Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: The Timing of Continuous Renal Replacement Therapy Initiation in Sepsis-associated Acute Kidney Injury in the Intensive Care Unit
Brief Summary: Sepsis continues to be a major global cause of both mortality and morbidity. Furthermore, the development of acute kidney injury (AKI) in sepsis increases the risk of unfavorable outcomes. Besides source control, fluid resuscitation and the use of antibiotics, application of extracorporeal renal replacement therapies (RRT) is the predominant treatment for sepsis-associated AKI (SAKI). However, the timing of initiation of RRT remains controversial. It is reported that a correlation was observed between the concentrations of circulating inflammatory cytokines and mortality in patients with septic shock. Therefore, it is hypothesis that adequate removal of inflammatory mediators from the circulation may provide a potential therapy for this devastating condition. Indeed, data from meta-analyses, observational studies and randomized controlled trial (RCT) suggests that initiating RRT in critical ill patients (including patients with sepsis and non-sepsis) at early stage may be beneficial. But in some studies, initiating RRT at early stage do not shown to improve survival compared with initiating RRT at late stage. At present, large-scale prospective RCT about the timing for initiating RRT in SAKI was still lack.The decision when to start RRT is not merely academic but may impact on outcomes. Therefore, in our study, 460 patients with SAKI at KDIGO 2 from multicenter in China will be recruited. And then the patients will be divided into early group and delayed group randomly. In the early group, continuous RRT (CRRT) was started immediately after randomization. In the delay group, CRRT was initiated if at least one of the following criteria was met: KDIGO 3, severe hyperkalemia, pulmonary edema, blood urea nitrogen level higher than 112 mg per deciliter after randomization. Overall survival at day 90 will be observed in order to understand whether different CRRT strategy would affect the outcomes of SAKI. This clinical study will be a large-scale, multi center, prospective, randomized trial about SAKI. It will help clinician choose appropriate timing to initiate CRRT and improve outcomes of SAKI.


Options:
A: Arm Label: Early renal replacement therapy; Type: EXPERIMENTAL; Interventions: Device: Dialysis with continuous renal replacement therapy, Device: Mechanical ventilator, Drug: Anti-Bacterial Agents, Drug: Vasopressors | Arm Label: Conventional renal replacement therapy; Type: PLACEBO_COMPARATOR; Interventions: Device: Dialysis with continuous renal replacement therapy, Device: Mechanical ventilator, Drug: Anti-Bacterial Agents, Drug: Vasopressors | Intervention Type: DEVICE; Name: Dialysis with continuous renal replacement therapy; Assigned to Arm(s): Conventional renal replacement therapy, Early renal replacement therapy | Intervention Type: DEVICE; Name: Mechanical ventilator; Assigned to Arm(s): Conventional renal replacement therapy, Early renal replacement therapy | Intervention Type: DRUG; Name: Anti-Bacterial Agents; Assigned to Arm(s): Conventional renal replacement therapy, Early renal replacement therapy | Intervention Type: DRUG; Name: Vasopressors; Assigned to Arm(s): Conventional renal replacement therapy, Early renal replacement therapy
B: Arm Label: 1; Type: EXPERIMENTAL; Interventions: Device: Continuous venvenous hemofiltration (CVVH) | Arm Label: 2; Type: ACTIVE_COMPARATOR; Interventions: Device: Continuous venovenous hemodialysis (CVVHD) | Intervention Type: DEVICE; Name: Continuous venvenous hemofiltration (CVVH); Assigned to Arm(s): 1 | Intervention Type: DEVICE; Name: Continuous venovenous hemodialysis (CVVHD); Assigned to Arm(s): 2
C: Arm Label: Intensive renal replacement therapy; Type: EXPERIMENTAL; Interventions: Procedure: renal replacement therapy | Arm Label: Less-intensive renal replacement therapy; Type: ACTIVE_COMPARATOR; Interventions: Procedure: renal replacement therapy | Intervention Type: PROCEDURE; Name: renal replacement therapy; Assigned to Arm(s): Intensive renal replacement therapy, Less-intensive renal replacement therapy
D: Arm Label: early group; Type: EXPERIMENTAL; Interventions: Procedure: continuous renal replacement therapies | Arm Label: delayed group; Type: EXPERIMENTAL; Interventions: Procedure: continuous renal replacement therapies | Intervention Type: PROCEDURE; Name: continuous renal replacement therapies; Assigned to Arm(s): delayed group, early group

Answer: D