Grant: Project Grant

Individuals with critical illness requiring intensive care frequently develop severe acute kidney injury. Unfortunately, short-term death occurs in up to 40% of patients who develop this condition. An abrupt reduction of the ability of the kidneys to produce urine almost always results in fluid accumulation. Considerable evidence suggests that fluid accumulation may impair the function of multiple organs and lead to major complications and increase the risk of death. Kidney replacement therapy enables the removal of fluid in this setting. However, rapid fluid removal may also harm individuals when it results in significant instability. It is therefore urgent to determine what is the best strategy for these patients. This clinical trial proposes to use a proactive approach aimed to avoid fluid accumulation to effectively and safely optimize fluid removal in a critically ill patient with acute kidney injury on kidney replacement therapy. The aim of this pilot study is to enroll 125 individuals to determine whether a larger would be possible to perform. In half of the participants, fluid removal prescription will follow a pre-specified and regularly updated template while fluid removal in the other half will be prescribed according to usual care. The proactive fluid removal strategy will continue until 14 days after enrollment. Participants will be followed until 90 days to assess whether the intervention is safe, whether it is associated with important events, and to determine its impact on the use of healthcare resources. The proposed study is the first step to perform a large-scale definitive study to determine if a proactive fluid management strategy aiming at limiting fluid accumulation is able to improve chances of survival in critically ill adults with severe acute kidney injury. This question is a priority considering the high mortality rate in this population.