Fluid-removal Guided by VeXUS Score With Usual Care in Patients With Acute Kidney Injury After Cardiac Surgery

Last updated: April 9, 2025
Sponsor: Hospices Civils de Lyon
Overall Status: Active - Recruiting

Phase

N/A

Condition

Cardiac Surgery

Stasis Dermatitis

Kidney Disease

Treatment

VeXUS score guided fluid management strategy

Usual care

Clinical Study ID

NCT06251713
69HCL23_0891
  • Ages 18-85
  • All Genders

Study Summary

Acute kidney injury affects more than 30% of patients after cardiac surgery, and is associated with an excess in mortality. There is a clinical continuum between acute kidney injury (transient if <48h, persistent if >48h), the development of acute kidney and chronic renal failure. Each of these entities characterising renal recovery is associated with an increase in long-term morbidity and mortality. Fluid management in patients with acute kidney injury is challenging, as both hypovolaemia and hypervolaemia are detrimental. Venous congestion (reflecting intravascular hypervolaemia), is a well-established haemodynamic factor contributing to acute kidney injury after cardiac surgery. An ultrasound score, based on the venous doppler pattern explored in intra-abdominal organs, has recently been developed and is a better predictor of acute kidney injury than central venous pressure. Whether using the VeXUS score to guide fluid removal in haemodynamically stabilised patients could promote renal recovery after acute kidney injury remains to be investigated.

Before designing a large randomised trial to test such a strategy, its feasibility in a pilot randomised trial is assessed.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Intensive care unit admission within 72 hours of cardiac surgery with extracorporealcirculation

  • Acute kidney injury defined by KDIGO criteria

  • Vasoactive inotropic score <45 and capillary refill time <3s

  • Informed written consent

Exclusion

Exclusion Criteria:

  • Hypokalaemia <3.5mmol/L

  • Hyponatremia<125mmol/L

  • Hypernatremia >145mmol/L

  • Metabolic alkalosis with pH >7.50

  • Impossibility to measure capillary refill time

  • Chronic liver disease

  • Cirrhosis with portal hypertension

  • Known thrombus of the inferior vena cava

  • Mechanical circulatory assistance (ECMO or mono left ventricular assistance)

  • Severe pre-operative chronic kidney disease (GFR < 30mL/min/1.73m2)

  • Need for renal replacement therapy anticipated by the attending physician within 24hours

  • Known hypersensitivity to Furosemide and/or hydrochlorothiazide

  • Severe allergy to wheat

  • Patient already included in another interventional study with an exclusion periodstill in progress

  • Pregnant, breast-feeding or women of childbearing age without suitable contraception

  • Patients under guardianship, curatorship or safeguard of justice

  • Patients under psychiatric care

  • Patients not affiliated to a social security scheme or beneficiaries of a similarscheme

Study Design

Total Participants: 40
Treatment Group(s): 2
Primary Treatment: VeXUS score guided fluid management strategy
Phase:
Study Start date:
July 31, 2024
Estimated Completion Date:
July 31, 2026

Connect with a study center

  • Hopital cardiologique Louis Pradel

    Bron,
    France

    Active - Recruiting

  • Hôpital Louis Pradel, Groupement Hospitalier Est, Hospices Civils de Lyon

    Bron, 69500
    France

    Site Not Available

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