Skip to main content
Top
Published in: Trials 1/2018

Open Access 01-12-2018 | Study protocol

VolumE maNagement Under body composition monitoring in critically ill patientS on CRRT: study protocol for a randomized controlled trial (VENUS trial)

Authors: Hyung Jung Oh, Jung Nam An, Sohee Oh, Harin Rhee, Jung Pyo Lee, Dong Ki Kim, Dong-Ryeol Ryu, Sejoong Kim

Published in: Trials | Issue 1/2018

Login to get access

Abstract

Background

Despite recent technical advances in the management of acute kidney injury (AKI), such as continuous renal replacement therapy (CRRT), intensive care unit mortality is still high, at approximately 40 to 50%. Although several factors have been reported to predict mortality in AKI patients, fluid overload (FO) during CRRT is a well-known predictor of patient survival. However, FO has been mostly quantified as an arithmetical calculation and determined on the basis of the physicians’ perception. Even though such quantification and assessment provides an easy evaluation of a patient’s fluid status and is a simple method, it is not applicable unless a detailed record of fluid monitoring is available. Furthermore, the method cannot differentiate excess water in individual water compartments but can only reflect excess total body water. Bioimpedance analysis (BIA) has been used to measure the nutritional component of body composition and is a promising tool for the measurement of volume status. However, there has been no prospective interventional study for fluid balance among CRRT-treated AKI patients using BIA. Therefore, we will investigate the usefulness of fluid management using the InBody S10 (InBody®, Seoul, Korea), a BIA tool, compared with that of generally used quantification methods.

Methods/design

This will be a multicenter, prospective, randomized controlled trial. A total of 244 patients undergoing CRRT treatment will be enrolled and randomly assigned to receive either to InBody S10-guided management or to fluid management based only on clinical information for 7 days. The primary outcome is to compare the rate of euvolemic status 7 days after the initiation of CRRT, with a secondary outcome being to compare the 28-, 60-, and 90-day mortality rates between the two groups.

Discussion

This will be the first clinical trial to investigate the effect of using BIA-guided fluid management to achieve euvolemia in CRRT-treated AKI patients.

