Hemodynamic Effects of Blood Flow Variation in Continuous Renal Replacement Therapy

Study Overview
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Brief Summary
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Purpose of this study is to evaluate the short-term hemodynamic effects of changes in blood flow rates in critically ill patients receiving continuous renal replacement therapy.

Official Title
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Hemodynamic Effects of Blood Flow Variation in Continuous Renal Replacement Therapy

Conditions
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Acute Kidney Injury, End-stage Renal Disease

Intervention / Treatment
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* Device: continuous renal replacement therapy using System One (TM) setup (Nxstage)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18-89 Acute renal failure or end-stage renal disease necessitating CRRT Admitted to the MICU service If on vasopressor/inotropic agent, norepinephrine as only intravenous pressor If on vasopressor/inotropic agent, at stable pressor dose for at least four hours If on IV fluids, stable dose of crystalloids <= 100cc/hour and is not receiving colloids for 4 hours or more prior to initiation of CRRT Mean arterial pressure (MAP) >= 65 Arterial catheter present for continuous blood pressure monitoring CRRT duration of 48 hours or less using NxStage System One dialysis system successfully tolerated CRRT for at least 4 hours without clotting or hemodynamic instability no other procedures, blood products transfusion, or additional medication administration are anticipated during the study period Exclusion Criteria: listed for organ transplant atrial fibrillation, other irregular heart rhythm, unstable arrhythmia need for more than one intravenous vasopressor agent intravenous vasopressor/inotropic agent other than norepinephrine (ie dobutamine, dopamine, vasopressin, epinephrine) therapeutic anticoagulation being administered known acute myocardial infarction as defined by elevated troponin along with a documented clinical diagnosis during current hospitalization known acute stroke, intracerebral hemorrhage, intracranial mass effect, or elevated intracranial pressure within the last 30 days. dialysis catheter malfunction and unable to maintain target blood flow rate fluid removal (ultrafiltration) rate > 100mL/hour

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 89 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: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental arm<br>The patients will have the blood flow rate adjusted on CRRT gradually increased to assess the effect on hemodynamics | Device: continuous renal replacement therapy using System One (TM) setup (Nxstage)<br>* Participants who have been prescribed continuous renal replacement therapy will have hemodynamic parameters measured at various blood flow rates<br>* Other names: NxStage;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Blood Pressure Change | Change in mean arterial pressure from period 1 to period 2 | 10 minutes |