Haemofiltration Study : IVOIRE (hIgh VOlume in Intensive Care)

NCT ID: NCT00241228

Last Updated: 2010-10-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

139 participants

Study Classification

INTERVENTIONAL

Study Start Date

2005-10-31

Study Completion Date

2010-10-31

Brief Summary

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Sepsis and septic shock are still important causes of mortality in intensive care medicine. Renal replacement therapy by standard volume haemofiltration is currently used, but a higher-volume haemofiltration may improve the prognosis. The study is a prospective randomized multicenter trial comparing two treatments in patients suffering from septic shock complicated with acute renal failure admitted to ICU. One group will be treated by early high volume haemofiltration (70 ml/kg/h) and the second group by standard volume haemofiltration (35 ml/kg/h). The main outcome will be one-month mortality.

Detailed Description

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Background

Sepsis and septic shock are still important causes of mortality in intensive care medicine nowadays. Mortality ranges from 40 up to 80 % depending on the number of organ failures. Therapeutic strategy consists of two major components: haemodynamic stabilization with restoration of adequate arterial pressure and optimization of peripheral perfusion delivery, and infection treatment. Mortality remains high despite the use of new antimicrobial therapy and adjuvant therapies such as activated protein C, low dose corticoids and haemofiltration. Initial observations in patients with acute renal failure treated by haemofiltration showed azotemia control, restoration of the sodium-water balance, elimination of inflammatory mediators and improvement of the cardiac and pulmonary functions was demonstrated independently of a negative water balance. There is no human randomized study so far demonstrating these preliminary findings. Nevertheless, several authors have demonstrated inflammatory mediators elimination by the use of haemofiltration. Moreover, the clinical improvement seems to be related to the ultra filtration dose and to the early initiation of therapy. Joannes-Boyau et al carried out a pilot study in abdominal surgery patients demonstrating that the use of high volume haemofiltration in patients with septic shock and multiple organ failure restores hemodynamic stability with drastic reductions in catecholamine requirements and a substantial reduction of observed vs. expected mortality.

Objectives

The principal objective of the study is to evaluate the effect of early Continuous High Volume Haemofiltration on 28-day mortality in patients with septic shock complicated by acute renal failure. The secondary objectives are to assess the effect of High Volume Haemofiltration on haemodynamics, doses of catecholamines, organ failures, duration of mechanical ventilation, duration of renal replacement therapy need, morbidity, length of ICU and hospital stay, and 60- and 90-day mortality.

Study design

Open label randomized multicenter controlled trial on two parallel groups of patients with septic shock and acute renal failure admitted to ICU, treated early either by high volume (70 ml/kg/h) or by standard volume (35 ml/kg/h) haemofiltration.

Eligibility criteria

Inclusion criteria. Septic shock (Bone criteria) for less than 24 hours, RIFLE criteria : injury or worse, age over 18 years, and written informed consent by next of kin. Non inclusion criteria. Cirrhosis, age over 80 years, life expectancy less than 3 months or metastatic cancer.

Intervention

High volume (70 ml/kg/h) vs. standard volume (35 ml/kg/h) haemofiltration during 96 hours. Further renal replacement therapy (if haemofiltration, only standard volume is allowed) may be used according to investigator decision.

Primary endpoint

All cause 28-day mortality.

Statistical aspects

460 patients are planned to be included (230 in each group). A 15 % absolute reduction in 28-days all-cause mortality in the high volume group compared with the standard group is expected. However, as this reduction might be greater, an interim analysis is planned when half of the total sample size will have been included. Data will be analyzed on an intention-to-treat basis.

Duration of the study: 3 years.

