Acetate Ringer's solution versus 0.9% saline for septic patients: study protocol for a randomized controlled multicenter crossover trial

Abstract Background: The previous study demonstrated that there were no significant differences between saline and balanced crystalloid solution infused in critical illness. However, the sepsis subgroup analysis showed the statistical difference. Thus, we will specifically focus on septic patients in this study to compare the effects of saline and balanced solution. We hypothesize that effects of saline on acute kidney injury (AKI) are related to the underline AKI severity and total volumes of infusion. Methods/design: The investigators designed a pragmatic, multi-centered crossover trial recruiting 312 patients who are diagnosed as sepsis/septic shock in the intensive care unit (ICU) and will be assigned with either acetate Ringer's solution or saline in the corresponding month. Patients with an end-stage renal disease (ESRD) or who need renal replacement therapy (RRT) prior to or at the time of enrollment are excluded. Enrolled patients will be regarded as with mild, moderate or severe sepsis on the basis of the severity of their illness, and will be divided into subgroups according to their initial renal function and various intravenous infusion volumes when being analyzed. The primary outcome is major adverse kidney events (MAKE), including the composite of in-hospital death, receipt of new renal replacement therapy, or persistent renal dysfunction. Secondary outcomes include 28 days-mortality, internal environment disturbance, incidence and duration of vasoactive drug treatment, duration of mechanical ventilation, duration of RRT and ICU and hospital length of stay. Results and Conclusions: To our knowledge, this study will be the first to focus on septic patients and provide credible and evident data on the comparison of outcome between acetate Ringer’s solution and saline for intravenous infusion in adult septic patients on the basis of baseline renal function and infusion volumes taken into consideration. Trial registration: ClinicalTrials.gov, identifiers: NCT03685214. Registered on August 15, 2018. https://clinicaltrials.gov/ct2/show/NCT03685214 Keywords: sepsis; septic shock; acute kidney injury; saline; acetate Ringer's solution.

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Acetate Ringer's solution versus 0.9% saline for septic patients: study protocol for a multi-center parallel controlled trial

10.21203/rs.3.rs-21846/v3 ◽

2020 ◽

Author(s):

Fang Liu ◽

Jing Zhang ◽

Yuan Zhu ◽

Lianjiu Su ◽

Yiming Li ◽

...

Keyword(s):

Renal Function ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Intravenous Infusion ◽

Controlled Trial ◽

Kidney Injury ◽

Hospital Length Of Stay ◽

Hospital Death ◽

Ringer’S Solution ◽

Mechanical Ventilation Duration

Abstract Background: Previous study drew different conclusions on significant differences between saline and balanced crystalloid solution infused in critical illness but both the statistical difference in sepsis subgroup. Thus, we will specifically focus on septic patients in this study to compare the effects of saline and balanced solution. We hypothesize that effects of saline on acute kidney injury (AKI) are related to the underline AKI severity and total volumes of infusion.Methods/design: The investigators designed a pragmatic, multi-center parallel controlled trial recruiting 312 patients who are diagnosed with sepsis/septic shock in the intensive care unit (ICU) and will be assigned with either acetate Ringer’s solution or saline in the corresponding month. Patients with an end-stage renal disease (ESRD) or who need renal replacement therapy (RRT) prior to or at the time of enrolment are excluded. Enrolled patients will be regarded as with mild, moderate or severe sepsis on the basis of the severity of their illness, and will be divided into subgroups according to their initial renal function and various intravenous infusion volumes when being analyzed. The primary outcome is major adverse kidney events within 28 days (MAKE28), including the composite of in-hospital death, receipt of new renal replacement therapy, or persistent renal dysfunction. Secondary outcomes include 28 days-mortality, internal environment disturbance, incidence and duration of vasoactive drug treatment, duration of mechanical ventilation, duration of RRT and ICU and hospital length of stay.Results and conclusions: To our knowledge, this study will be the first to focus on septic patients and provide credible and evident data on the comparison of outcome between acetate Ringer’s solution and saline for intravenous infusion in adult septic patients on the basis of baseline renal function and infusion volumes taken into consideration.Trial registration: ClinicalTrials.gov, identifiers: NCT03685214. Registered on August 15th, 2018. https://clinicaltrials.gov/ct2/show/NCT03685214

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Acetate Ringer’s solution versus 0.9% saline for septic patients: study protocol for a multi-center parallel controlled trial

Trials ◽

10.1186/s13063-020-05007-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Fang Liu ◽

Jing Zhang ◽

Yuan Zhu ◽

Lianjiu Su ◽

Yiming Li ◽

...