Trial registration

ClinicalTrials.gov, ID: NCT03330626. Registered on 6 November 2017.
Appendix
Available only for authorised users
Literature
1.
go back to reference Ostermann M, Joannidis M, Pani A, et al. Patient selection and timing of continuous renal replacement therapy. Blood Purif. 2016;42:224–37.CrossRef Ostermann M, Joannidis M, Pani A, et al. Patient selection and timing of continuous renal replacement therapy. Blood Purif. 2016;42:224–37.CrossRef
2.
go back to reference Bagshaw SM, Chakravarthi MR, Ricci Z, et al. Precision continuous renal replacement therapy and solute control. Blood Purif. 2016;42:238–47.CrossRef Bagshaw SM, Chakravarthi MR, Ricci Z, et al. Precision continuous renal replacement therapy and solute control. Blood Purif. 2016;42:238–47.CrossRef
3.
go back to reference Murugan R, Hoste E, Mehta RL, et al. Precision fluid management in continuous renal replacement therapy. Blood Purif. 2016;42:266–78.CrossRef Murugan R, Hoste E, Mehta RL, et al. Precision fluid management in continuous renal replacement therapy. Blood Purif. 2016;42:266–78.CrossRef
4.
go back to reference Cerda J, Baldwin I, Honore PM, Villa G, Kellum JA, Ronco C. Role of technology for the management of AKI in critically ill patients: from adoptive technology to precision continuous renal replacement rherapy. Blood Purif. 2016;42:248–65.CrossRef Cerda J, Baldwin I, Honore PM, Villa G, Kellum JA, Ronco C. Role of technology for the management of AKI in critically ill patients: from adoptive technology to precision continuous renal replacement rherapy. Blood Purif. 2016;42:248–65.CrossRef
5.
go back to reference Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet. 2000;356:26–30.CrossRef Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet. 2000;356:26–30.CrossRef
6.
go back to reference Heering P, Morgera S, Schmitz FJ, et al. Cytokine removal and cardiovascular hemodynamics in septic patients with continuous venovenous hemofiltration. Intensive Care Med. 1997;23:288–96.CrossRef Heering P, Morgera S, Schmitz FJ, et al. Cytokine removal and cardiovascular hemodynamics in septic patients with continuous venovenous hemofiltration. Intensive Care Med. 1997;23:288–96.CrossRef
7.
go back to reference Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–8.CrossRef Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–8.CrossRef
8.
go back to reference Nisula S, Kaukonen KM, Vaara ST, et al. Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med. 2013;39:420–8.CrossRef Nisula S, Kaukonen KM, Vaara ST, et al. Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med. 2013;39:420–8.CrossRef
9.
go back to reference Oh HJ, Kim MH, Ahn JY, et al. Can early initiation of continuous renal replacement therapy improve patient survival with septic acute kidney injury when enrolled in early goal-directed therapy? J Crit Care. 2016;35:51–6.CrossRef Oh HJ, Kim MH, Ahn JY, et al. Can early initiation of continuous renal replacement therapy improve patient survival with septic acute kidney injury when enrolled in early goal-directed therapy? J Crit Care. 2016;35:51–6.CrossRef
10.
go back to reference Oh HJ, Shin DH, Lee MJ, et al. Early initiation of continuous renal replacement therapy improves patient survival in severe progressive septic acute kidney injury. J Crit Care. 2012;27:743.e9–18.CrossRef Oh HJ, Shin DH, Lee MJ, et al. Early initiation of continuous renal replacement therapy improves patient survival in severe progressive septic acute kidney injury. J Crit Care. 2012;27:743.e9–18.CrossRef
11.
go back to reference Bagshaw SM, Brophy PD, Cruz D, Ronco C. Fluid balance as a biomarker: impact of fluid overload on outcome in critically ill patients with acute kidney injury. Crit Care. 2008;12:169.CrossRef Bagshaw SM, Brophy PD, Cruz D, Ronco C. Fluid balance as a biomarker: impact of fluid overload on outcome in critically ill patients with acute kidney injury. Crit Care. 2008;12:169.CrossRef
12.
go back to reference Cerda J, Sheinfeld G, Ronco C. Fluid overload in critically ill patients with acute kidney injury. Blood Purif. 2010;29:331–8.CrossRef Cerda J, Sheinfeld G, Ronco C. Fluid overload in critically ill patients with acute kidney injury. Blood Purif. 2010;29:331–8.CrossRef
13.
go back to reference Metnitz PG, Krenn CG, Steltzer H, et al. Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med. 2002;30:2051–8.CrossRef Metnitz PG, Krenn CG, Steltzer H, et al. Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med. 2002;30:2051–8.CrossRef
14.
go back to reference Neyra JA, Li X, Canepa-Escaro F, et al. Cumulative fluid balance and mortality in septic patients with or without acute kidney injury and chronic kidney disease. Crit Care Med. 2016;44:1891–900.CrossRef Neyra JA, Li X, Canepa-Escaro F, et al. Cumulative fluid balance and mortality in septic patients with or without acute kidney injury and chronic kidney disease. Crit Care Med. 2016;44:1891–900.CrossRef
15.
go back to reference Bellomo R, Cass A, Cole L, et al. An observational study fluid balance and patient outcomes in the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy trial. Crit Care Med. 2012;40:1753–60.CrossRef Bellomo R, Cass A, Cole L, et al. An observational study fluid balance and patient outcomes in the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy trial. Crit Care Med. 2012;40:1753–60.CrossRef
16.
go back to reference Garzotto F, Ostermann M, Martin-Langerwerf D, et al. The Dose Response Multicentre Investigation on Fluid Assessment (DoReMIFA) in critically ill patients. Crit Care. 2016;20:196.CrossRef Garzotto F, Ostermann M, Martin-Langerwerf D, et al. The Dose Response Multicentre Investigation on Fluid Assessment (DoReMIFA) in critically ill patients. Crit Care. 2016;20:196.CrossRef
17.