Conditions

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Shock, Septic Renal Failure, Acute

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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High Volume

ultra filtration : High volume : 70 ml/kg/h

Group Type EXPERIMENTAL

Venovenous haemofiltration (renal replacement therapy)

Intervention Type DEVICE

High Volume ultra filtration (70 ml/kg/h)

Medium Volume

Ultra filtration : conventional volume : 35 ml/kg/h

Group Type ACTIVE_COMPARATOR

Venovenous haemofiltration (renal replacement therapy)

Intervention Type DEVICE

Conventional Volume (35 ml/kg/h)

Interventions

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Venovenous haemofiltration (renal replacement therapy)

High Volume ultra filtration (70 ml/kg/h)

Intervention Type DEVICE

Venovenous haemofiltration (renal replacement therapy)

Conventional Volume (35 ml/kg/h)

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* septic shock (Bone criteria) for less than 24 hours
* RIFLE criteria : injury or worse
* age over 18 years
* written informed consent by next of kin.

Exclusion Criteria

* cirrhosis
* age over 80 years
* life expectancy less than 3 months or metastatic cancer
* for women : pregnancy and breastfeeding
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ministry of Health, France

OTHER_GOV

Sponsor Role collaborator

University Hospital, Bordeaux

OTHER

Sponsor Role lead

Responsible Party

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University Hospital, Bordeaux

Principal Investigators

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Olivier JOANNES-BOYAU, Dr

Role: PRINCIPAL_INVESTIGATOR

University Hospital, Bordeaux, France

Patrick HONORE, Dr

Role: PRINCIPAL_INVESTIGATOR

Quuen Astrid Military Hospital, BRUXELLES - Belgium

Paul Perez, Dr

Role: STUDY_CHAIR

University Hospital, Bordeaux, France

Locations

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Cliniques de l'Europe

Brussels, , Belgium

Site Status

Astrid Queen Military Hospital

Bruxelles (Neder Over Hembeek), , Belgium

Site Status

TIVOLI Hospital

La Louvière, , Belgium

Site Status

University Hospital

Liège, , Belgium

Site Status

St-Pierre Para-University Hospital

Ottignies-Louvain-la-Neuve, , Belgium

Site Status

Hospital

Agen, , France

Site Status

Clinic Bordeaux Nord

Bordeaux, , France

Site Status

University Hospital

Brest, , France

Site Status

University Hospital

Grenoble, , France

Site Status

Hospital R Boulin - Libourne

Libourne, , France

Site Status

University Hospital

Lyon, , France

Site Status

Aphp - Hegp

Paris, , France

Site Status

Service d'Anesthésie-Réanimation II, Groupe Hospitalier Sud, CHU de Bordeaux

Pessac, , France

Site Status

Hospital

Tourcoing, , France

Site Status

Hospital

Delf, , Netherlands

Site Status

Hospital

Heerlen, , Netherlands

Site Status

Countries

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Belgium France Netherlands

References

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Medica D, Quercia AD, Marengo M, Fanelli V, Castellano G, Fabbrini P, Migliori M, Merlotti G, Camussi G, Joannes-Boyau O, Honore PM, Cantaluppi V. High-volume hemofiltration does not protect human kidney endothelial and tubular epithelial cells from septic plasma-induced injury. Sci Rep. 2024 Aug 7;14(1):18323. doi: 10.1038/s41598-024-69202-z.

Reference Type DERIVED
PMID: 39112634 (View on PubMed)

Joannes-Boyau O, Honore PM, Perez P, Bagshaw SM, Grand H, Canivet JL, Dewitte A, Flamens C, Pujol W, Grandoulier AS, Fleureau C, Jacobs R, Broux C, Floch H, Branchard O, Franck S, Roze H, Collin V, Boer W, Calderon J, Gauche B, Spapen HD, Janvier G, Ouattara A. High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial. Intensive Care Med. 2013 Sep;39(9):1535-46. doi: 10.1007/s00134-013-2967-z. Epub 2013 Jun 6.

Reference Type DERIVED
PMID: 23740278 (View on PubMed)

Other Identifiers

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2004-024

Identifier Type: -

Identifier Source: secondary_id

9410-04

Identifier Type: -

Identifier Source: org_study_id