Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Optimal Mode of Renal Replacement Therapy in Acute Kidney Injury (OMAKI) Study: A Pilot Randomized Controlled Trial of Convective Versus Diffusive Clearance
Brief Summary: Acute kidney injury (AKI) in the intensive care unit is common, devastating and costly. However, minimal evidence exists to guide the prescription of optimal renal replacement therapy (RRT). An important area of uncertainty surrounds the relative effects of convective versus diffusive modes of clearance. Although both clearance modes provide similar degrees of small molecule clearance, convective modes permit the enhanced clearance of larger-sized molecules which may mediate kidney and systemic toxicity in the setting of AKI.

Continuous renal replacement therapies (CRRTs) are frequently applied in critically ill patients with AKI. Convective clearance, as applied through continuous venovenous hemofiltration (CVVH) and diffusive clearance, as applied through continuous venovenous hemodialysis (CVVHD), may be readily compared in the context of patients receiving CRRT.

The purpose of this study is to examine the feasibility of conducting a larger study that will determine whether convective clearance (hemofiltration) confers improved outcomes as compared to diffusive clearance (hemodialysis) in patients with AKI.


Options:
A: Inclusion Criteria:

1. Cardiac surgery with cardiopulmonary bypass
2. Patient still on high doses catecholamines 3 to 24 hours following cardiac-surgical ICU admission. High doses catecholamines is defined by IV infusion of :

   1. Epinephrine \>0.2 microg/kg/min or
   2. Norepinephrine \>0.4 microg/kg/min or
   3. Epinephrine + (Norepinephrine /2) \>0.2 microg/kg/min
   4. Cardiac assistance using ECMO/ECLS technique are considered equivalent to high doses catecholamines.
3. Informed consent has been obtained from next of kin or when consent cannot be obtained, the intervention is randomized, and written informed consent obtained from the patient as soon as he regains consciousness. This practice is consistent with the French law for clinical research.

Exclusion Criteria:

1. Age \< 18 years
2. Pregnancy
3. Chronic hemodialysis prior to heart surgery
4. Body weight \>120 kg
5. Moribund state, defined as SAPS 2 score\> 90
6. Severe underlying disease with survival expectancy of less than 8 days
7. Decision to withhold or withdraw active therapeutics
8. PrismaFlex machine unavailable in the unit
9. Intravascular access with dialysis catheter impossible -
B: Inclusion Criteria:

* acute renal failure requiring renal replacement therapy

Exclusion Criteria:

* (recent) bleeding or a suspicion of bleeding necessitating transfusion,
* need of therapeutic anticoagulation or
* (suspected) heparin-induced thrombocytopenia
C: Inclusion criteria The following five criteria are required for inclusion

1. Hospitalized in intensive care unit
2. Age ≥ 18 years
3. Acute kidney injury compatible with the diagnosis of acute tubular necrosis defined by a clinical ischemic or toxic insult context
4. Have an AKI classified as RIFLE F, that is to say, with at least one of the following three criteria:

   * creatinine\> 354 mmol / l or \> 3 times the baseline creatinine
   * anuria for more than 12 hours
   * oliguria defined as urine output \< 0.3 ml / kg / h or \< 500ml/d for more than 24 hours
5. Mechanical ventilation and/or catecholamines infusion (noradrenaline or/and adrenaline)

Non-inclusion criteria

One or more of the following criteria:

* Chronic renal failure (defined as creatinine clearance \< 30 ml / min)
* Patients already enrolled in the study
* Inclusion criteria number 4 present for more than 5 hours
* Acute renal failure due to:

  * urinary tract obstruction
  * renal vessels obstruction
  * tumor lysis syndrome
  * thrombotic microangiopathy
  * acute glomerulonephritis
* Intoxication with a dialyzable product
* Child-Pugh class C liver cirrhosis
* Renal transplant
* Cardiac arrest without awakening at time of potential inclusion
* Moribund state
* Decision to limit treatment
* RRT already started for the current episode of AKI
* Presenting (at the time of potential inclusion) a strong indication for immediate RRT

  * oligoanuria for more than 3 days
  * serum urea concentration \> 40 mmol / l serum potassium concentration \> 6 mmol /L, serum potassium concentration \> 5.5 mmol /L that persists despite well-conducted medical treatment with at least sodium bicarbonate and / or glucose-insulin infusion, arterial pH \< 7.15 in the context of pure metabolic acidosis (PaCO2 \<35 mmHg) or in the context of mixed acidosis with PaCO2\> 50 mmHg without possibility of lowering this PaCO2 value, acute overload pulmonary edema generating severe hypoxemia requiring oxygen flow\> 5L/min in spontaneously breathing patients or FiO2\> 50% in mechanically (invasive or noninvasive) ventilated to maintain SpO2\> 95%, despite diuretic therapy.
* Under cardiopulmonary bypass
* Included in another clinical trial on RRT modalities.
D: Inclusion Criteria:

1. Adult patients (over 16 years of age) admitted to a participating ICU
2. Serum creatinine increase of ≥ 50% from baseline
3. Hemodynamic instability as defined by the cardiovascular component of the SOFA score of ≥ 1
4. Attending physician deems the patient a candidate for RRT for at least one of the following reasons:

   1. Presence of oliguria, defined as a urine output of \< 100 mL in the preceding 4 hours
   2. metabolic acidosis (HCO3- \< 15 mmol/L and pH \< 7.25)
   3. refractory hyperkalemia (K \> 6.0 mmol/L)
   4. azotemia (BUN \> 50 mmol/L)
   5. suspected uremic organ involvement (pericarditis, encephalopathy, neuropathy or myopathy)

Exclusion Criteria:

1. renal replacement therapy within the previous 2 months
2. presence of renal obstruction
3. receipt of a kidney transplant in the previous year
4. diagnosis of rapidly progressive glomerulonephritis, vasculitis, or acute interstitial nephritis
5. indication for intermittent hemodialysis, specifically severe hyperkalemia, dialyzable drug or toxin
6. terminal illness with associated life expectancy less than 2 months
7. patients who are moribund
8. prior enrollment in this study
9. enrollment in a competing ICU interventional study
10. no CRRT machine available
11. acute renal replacement ongoing for \> 36 hours

Answer: D