The only supportive therapy for patients with AKI is renal replacement therapy (RRT). In the ICU setting, continuous RRT (CRRT) is mostly favored. In a post-hoc analysis of the RICH trial (regional citrate versus systemic heparin anticoagulation for CRRT in critically ill patient with AKI), it was shown that the filter life span is associated with an increased rate of new infection and that the type of anticoagulants did not directly affect infection rate. The mechanisms of this infection rate is unknown.
Approximately every second patient in the ICU suffers from acute kidney injury (AKI) which complicates the clinical course of these patients. Continuous renal replacement therapy (CRRT) has become the most widely used form of renal support in critically ill patients as it allows continuous, controlled removal of fluids and is hemodynamically better tolerated compared to intermittent dialysis. The requirement for intravascular access and artificial circuits may increase the risk of infection. However, there are no studies analyzing the incidence and characteristics of infections in critically ill patients with CRRT or the implications for outcome. Therefore, this observational trial investigates the factors that influences new onset infection in critically ill patients with CRRT.
Study Type
OBSERVATIONAL
Enrollment
600
Due to the observational design of the study, no study-specific interventions are performed. The treatment of the patients is completely guided by the responsible ICU physicians.
Univ.-Klinik Innsbruck
Innsbruck, Austria
RECRUITINGUniversidade de São Paulo
São Paulo, Brazil
RECRUITINGUniversitätsklinikum Erlangen-Nürnberg, Abteilung für Nephrologie und Hypertensiologie
Erlangen, Germany
RECRUITINGKliniken Maria Hilf, Klinik für Anästhesiologie und Operative Intensivmedizin
Mönchengladbach, Germany
RECRUITINGUniversity Hospital Muenster
Münster, Germany
RECRUITINGNumber of new infections since start of dialysis
Time frame: From start of dialysis until day 28
Number of new blood stream infections
Time frame: From start of dialysis until day 28
Number of new pneumonia
Time frame: From start of dialysis until day 28
Number of new urinary tract infection
Time frame: From start of dialysis until day 28
Number of new catheter blood stream infection
Time frame: From start of dialysis until day 28
Number of new other infections
Time frame: From start of dialysis until day 28
Filter live span
Time frame: From start of dialysis until day 28 or end of CRRT, whatever occurs first
Number of bacterial contamination of t he CRRT circuit proven by culture
Time frame: From start of dialysis until day 28 or end of CRRT, whatever occurs first
Down-time of CRRT in hours
Time frame: From start of dialysis until day 28 or end of CRRT, whatever occurs first
Days on renal replacement therapy
Time frame: From start of dialysis until day 28
Duration of mechanical ventilation in hours
Time frame: From start of dialysis until day 28
Number of bleeding complications
defined as bleeding with the need for at least 1 packed red cells (RBC)
Time frame: From start of dialysis until day 28
Recovery of kidney function
Recovery of kidney function (defined as complete recovery: serum-creatinine ≤0.5 mg/dl higher than baseline; partial recovery: serum creatinine \>0.5 mg/dl higher than baseline but no dialysis-dependence; non-recovery: patients who remained dialysis-dependent)
Time frame: At day 28 after start of dialysis
Recovery of kidney function
Recovery of kidney function (defined as complete recovery: serum-creatinine ≤0.5 mg/dl higher than baseline; partial recovery: serum creatinine \>0.5 mg/dl higher than baseline but no dialysis-dependence; non-recovery: patients who remained dialysis-dependent)
Time frame: At day 60 after start of dialysis
Recovery of kidney function
Recovery of kidney function (defined as complete recovery: serum-creatinine ≤0.5 mg/dl higher than baseline; partial recovery: serum creatinine \>0.5 mg/dl higher than baseline but no dialysis-dependence; non-recovery: patients who remained dialysis-dependent)
Time frame: At day 90 after start of dialysis
Number of patients with need for kidney replacement therapy
Time frame: At day 28 after start of dialysis
Number of patients with need for kidney replacement therapy
Time frame: At day 60 after start of dialysis
Number of patients with need for kidney replacement therapy
Time frame: At day 90 after start of dialysis
Mortality
Time frame: At day 28 after start of dialysis
Mortality
Time frame: At day 60 after start of dialysis
Mortality
Time frame: At day 90 after start of dialysis
Major adverse kidney events (MAKE)
Composite endpoint consisting of death, renal replacement therapy, and persistent renal dysfunction
Time frame: At day 28 after start of dialysis
Major adverse kidney events (MAKE)
Composite endpoint consisting of death, renal replacement therapy, and persistent renal dysfunction
Time frame: At day 60 after start of dialysis
Major adverse kidney events (MAKE)
Composite endpoint consisting of death, renal replacement therapy, and persistent renal dysfunction
Time frame: At day 90 after start of dialysis
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