Keyword(s):

Renal Function ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Intravenous Infusion ◽

Controlled Trial ◽

Kidney Injury ◽

Hospital Length Of Stay ◽

Hospital Death ◽

Ringer’S Solution ◽

Mechanical Ventilation Duration

Abstract Background Previous study drew different conclusions on significant differences between saline and balanced crystalloid solution infused in critical illness but both showed a statistical difference in the sepsis subgroup. Thus, we will specifically focus on septic patients in this study to compare the effects of saline and balanced solution. We hypothesize that effects of saline on renal outcomes are related to the underline acute kidney injury (AKI) severity and total volumes of infusion. Methods/design The investigators designed a pragmatic, multi-center parallel controlled trial recruiting 312 patients who are diagnosed with sepsis/septic shock in the intensive care unit (ICU) and will be assigned with either acetate Ringer’s solution or saline in the corresponding month. Patients with an end-stage renal disease (ESRD) or who need renal replacement therapy (RRT) prior to or at the time of enrolment are excluded. Enrolled patients will be regarded as with mild, moderate, or severe sepsis on the basis of the severity of their illness and will be divided into subgroups according to their initial renal function and various intravenous infusion volumes when being analyzed. The primary outcome is major adverse kidney events within 28 days (MAKE28), including the composite of in-hospital death, receipt of new renal replacement therapy, or persistent renal dysfunction. Secondary outcomes include 28-day mortality, internal environment disturbance, incidence and duration of vasoactive drug treatment, duration of mechanical ventilation, duration of RRT, and ICU and hospital length of stay. Results and conclusions To our knowledge, this study will be the first to focus on septic patients and provide credible and evident data on the comparison of outcome between acetate Ringer’s solution and saline for intravenous infusion in adult septic patients on the basis of baseline renal function and infusion volumes taken into consideration. Trial registration ClinicalTrials.gov NCT03685214. Registered on August 15, 2018

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Acetate Ringer's solution versus 0.9% saline for septic patients: study protocol for a multi-center parallel controlled trial

10.21203/rs.3.rs-21846/v2 ◽

2020 ◽

Author(s):

Fang Liu ◽

Jing Zhang ◽

Yuan Zhu ◽

Lianjiu Su ◽

Yiming Li ◽

...

Keyword(s):

Renal Function ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Intravenous Infusion ◽

Controlled Trial ◽

Kidney Injury ◽

Hospital Length Of Stay ◽

Hospital Death ◽

Ringer’S Solution ◽

Mechanical Ventilation Duration

Abstract Background: Previous study drew different conclusions on significant differences between saline and balanced crystalloid solution infused in critical illness but both the statistical difference in sepsis subgroup. Thus, we will specifically focus on septic patients in this study to compare the effects of saline and balanced solution. We hypothesize that effects of saline on acute kidney injury (AKI) are related to the underline AKI severity and total volumes of infusion.Methods/design: The investigators designed a pragmatic, multi-center parallel controlled trial recruiting 312 patients who are diagnosed as sepsis/septic shock in the intensive care unit (ICU) and will be assigned with either acetate Ringer’s solution or saline in the corresponding month. Patients with an end-stage renal disease (ESRD) or who need renal replacement therapy (RRT) prior to or at the time of enrollment are excluded. Enrolled patients will be regarded as with mild, moderate or severe sepsis on the basis of the severity of their illness, and will be divided into subgroups according to their initial renal function and various intravenous infusion volumes when being analyzed. The primary outcome is major adverse kidney events within 28 days (MAKE28), including the composite of in-hospital death, receipt of new renal replacement therapy, or persistent renal dysfunction. Secondary outcomes include 28 days-mortality, internal environment disturbance, incidence and duration of vasoactive drug treatment, duration of mechanical ventilation, duration of RRT and ICU and hospital length of stay.Results and conclusions: To our knowledge, this study will be the first to focus on septic patients and provide credible and evident data on the comparison of outcome between acetate Ringer’s solution and saline for intravenous infusion in adult septic patients on the basis of baseline renal function and infusion volumes taken into consideration.Trial registration: ClinicalTrials.gov, identifiers: NCT03685214. Registered on August 15th, 2018. https://clinicaltrials.gov/ct2/show/NCT03685214

