Approximately 50% of patients in the intensive care unit (ICU) develop acute kidney injury (AKI) and more than 10% need dialysis. There is no treatment for AKI. Care is aiming for optimization of circulation and blood flow to the kidneys and avoiding nephrotoxic agents. There is conflicting data concerning whether early or late dialysis is harmful for the kidneys. No one has examined the physiological changes in the kidney when starting dialysis and which blood pressure that leads to most optimal physiological conditions for the kidneys during dialysis. In this descriptive study of 20 ICU patients suffering from AKI we aim to investigate renal physiology when starting continuous renal replacement therapy (CRRT) and also at different target blood pressures using retrograde renal vein thermodilution technique. In parallel we will also investigate and validate this invasive method with contrast enhanced ultrasound of the kidneys.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
20
Using norepinephrine, patients will receive high or low blood pressure to start with and after measurements cross to receive the other blood pressure target
Sahlgrenska University Hospital
Gothenburg, Sweden
RECRUITINGRenal blood flow and CRRT
Changes in renal blood flow when CRRT is started? How will renal blood flow and oxygenation change at different blood pressure targets?
Time frame: 6 hours
Renal blood flow and blood pressure
Renal blood flow changes at different mean arterial blood pressure targets during CRRT?
Time frame: 6 hours
Glomerular filtration rate (GFR) and blood pressure
GFR changes at different mean arterial blood pressure targets during CRRT?
Time frame: 6 hours
Glomerular filtration rate (GFR) and CRRT
Changes in GFR when CRRT is started?
Time frame: 6 hours
Renal oxygenation during CRRT
Renal oxygenation before CRRT and during CRRT
Time frame: 6 hours
Renal oxygenation and blood pressure
Renal oxygenation changes at different mean arterial blood pressure targets during CRRT?
Time frame: 6 hours
Contrast enhanced renal ultrasound (CEUS)
Validation of CEUS compared to retrograde renal vein thermodilution in measuring renal blood flow
Time frame: 2 hours
atrial natriuretic peptide (ANP)
Differences in serum atrial natriuretic peptide (ANP) during CRRT
Time frame: 6 hours
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