Evaluating High-Rate Versus Standard Fluid Removal with Ultrasound Guidance in Hospitalized Patients with Severe Fluid Overload and End-Stage Kidney Disease

What this Trial Is About

Researchers are evaluating whether a personalized, high-rate fluid removal strategy guided by ultrasound is as safe and effective as the standard fluid removal rate for patients with advanced kidney disease hospitalized due to severe fluid overload. This study focuses on patients with End-Stage Renal Disease ESRD on chronic hemodialysis who require urgent fluid removal to relieve symptoms such as severe shortness of breath. Traditional guidelines recommend conservative fluid removal rates to avoid sudden blood pressure drops, but doctors sometimes use higher rates in urgent cases without strong evidence. Participants are randomly assigned to one of two groups during their first in-hospital hemodialysis session. The Standard Group receives a fluid removal rate of 10 mLkgh, while the High-Rate Group receives a higher rate above 13 mLkgh, up to a safety limit of 15 mLkgh. The study uses advanced bedside ultrasound protocols like lung ultrasound and VExUS to measure fluid congestion inside the blood vessels and guide treatment. During the study, participants will be monitored for safety by tracking the incidence of intradialytic hypotension blood pressure drops during the dialysis session. Effectiveness will be assessed by comparing ultrasound congestion scores, respiratory symptoms, and oxygen needs before and within 24 hours after treatment. Additional evaluations include blood pressure, biomedical and echocardiographic variables, and hospital stay outcomes up to 30 days. Participants will be observed throughout their hospital stay with follow-up until discharge.

The FILTRATE Trial: High-Rate Ultrafiltration for Intravascular Congestion