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

NCT05209230 | Completed

• 1 other identifier: 69HCL21_1013
• Study Type: interventional
• Target: 42
• Locations: 1 country
• Sites: 3

Brief Summary

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.

Conditions

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

Keywords

Acute kidney injury,; continuous renal replacement therapy; myocardial stunning; regional wall motion abnormalities; 2D speckle tracking echocardiography

Outcome Measures

Primary Outcomes (1)

• 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.

Study Arms (2)

Continuous renal replacement therapy arm

EXPERIMENTAL

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

Control arm

OTHER

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

Interventions

Continuous renal replacement therapy PROCEDURE

Continuous renal replacement therapy (veno venous hemofiltration) without net ultrafiltration, through a dedicated central venous catheter

Continuous renal replacement therapy arm

Control group OTHER

Continuous renal replacement therapy is differed from 6 hours to allowed 2 control echocardiographic evaluations

Control arm

Eligibility Criteria

• Age: 18 Years - 90 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age \> 18 years old
• Acute Kidney Injury grade 3 (KDIGO)
• Indication for renal replacement therapy for the clinician in charge

You may not qualify if:

• 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.

Sponsors & Collaborators

• Hospices Civils de Lyon: lead

Study Sites (3)

Département d'anesthésie-réanimation Hôpital cardiologique Louis Pradel Groupe Hospitalier Est

Bron, Bron, 69500, France

Location

Ruste Martin

Bron, BRON, 69500, France

Location

Hopital Edourd Herriot

Lyon, 69008, France

Location

MeSH Terms

Conditions

Myocardial Stunning; Acute Kidney Injury

Interventions

Continuous Renal Replacement Therapy; Control Groups

Condition Hierarchy (Ancestors)

Heart Diseases; Cardiovascular Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Renal Insufficiency; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases

Intervention Hierarchy (Ancestors)

Renal Replacement Therapy; Therapeutics; Extracorporeal Circulation; Surgical Procedures, Operative; Epidemiologic Research Design; Epidemiologic Methods; Investigative Techniques; Research Design; Methods

Study Officials

• RUSTE Martin, MD, Msc

  Hospices Civils de Lyon

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 11, 2022
• First Posted: January 26, 2022
• Study Start: April 15, 2022
• Primary Completion: December 18, 2025
• Study Completion: December 18, 2025
• Last Updated: January 8, 2026

Record last verified: 2026-01

Locations

FR (3)