Observational studies among patients with acute kidney injury (AKI) have shown an association with fluid accumulation and increased mortality. Trials among other subgroups of critically ill patients have demonstrated that restricting fluid input after the initial resuscitation appears safe.
The objective if this study is to determine whether a fluid restrictive treatment regimen will lead to a lower cumulative fluid balance at 72 hours from randomization in critically ill patients with AKI and whether this approach is safe and feasible.
Who can participate
Age range18 Years
SexALL
See this in plain English?
AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.
Inclusion criteria
✓. 18-years or older and admitted to critical care with an arterial line in place
✓. The patient has been in critical care for at least 12 hours but no more than 72 hours
✓. The patient has AKI but is not receiving acute RRT:
✓. Increase in serum creatinine over 1.5-times above baseline without a decline of 27umol/l or more from the last preceding measurement (at least 12 hours apart) AND/OR
✓. Overall urine output less than 0.5ml/kg/h (or 6ml/kg) for the previous 12h (with urine catheter in place for the period)
✓. The patient is judged by the treating clinician not to be intravascularly hypovolemic
✓. The patient is likely to remain in critical care for 48 hours after randomization
Exclusion criteria
✕. Active bleeding necessitating transfusion
✕. Maintenance fluid therapy is necessary due to diabetic ketoacidosis, non-ketotic coma, severe burns or other clinical reason determined by the medical staff
✕. Need for RRT due to intoxication of a dialyzable toxin
✕. Commencement of RRT is expected in the next 6 hours
✕. On chronic renal replacement therapy (maintenance dialysis or renal transplant)
. Presence or a strong clinical suspicion of parenchymal AKI (for example glomerulonephritis, vasculitis, acute interstitial nephritis), or post-renal obstruction
✕. Severe hyponatremia (Na \<125mmol/L) or hypernatremia (Na \>155mmol/L)
✕. Need for extracorporeal membrane oxygenation or molecular absorbent recirculating system (MARS-therapy)