Study Comparing High Cut-off Haemofiltration With Standard Haemofiltration in Acute Renal Failure

NCT ID: NCT00912184

Last Updated: 2012-01-31

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

PHASE1/PHASE2

Total Enrollment

76 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-05-31

Study Completion Date

2012-01-31

Brief Summary

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This trial aims to study the effect of combining continuous and a new polyamide membrane with larger pores in the treatment of critically ill patients with acute renal failure and low blood pressure (shock) requiring noradrenaline. The investigators wish to compare the clinical effect of this new therapy to that of haemofiltration with a standard membrane.

Detailed Description

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During acute renal failure, small and middle molecular-weight toxins accumulate. These molecules are difficult to remove by standard haemofiltration. Accordingly, they accumulate and contribute to morbidity in long-term dialysis patients. Molecules such as cytokines have been shown to play a central pathogenic role in critical illness. In critically ill acute renal failure patients, they accumulate in serum and likely contribute to much morbidity (fever, low blood pressure, myocardial dysfunction, renal failure itself etc.) Therefore, the removal of cytokines appears desirable. Although different approaches have been undertaken, all have had limited success due to complexity, limited efficacy or uncertain clinical response \[10-15\].

It is possible that in using a different and more porous membrane, the removal of cytokines would be much more efficient and that clinical benefits of blood purification would, therefore, be greater.

A membrane of this kind is now available. It is a modification (moderate increase in pore size) of another standard material called polyamide, which has already been used in millions of people for dialysis and haemofiltration. The increased pore size of these new membranes is directed at a more effective removal of middle molecular-weight toxins such as cytokines.

Conditions

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Kidney Failure, Acute Shock

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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1

CVVH with high cut-off polyamide membrane (P2SH) using standard continuous veno-venous hemofiltration (CVVH) settings

Group Type EXPERIMENTAL

High cut-off (super high flux) polyamide membrane

Intervention Type DEVICE

CVVH with standard haemofiltration settings; blood flow 200 ml/min, ultrafiltrate 25 ml/kg/hour, anticoagulation as clinically indicated, bicarbonate-buffered replacement fluid

2

CVVH using standard high flux membrane with standard CVVH settings

Group Type ACTIVE_COMPARATOR

Standard polyamide high flux membrane

Intervention Type DEVICE

Standard haemofiltration; CVVH; blood flow 200 ml/min, ultrafiltrate 25 ml/kg/hr, anticoagulation as clinically indicated, bicarbonate buffered replacement fluid

Interventions

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Standard polyamide high flux membrane

Standard haemofiltration; CVVH; blood flow 200 ml/min, ultrafiltrate 25 ml/kg/hr, anticoagulation as clinically indicated, bicarbonate buffered replacement fluid

Intervention Type DEVICE

High cut-off (super high flux) polyamide membrane

CVVH with standard haemofiltration settings; blood flow 200 ml/min, ultrafiltrate 25 ml/kg/hour, anticoagulation as clinically indicated, bicarbonate-buffered replacement fluid

Intervention Type DEVICE

Other Intervention Names

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High flux membrane P2SH Super high flux membrane

Eligibility Criteria

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Inclusion Criteria

* The treating clinician believes that the patient requires haemofiltration for acute renal failure
* The patient is on noradrenaline infusion for haemodynamic support
* The patient was commenced on noradrenaline or haemofiltration within the last 12 hours
* The clinician is uncertain about the balance of benefits and risks likely to be conferred by treatment with different membranes
* The treating clinicians anticipate treating the patient with haemofiltration for at least 72 hours
* Informed consent has been obtained
* The patient fulfils ONE of the following clinical criteria for initiating haemofiltration:
* Oliguria (urine output \< 100 ml/6 hr) that has been unresponsive to fluid resuscitation measures.
* Hyperkalemia (\[K+\] \> 6.5 mmol/L)
* Severe acidemia (pH \< 7.2)
* Urea \> 25 mmol/liter
* Creatinine \> 300 mmol/L
* Clinically significant organ oedema in the setting of ARF (e.g., lung)

