Is Myocardial Stunning Induced by Continuous Renal Replacement Therapy a Reality in Critically Ill Patients?

Study Overview
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Brief Summary
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Myocardial stunning during chronic intermittent hemodialysis is a well-described phenomenon. Little case series of patients presenting myocardial stunning during renal replacement therapy for acute kidney injury in critically ill patients are reported, with intermittent hemodialysis and continuous renal replacement therapy. However, the small sample sizes and the absence of a control arm limit their interpretation, mainly whether the myocardial stunning may be related to cardiac loading conditions variations and whether it may impact the hemodynamic. The investigator hypothesize that myocardial stunning induced by renal replacement therapy is frequent, independent from cardiac loading conditions and associated with peripheral hypoperfusion.

Official Title
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Is Myocardial Stunning Induced by Continuous Renal Replacement Therapy a Reality in Critically Ill Patients?

Conditions
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Acute Kidney Injury KDIGO 3, Continuous Renal Replacement Therapy Initiated by the Clinician in Charge Without Emergency, Myocardial Stunning

Intervention / Treatment
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* Procedure: Continuous renal replacement therapy
* Other: Control group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age > 18 years old Acute Kidney Injury grade 3 (KDIGO) Indication for renal replacement therapy for the clinician in charge Exclusion Criteria: Emergency indication to renal replacement therapy (pH<7.15, Kaliemia > 6mmol/L, refractory pulmonary oedema) Poor echogenicity with speckle tracking analysis failure Chronic hemodialysis Extra corporeal membrane oxygenation, left ventricular assist device.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Continuous renal replacement therapy arm<br>Echocardiographic evaluation (with 2D speckle tracking analysis of left ventricular segmental function) 1 hour before and 3 hours after the initiation of continuous renal replacement therapy (continuous veno venous hemofiltration) initiation | Procedure: Continuous renal replacement therapy<br>* Continuous renal replacement therapy (veno venous hemofiltration) without net ultrafiltration, through a dedicated central venous catheter<br>|
| Other: Control arm<br>Two echocardiographic evaluations (with 2D speckle tracking analysis of left ventricular segmental function) at an interval of 4 hours, before the continuous renal replacement therapy initiation. | Other: Control group<br>* Continuous renal replacement therapy is differed from 6 hours to allowed 2 control echocardiographic evaluations<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of segment of the left ventricle with regional wall motion abnormalities | Numbers of segments of the left ventricle (by patient) with a decrease greater than 20% of the peak systolic longitudinal strain (2D speckle tracking) on the second echocardiography as compared to baseline. | Change between the echocardiography at baseline and the echocardiography 4 hours after. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acute kidney injury,, continuous renal replacement therapy, myocardial stunning, regional wall motion abnormalities, 2D speckle tracking echocardiography