Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Regional Citrate Versus Systemic Heparin Anticoagulation for Super High-flux Continuous Hemodialysis in Septic Shock: Effect on Middle Molecular Weight Molecules Clearances
Brief Summary: Sepsis is responsible for 50% of all acute kidney injury (AKI) in intensive care units (ICUs), contributing greatly to multiple organ dysfunction syndrome (MODS). Special types of continuous renal replacement therapies (CRRT) have been proposed as adjuvant therapies for septic shock due to their ability to remove middle molecular weight molecules such as inflammatory mediators involved in MODS pathophysiology. These therapies are called extracorporeal " blood purification " therapies.

When CRRT is used, an anticoagulation is required to prevent clotting of the extracorporeal circuit, possibly causing bleeding in selected patients. Many anticoagulation strategies have been proposed and the most commonly used in 2013 is still unfractionated heparin. Regional citrate anticoagulation (RCA) is an interesting alternative as it dramatically decreases the bleeding risk.

The investigators hypothesize that the use of citrate with Super High Flux Continuous Veno-Venus Hemodialysis (SHF-CVVHD) would be highly beneficial over time by preserving the filter effectiveness via limiting protein adhesion (which subsequently reduces filter pore sizes (protein cake)), as compared to heparin. Consequently, higher clearances of the inflammatory mediators could be maintained over time with citrate as compared to heparin anticoagulation. In other words, for the same duration of filter use, middle molecular weight molecules and cytokines clearances would be greater with citrate as compared to heparin. To test this hypothesis, the investigators will perform a clinical randomized controlled trial which aim would be to compare middle molecular weight molecules and cytokines clearances in SHF-CVVHD using RCA versus systemic heparin anticoagulation in septic patients with AKI.


Options:
A: Arm Label: hemofiltration at 4L/h; Type: ACTIVE_COMPARATOR; Interventions: Procedure: CVVH 4 to 2 L/h | Arm Label: hemofiltration at 2L/h; Type: ACTIVE_COMPARATOR; Interventions: Procedure: CVVH 2 to 4L/h | Intervention Type: PROCEDURE; Name: CVVH 4 to 2 L/h; Assigned to Arm(s): hemofiltration at 4L/h | Intervention Type: PROCEDURE; Name: CVVH 2 to 4L/h; Assigned to Arm(s): hemofiltration at 2L/h
B: Arm Label: Higher intensity CRRT regimen; Type: EXPERIMENTAL; Interventions: Procedure: "augmented" CRRT regimen | Arm Label: Lower intensity CRRT regimen; Type: ACTIVE_COMPARATOR; Interventions: Procedure: "augmented" CRRT regimen | Intervention Type: PROCEDURE; Name: "augmented" CRRT regimen; Assigned to Arm(s): Higher intensity CRRT regimen, Lower intensity CRRT regimen
C: Arm Label: heparin anticoagulation; Type: ACTIVE_COMPARATOR; Interventions: Drug: Heparin | Arm Label: citrate anticoagulation; Type: EXPERIMENTAL; Interventions: Drug: Citrate | Intervention Type: DRUG; Name: Heparin; Assigned to Arm(s): heparin anticoagulation | Intervention Type: DRUG; Name: Citrate; Assigned to Arm(s): citrate anticoagulation
D: Arm Label: RCA Group; Type: EXPERIMENTAL; Interventions: Drug: Anticoagulation to prevent clotting of the extracorporeal circuit. (regional citrate anticoagulation) | Arm Label: Heparin group; Type: EXPERIMENTAL; Interventions: Drug: Anticoagulation to prevent clotting of the extracorporeal circuit (Unfractionated heparin) | Intervention Type: DRUG; Name: Anticoagulation to prevent clotting of the extracorporeal circuit. (regional citrate anticoagulation); Assigned to Arm(s): RCA Group | Intervention Type: DRUG; Name: Anticoagulation to prevent clotting of the extracorporeal circuit (Unfractionated heparin); Assigned to Arm(s): Heparin group

Answer: D