go back to reference Rhee H, Jang KS, Shin MJ, et al. Use of multifrequency bioimpedance analysis in male patients with acute kidney injury who are undergoing continuous veno-venous hemodiafiltration. PLoS One. 2015;10:e0133199.CrossRef Rhee H, Jang KS, Shin MJ, et al. Use of multifrequency bioimpedance analysis in male patients with acute kidney injury who are undergoing continuous veno-venous hemodiafiltration. PLoS One. 2015;10:e0133199.CrossRef
18.
go back to reference Kyle UG, Unger P, Dupertuis YM, Karsegard VL, Genton L, Pichard C. Body composition in 995 acutely ill or chronically ill patients at hospital admission: a controlled population study. J Am Diet Assoc. 2002;102:944–55.CrossRef Kyle UG, Unger P, Dupertuis YM, Karsegard VL, Genton L, Pichard C. Body composition in 995 acutely ill or chronically ill patients at hospital admission: a controlled population study. J Am Diet Assoc. 2002;102:944–55.CrossRef
19.
go back to reference Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr. 2004;23:1430–53.CrossRef Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr. 2004;23:1430–53.CrossRef
20.
go back to reference Malbrain ML, Huygh J, Dabrowski W, De Waele JJ, Staelens A, Wauters J. The use of bio-electrical impedance analysis (BIA) to guide fluid management, resuscitation and deresuscitation in critically ill patients: a bench-to-bedside review. Anaesthesiol Intensive Ther. 2014;46:381–91.CrossRef Malbrain ML, Huygh J, Dabrowski W, De Waele JJ, Staelens A, Wauters J. The use of bio-electrical impedance analysis (BIA) to guide fluid management, resuscitation and deresuscitation in critically ill patients: a bench-to-bedside review. Anaesthesiol Intensive Ther. 2014;46:381–91.CrossRef
21.
go back to reference Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis—part I: review of principles and methods. Clin Nutr. 2004;23:1226–43.CrossRef Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis—part I: review of principles and methods. Clin Nutr. 2004;23:1226–43.CrossRef
22.
go back to reference Chamney PW, Wabel P, Moissl UM, et al. A whole-body model to distinguish excess fluid from the hydration of major body tissues. Am J Clin Nutr. 2007;85:80–9.CrossRef Chamney PW, Wabel P, Moissl UM, et al. A whole-body model to distinguish excess fluid from the hydration of major body tissues. Am J Clin Nutr. 2007;85:80–9.CrossRef
23.
go back to reference O’Lone EL, Visser A, Finney H, Fan SL. Clinical significance of multi-frequency bioimpedance spectroscopy in peritoneal dialysis patients: independent predictor of patient survival. Nephrol Dial Transplant. 2014;29:1430–7.CrossRef O’Lone EL, Visser A, Finney H, Fan SL. Clinical significance of multi-frequency bioimpedance spectroscopy in peritoneal dialysis patients: independent predictor of patient survival. Nephrol Dial Transplant. 2014;29:1430–7.CrossRef
24.
go back to reference Koh KH, Wong HS, Go KW, Morad Z. Normalized bioimpedance indices are better predictors of outcome in peritoneal dialysis patients. Perit Dial Int. 2011;31:574–82.CrossRef Koh KH, Wong HS, Go KW, Morad Z. Normalized bioimpedance indices are better predictors of outcome in peritoneal dialysis patients. Perit Dial Int. 2011;31:574–82.CrossRef
25.
go back to reference Alijanian N, Naini AE, Shahidi S, Liaghat L, Samani RR. The comparative evaluation of patients’ body dry weight under hemodialysis using two methods: bioelectrical impedance analysis and conventional method. J Res Med Sci. 2012;17:923–7.PubMedPubMedCentral Alijanian N, Naini AE, Shahidi S, Liaghat L, Samani RR. The comparative evaluation of patients’ body dry weight under hemodialysis using two methods: bioelectrical impedance analysis and conventional method. J Res Med Sci. 2012;17:923–7.PubMedPubMedCentral
26.
go back to reference Tattersall J. Bioimpedance analysis in dialysis: state of the art and what we can expect. Blood Purif. 2009;27:70–4.CrossRef Tattersall J. Bioimpedance analysis in dialysis: state of the art and what we can expect. Blood Purif. 2009;27:70–4.CrossRef
27.
go back to reference Kotanko P, Levin NW, Zhu F. Current state of bioimpedance technologies in dialysis. Nephrol Dial Transplant. 2008;23:808–12.CrossRef Kotanko P, Levin NW, Zhu F. Current state of bioimpedance technologies in dialysis. Nephrol Dial Transplant. 2008;23:808–12.CrossRef
28.
go back to reference Basso F, Berdin G, Virzi GM, et al. Fluid management in the intensive care unit: bioelectrical impedance vector analysis as a tool to assess hydration status and optimal fluid balance in critically ill patients. Blood Purif. 2013;36:192–9.CrossRef Basso F, Berdin G, Virzi GM, et al. Fluid management in the intensive care unit: bioelectrical impedance vector analysis as a tool to assess hydration status and optimal fluid balance in critically ill patients. Blood Purif. 2013;36:192–9.CrossRef
29.
go back to reference Dabrowski W, Kotlinska-Hasiec E, Schneditz D, et al. Continuous veno-venous hemofiltration to adjust fluid volume excess in septic shock patients reduces intra-abdominal pressure. Clin Nephrol. 2014;82:41–50.PubMed Dabrowski W, Kotlinska-Hasiec E, Schneditz D, et al. Continuous veno-venous hemofiltration to adjust fluid volume excess in septic shock patients reduces intra-abdominal pressure. Clin Nephrol. 2014;82:41–50.PubMed
Metadata
Title
VolumE maNagement Under body composition monitoring in critically ill patientS on CRRT: study protocol for a randomized controlled trial (VENUS trial)
Authors
Hyung Jung Oh
Jung Nam An
Sohee Oh
Harin Rhee
Jung Pyo Lee
Dong Ki Kim
Dong-Ryeol Ryu
Sejoong Kim
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Trials / Issue 1/2018
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-018-3056-y

Other articles of this Issue 1/2018

Trials 1/2018 Go to the issue