Exclusion Criteria

* Patient age is \< 18 years
* Death is imminent (\< 24 hours)
* There is a strong likelihood that the study treatment would not be continued in accordance with the study protocol
* The patient has been treated with haemofiltration or other dialysis previously during the same hospital admission
* The patient was on maintenance dialysis prior to the current hospitalisation
* Any other major illness that, in the investigator's judgment, will substantially increase the risk associated with the subject's participation in this study
* The patient is pregnant or is breastfeeding
* The patient has previously been enrolled in this study
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Austin Health

OTHER_GOV

Sponsor Role lead

Responsible Party

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Rafidah Atan

PhD student

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Rafidah Atan, MBBS, FANZCA

Role: PRINCIPAL_INVESTIGATOR

Austin Health

Locations

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Austin Hospital

Heidelberg, Victoria, Australia

Site Status

Countries

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Australia

References

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Ronco C, Tetta C, Mariano F, Wratten ML, Bonello M, Bordoni V, Cardona X, Inguaggiato P, Pilotto L, d'Intini V, Bellomo R. Interpreting the mechanisms of continuous renal replacement therapy in sepsis: the peak concentration hypothesis. Artif Organs. 2003 Sep;27(9):792-801. doi: 10.1046/j.1525-1594.2003.07289.x.

Reference Type BACKGROUND
PMID: 12940901 (View on PubMed)

Marshall JC. Inflammation, coagulopathy, and the pathogenesis of multiple organ dysfunction syndrome. Crit Care Med. 2001 Jul;29(7 Suppl):S99-106. doi: 10.1097/00003246-200107001-00032.

Reference Type BACKGROUND
PMID: 11445742 (View on PubMed)

Parrillo JE. Pathogenetic mechanisms of septic shock. N Engl J Med. 1993 May 20;328(20):1471-7. doi: 10.1056/NEJM199305203282008. No abstract available.

Reference Type BACKGROUND
PMID: 8479467 (View on PubMed)

Bone RC. Sir Isaac Newton, sepsis, SIRS, and CARS. Crit Care Med. 1996 Jul;24(7):1125-8. doi: 10.1097/00003246-199607000-00010. No abstract available.

Reference Type BACKGROUND
PMID: 8674323 (View on PubMed)

Pinsky MR, Vincent JL, Deviere J, Alegre M, Kahn RJ, Dupont E. Serum cytokine levels in human septic shock. Relation to multiple-system organ failure and mortality. Chest. 1993 Feb;103(2):565-75. doi: 10.1378/chest.103.2.565.

Reference Type BACKGROUND
PMID: 8432155 (View on PubMed)

Hack CE, Aarden LA, Thijs LG. Role of cytokines in sepsis. Adv Immunol. 1997;66:101-95. doi: 10.1016/s0065-2776(08)60597-0. No abstract available.

Reference Type BACKGROUND
PMID: 9328641 (View on PubMed)

Dinarello CA. Proinflammatory cytokines. Chest. 2000 Aug;118(2):503-8. doi: 10.1378/chest.118.2.503.

Reference Type BACKGROUND
PMID: 10936147 (View on PubMed)

Glauser MP. The inflammatory cytokines. New developments in the pathophysiology and treatment of septic shock. Drugs. 1996;52 Suppl 2:9-17. doi: 10.2165/00003495-199600522-00004.

Reference Type BACKGROUND
PMID: 8869831 (View on PubMed)

Bellomo R, Tipping P, Boyce N. Continuous veno-venous hemofiltration with dialysis removes cytokines from the circulation of septic patients. Crit Care Med. 1993 Apr;21(4):522-6. doi: 10.1097/00003246-199304000-00011.

