Consecutive patients with cirrhosis and septic shock with AKI who give written informed consent will be included in this prospective trial. At baseline NT-Pro BNP, urine N-GAL will be done for all patients. A baseline serum blood sample (10 ml) and urine sample will be stored. Septic shock will be defined by the presence of two or more diagnostic criteria for the systemic inflammatory response syndrome, proven or suspected infection with hypotension non-responsive to adequate fluid resuscitation assessed by no evidence of stroke volume variation on flow track and need of a vasopressor to achieve a target mean arterial pressure (MAP) of ≥ 65 mm Hg. A record of CVP, IVC diameter and B-lines on ultrasound lung would also be done. Patients with age less than 18 years, severe known cardiopulmonary disease (structural or valvular heart disease, coronary artery disease, COPD) pregnancy, chronic kidney disease on hemodialysis, patients already meeting emergency criteria for immediate hemodialysis at the time of randomization as specified in the late group, patients transferred from other hospitals who have already been on hemodialysis before their arrival in the intensive care unit, extremely moribund patients with an expected life expectancy of less than 24 hours, failure to give informed consent from family members.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
150
withing 6 to 12 hours
when absolute indications will meet
Institute of Liver and Biliary Sciences
New Delhi, National Capital Territory of Delhi, India
RECRUITINGTransplant free survival in both groups
Time frame: 28 days
Incidence of intradialytic hypotension in both groups
Time frame: 48 hours
Hemodynamic stability in both groups
Time frame: 48 hours
Dialysis efficiency as measured by Urea Reduction ratio in both groups
Time frame: 2 days
Achievement of target ultrafiltration goals in both groups
Time frame: 48 hours
Recovery in renal functions in both groups
Recovery is defined as an increase in urine output to more than 400 ml/day
Time frame: 14 days
Duration of Intensive Care Unit stay in both groups
Time frame: 28 days
Duration of mechanical ventilation in both groups
Time frame: 28 days
Improvement in Sequential Organ Failure Assessment ( by 2 points) scores in both groups
Time frame: 28 days
Improvement in SOFA, Model for End stage Liver Disease ( by 2 points) scores
Time frame: 28 days
Improvement in Acute Physiology and Chronic Health Evaluation ( by 2 points) scores
Time frame: 28 days
Improvement in lactic acidosis and lactate clearance at 6 initiation of dialysis in both groups
Time frame: 6 hours
Improvement in lactic acidosis and lactate clearance at 24 hours after initiation of dialysis in both groups
Time frame: 12 hours
Improvement in lactic acidosis and lactate clearance at 24 hours after initiation of dialysis in both groups
Time frame: 24 hours
Death related with renal failure in both groups
Time frame: 7 day
Mortality due to renal failure related in both groups.
Time frame: 7 day
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