). Several randomized controlled trials have evaluated the effect of various hemodynamic protocols treating shock patients with a "one size fits all" approach. However, such protocols did not reduce mortality (6-8). The task force of the surviving sepsis campaign identified the personalization of sepsis resuscitation as a research priority (9). Moreover, a large RCT showed that personalizing blood pressure targets reduced the risk of postoperative organ dysfunction in patients undergoing major surgery (10). These findings suggest that applying individualized hemodynamic strategy may optimize shock treatment and potentially improve outcomes (11). Recent studies have investigated renin as a novel marker of tissue hypoperfusion in critically ill patients. While serum lactate level has been the most common and validated marker for tissue hypoperfusion (12), several studies are now suggesting that renin may predict mortality better than lactate in critically ill patients (13, 14). Notably, relative renin increase is associated with adverse clinical outcomes and shock reversal has been shown to decrease renin concentration (15). The investigators aim to perform the Randomized Evaluation of persoNalized hemodynamIc maNagement based on serum renin concentration (RENIN) trial to test the hypothesis that renin-guided hemodynamic management can reduce a composite of mortality and acute kidney injury (AKI) progression during the hospital stay in patients requiring vasopressors compared with usual care. ;

Study Design

Related Conditions & MeSH terms

Clinical Trial Details
NCT number NCT05898126
Study type Interventional
Source Università Vita-Salute San Raffaele
Contact Alessandro Belletti, MD
Phone 0039 0226436151
Email belletti.alessandro@hsr.it
Status Not yet recruiting
Phase N/A
Start date September 5, 2024
Completion date July 28, 2027
View Details
See also
  Status Clinical Trial Phase
Completed NCT05563701 - Evaluation of the LVivo Image Quality Scoring (IQS)
Recruiting NCT05066256 - LV Diastolic Function vs IVC Diameter Variation as Predictor of Fluid Responsiveness in Shock N/A
Not yet recruiting NCT05649891 - Checklists Resuscitation Emergency Department N/A
Terminated NCT02755155 - Optimization of Therapeutic Human Serum Albumin Infusion in Selected Critically Ill Patients Phase 4
Not yet recruiting NCT01941472 - Transcutaneous pO2, Transcutaneous pCO2 and Central Venous pO2 Variations to Predict Fluid Responsiveness N/A
Completed NCT01680783 - Non-Invasive Ventilation Via a Helmet Device for Patients Respiratory Failure N/A
Terminated NCT01696175 - PICU Admission Lactate and Central Venous Oxymetry Study N/A
Recruiting NCT01174966 - Assessment of Transcutaneous Oxygen Tension/Oxygen Challenge Test in Intensive Care Unit (ICU) Patients N/A
Recruiting NCT01157299 - Hemodynamic Evaluation of Preload Responsiveness in Children by Using PiCCO N/A
Completed NCT00743522 - Programming Implantable Cardioverter Defibrillators in Patients With Primary Prevention Indication
Completed NCT03296891 - Point of Care Ultrasonography In The Management of Shock: A Pilot Study N/A
Not yet recruiting NCT05922982 - Norepinephrine Weaning Guided by the Hypotension Prediction Index in Vasoplegic Shock After Cardiac Surgery N/A
Withdrawn NCT04705701 - Comparing Post Cardiac Surgery Outcomes in ESRD Patient's With Early Dialysis Versus Standard Care N/A
Recruiting NCT04615065 - Acutelines: a Large Data-/Biobank of Acute and Emergency Medicine
Completed NCT05330676 - Evaluation of Microcirculatory Function and Mitochondrial Respiration After Cardiovascular Surgery
Active, not recruiting NCT04079829 - Postoperative Respiratory Abnormalities
Completed NCT04089098 - VOLume and Vasopressor Therapy in Patients With Hemodynamic instAbility
Completed NCT03190408 - Variation in Fluids Administered in Shock
Completed NCT05193123 - Psychological Trauma and Resilience After Critical Illness
Recruiting NCT05092165 - Methylene Blue for the Prevention of Hypotension During Hemodialysis Phase 2