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Intermittent Hemodialysis For Patients With Acute Kidney Injury (AKI): Outcome In A Tertiary Level Hospital

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v17i1.18629 ◽

2018 ◽

Vol 17 (1) ◽

pp. 25-30

Author(s):

Arun Sharma ◽

Binod Karki ◽

Ajay Rajbhandari

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Acute Gastroenteritis ◽

Kidney Injury ◽

Tertiary Level ◽

Intermittent Hemodialysis ◽

The Mean ◽

Level Hospital

INTRODUCTION: Acute kidney injury (AKI) is the sudden loss of renal function with accumulation of nitrogenous waste compounds. In developing countries, community acquired AKI is common than AKI in hospitalized septic patients. With conservative management many patients recover renal function however few require renal support with intermittent Hemodialysis (HD). We conducted a study to find out the etiology and outcome of the patients presenting with AKI who required dialysis.METHODS: This is a descriptive follow up study of the patients who needed renal replacement therapy in the form of HD presenting to our Nephrology unit of the hospital over a period of two years. Patients were followed up for three months post discharge. Data were tabulated and analyzed using SPSS software.RESULTS: Total 50 patients were included in study with 67% male. The commonest etiologies were urinary tract infection (30%) and acute gastroenteritis (24%).The mean creatinine at the time of nephrology consultation, maximum level and at the time of discharge were 6.5(SD± 2.62), 7.3(SD ±2.13) and 2.2(SD ±1.75) respectively. Uremia with anuria was the most common reason for the initiation of HD in 54% cases. The mean number of intermittent HD used was 3.36. Complete recovery was seen in 68%, death in 26% and CKD in 6%.CONCLUSION: UTI followed by acute gastroenteritis are the leading cause of AKI in our tertiary level hospital. Timely initiated renal replacement therapy in the form of intermittent HD could lead to substantial renal recovery in almost three fourth of patients.

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Optimal timing of initiating continuous renal replacement therapy in septic shock patients with acute kidney injury

Scientific Reports ◽

10.1038/s41598-019-48418-4 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 6

Author(s):

Bo Ra Yoon ◽

Ah Young Leem ◽

Moo Suk Park ◽

Young Sam Kim ◽

Kyung Soo Chung

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Optimal Timing

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Timing for initiation of continuous renal replacement therapy in patients with septic shock and acute kidney injury

Critical Care ◽

10.1186/cc10968 ◽

2012 ◽

Vol 16 (S1) ◽

Author(s):

HP Shum ◽

KC Chan ◽

MC Kwan ◽

WT Yeung ◽

WS Cheung ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury

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Duration of anuria predicts recovery of renal function after acute kidney injury requiring continuous renal replacement therapy

The Korean Journal of Internal Medicine ◽

10.3904/kjim.2014.290 ◽

2016 ◽

Vol 31 (5) ◽

pp. 930-937 ◽

Cited By ~ 3

Author(s):

Hee-Yeon Jung ◽

Jong-Hak Lee ◽

Young-Jae Park ◽

Sang-Un Kim ◽

Kyung-Hee Lee ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury

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The Current State of Renal Replacement Therapy in the Treatment of Sepsis

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2021-18-4-80-89 ◽

2021 ◽

Vol 18 (4) ◽

pp. 80-89

Author(s):

T. G. Kim ◽

M. А. Magomedov ◽

D. N. Protsenko ◽

M. V. Zakharov ◽

А. V. Marukhov ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Results Of Treatment ◽

Current State ◽

Sepsis And Septic Shock ◽

Positive Results ◽

Organ Dysfunctions

Of all cases of acute kidney injury (AKI), 45-70% are associated with sepsis. Lethality in sepsis-associated AKI requiring renal replacement therapy (RRT) ranges from 40 to 50%, and in AKI combined with other organ dysfunctions - 60-80%. In order to improve the results of treatment of sepsis and septic shock, various methods of extracorporeal detoxification (ECD) have been developed. The effectiveness of these methods is controversial. In the treatment of sepsis, RRT is used not only to replace the impaired detoxification function of kidneys, but also to remove excess cytokines from the systemic bloodstream. The literature describes mainly positive results of the use of dialyzers with an adsorbing membrane, however, these data do not have the necessary degree of evidence. Currently, there are no clear criteria for the initiation of RRT, its duration and doses, the choice of methodology determined by specific clinical and laboratory parameters, and staging of this therapy. All this highlights the need for further research in this field.

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