During intermittent hemodialysis (IHD), the occurrence of intradialytic hemodynamic instability (IHI) is frequent in ICU and impacted morbidity and mortality. Bicarbonate dialysate buffer improves hemodynamic tolerance compared to acetate dialysate buffer. However, bicarbonate dialysate buffer still contains a lower concentration of acetate, which could contribute to hemodynamic instability. Recently, citrate-based dialysate in bicarbonate hemodialysis instead of acetate have been proposed. They have the appropriate authorizations for routine use. The aim of this study is to compare acetate- vs citrate-based dialysate in terms of hemodynamic tolerance and effectiveness.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
48
Intermittent hemodialysis with an acetate based dialysate.
Intermittent hemodialysis with an citrate based dialysate.
Centre Hospitalier Béthune
Béthune, France
RECRUITINGCHU
Caen, France
RECRUITINGCentre Hospitalier Universitaire de Dijon
Dijon, France
RECRUITINGCHRU Nancy
Nancy, France
RECRUITINGCHU de ROUEN
Rouen, France
NOT_YET_RECRUITINGTo show that the use of a citrate-based dialysate decreases the occurrence of intradialytic hypotension in the ICU compared with an acetate-based dialysate (The rate of sessions with occurence of at least one hemodynamic instability (IHI)).
The rate of sessions with occurence of at least one IHI.
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) the mortality at day 28 and in ICU;
Mortality at day 28 and in ICU;
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) the length of stay in Intensive Care Unit.
Length of stay in Intensive Care Unit
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) the Length of stay in hospital.
Length of stay in hospital;
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) the Number of days without dialysis in Intensive Care Unit.
Number of days without dialysis in Intensive Care Unit
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) the dialysis dependency at discharge from ICU and hospital.
Dialysis dependency at discharge from ICU and hospital.
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) the time to recovery of diuresis > 0.5ml/kg/h.
Time to recovery of diuresis \> 0.5ml/kg/h
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) the change in SOFA score between D0 and D7.
Change in SOFA score between D0 and D7
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) the number of days without catecholamine.
Number of days without catecholamine
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) the number of days without mechanical ventilation.
Number of days without mechanical ventilation.
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) the ratio of Kt/V (achieved/prescribed).
The ratio of Kt/V (achieved/prescribed)
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) session duration ratio (duration achieved/prescribed).
Difference between session duration achieved and prescribed
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) UF ratio (UF prescribed/realized)
UF ratio (UF prescribed/realized)
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) urea reduction rate (pre-dialysis urea - post-dialysis urea/pre-dialysis urea)
Urea reduction rate (pre-dialysis urea - post-dialysis urea/pre-dialysis urea)
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) average, maximum and end-of-session blood and dialysate flow rates.
Average, maximum and end-of-session blood and dialysate flow rates.
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) the pre-post dialysis variation in creatinine levels.
The pre-post dialysis variation in creatinine levels
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) the pre-post dialysis variation of pH and bicarbonate level.
The pre-post dialysis variation of pH and bicarbonate level
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) the pre-post dialysis variation in kalemia.
The pre-post dialysis variation in kalemia
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) the pre-post dialysis the rate variation of sodium, magnesium and calcium.
The pre-post dialysis rate variation of sodium, magnesium and calcium
Time frame: day 28
Compare between the two groups (acetate- vs citrate-based dialysate) the rate of calcium supplemented between two IHD sessions.
The rate of calcium supplemented between two IHD sessions.
Time frame: day 28
Evaluate the hemodynamic tolerance
according to the randomization groups : the response to the passive leg raising, respiratory variation of the inferior vena cava etc...
Time frame: Each dialysis until day 28
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