Reference Type BACKGROUND
PMID: 8472571 (View on PubMed)

Bellomo R. Continuous hemofiltration as blood purification in sepsis. New Horiz. 1995 Nov;3(4):732-7.

Reference Type BACKGROUND
PMID: 8574604 (View on PubMed)

De Vriese AS, Colardyn FA, Philippe JJ, Vanholder RC, De Sutter JH, Lameire NH. Cytokine removal during continuous hemofiltration in septic patients. J Am Soc Nephrol. 1999 Apr;10(4):846-53. doi: 10.1681/ASN.V104846.

Reference Type BACKGROUND
PMID: 10203370 (View on PubMed)

Hoffmann JN, Hartl WH, Deppisch R, Faist E, Jochum M, Inthorn D. Hemofiltration in human sepsis: evidence for elimination of immunomodulatory substances. Kidney Int. 1995 Nov;48(5):1563-70. doi: 10.1038/ki.1995.448.

Reference Type BACKGROUND
PMID: 8544415 (View on PubMed)

Gasche Y, Pascual M, Suter PM, Favre H, Chevrolet JC, Schifferli JA. Complement depletion during haemofiltration with polyacrilonitrile membranes. Nephrol Dial Transplant. 1996 Jan;11(1):117-9.

Reference Type BACKGROUND
PMID: 8649617 (View on PubMed)

Kellum JA, Johnson JP, Kramer D, Palevsky P, Brady JJ, Pinsky MR. Diffusive vs. convective therapy: effects on mediators of inflammation in patient with severe systemic inflammatory response syndrome. Crit Care Med. 1998 Dec;26(12):1995-2000. doi: 10.1097/00003246-199812000-00027.

Reference Type BACKGROUND
PMID: 9875910 (View on PubMed)

Cole L, Bellomo R, Hart G, Journois D, Davenport P, Tipping P, Ronco C. A phase II randomized, controlled trial of continuous hemofiltration in sepsis. Crit Care Med. 2002 Jan;30(1):100-6. doi: 10.1097/00003246-200201000-00016.

Reference Type BACKGROUND
PMID: 11902250 (View on PubMed)

Lee WC, Uchino S, Fealy N, Baldwin I, Panagiotopoulos S, Goehl H, Morgera S, Neumayer HH, Bellomo R. Super high flux hemodialysis at high dialysate flows: an ex vivo assessment. Int J Artif Organs. 2004 Jan;27(1):24-8. doi: 10.1177/039139880402700106.

Reference Type BACKGROUND
PMID: 14984180 (View on PubMed)

Uchino S, Bellomo R, Morimatsu H, Goldsmith D, Davenport P, Cole L, Baldwin I, Panagiotopoulos S, Tipping P, Morgera S, Neumayer HH, Goehl H. Cytokine dialysis: an ex vivo study. ASAIO J. 2002 Nov-Dec;48(6):650-3. doi: 10.1097/00002480-200211000-00013.

Reference Type BACKGROUND
PMID: 12455777 (View on PubMed)

Tsujimoto Y, Miki S, Shimada H, Tsujimoto H, Yasuda H, Kataoka Y, Fujii T. Non-pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy. Cochrane Database Syst Rev. 2021 Sep 14;9(9):CD013330. doi: 10.1002/14651858.CD013330.pub2.

Reference Type DERIVED
PMID: 34519356 (View on PubMed)

Atan R, Peck L, Prowle J, Licari E, Eastwood GM, Storr M, Goehl H, Bellomo R. A Double-Blind Randomized Controlled Trial of High Cutoff Versus Standard Hemofiltration in Critically Ill Patients With Acute Kidney Injury. Crit Care Med. 2018 Oct;46(10):e988-e994. doi: 10.1097/CCM.0000000000003350.

Reference Type DERIVED
PMID: 30074491 (View on PubMed)

Other Identifiers

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High cut-off trial

Identifier Type: -

Identifier Source: org_study_id

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