Early Fluid Removal Strategy Based on Tissue Perfusion During Renal Replacement Therapy in ICU Patients With Acute Kidney Injury

What this Trial Is About

Researchers are evaluating early fluid removal strategies in Intensive Care Unit ICU patients with acute kidney injury AKI who are receiving renal replacement therapy RRT and have fluid overload. Fluid overload in these patients is linked to increased complications and higher risk of death. The study compares two fluid removal approaches to see if a moderate removal rate guided by tissue blood flow monitoring can improve kidney, heart, and lung outcomes compared to a low removal rate that stabilizes fluid without such monitoring. Participants are randomly assigned to one of two groups. The experimental group will have fluid removed at a rate of 2 ml per kilogram per hour, adjusted based on tolerance and blood flow, aiming to reach their original body weight. If this target is not met within 24 hours, the rate can be increased. The control group will have fluid removal set between 0 and 1 mlkgh to maintain body weight stability, with adjustments as needed. Fluid removal may be paused temporarily if signs of poor blood flow or intolerance occur. During the study, participants will be closely monitored with assessments of organ function, kidney recovery, heart rhythm, and respiratory support needs for up to 30 days. The main measure is the number of days without needing organ support by day 30. Other evaluations include mortality, time off mechanical ventilation and vasopressors, ICU stay length, and complications such as strokes or intestinal ischemia. The trial aims to determine if a guided moderate fluid removal improves overall health outcomes in this critical patient group.

Early Deresuscitation Strategy Driven by Tissue Perfusion in Renal Replacement Therapy in Patients With Acute Renal Failure