During intermittent hemodialysis (IHD), the occurrence of intradialytic hemodynamic instability (IHI) is frequent in ICU and impacted morbidity and mortality. Bicarbonate dialysate buffer improves hemodynamic tolerance compared to acetate dialysate buffer. However, bicarbonate dialysate buffer still contains a lower concentration of acetate, which could contribute to hemodynamic instability. Recently, citrate-based dialysate in bicarbonate hemodialysis instead of acetate have been proposed. They have the appropriate authorizations for routine use. The aim of this study is to compare acetate- vs citrate-based dialysate in terms of hemodynamic tolerance and effectiveness.
Patient ≥ 18 years old
Patient hospitalized in an intensive care unit
Patient with acute renal failure defined by a KDIGO stage ≥ 1 and suspected non-obstructive
Patient at risk of per dialytic hypotension (capillary refill time ≥ 3 seconds and/or cardiovascular SOFA ≥ 1 and/or lactatemia > 2mmol/L)
Pregnant or breastfeeding woman
Known chronic renal insufficiency of any stage
Cardio-renal and hepato renal syndrome
Unstable hemodynamic state: refractory shock
Parallel
ACETATE based dialysate
DeviceIntermittent hemodialysis with an acetate based dialysate.
CITRATE based dialysate
DeviceIntermittent hemodialysis with an citrate based dialysate.
To show that the use of a citrate-based dialysate decreases the occurrence of intradialytic hypotension in the ICU compared with an acetate-based dialysate (The rate of sessions with occurence of at least one hemodynamic instability (IHI)).
The rate of sessions with occurence of at least one IHI.
Compare between the two groups (acetate- vs citrate-based dialysate) the mortality at day 28 and in ICU;
Mortality at day 28 and in ICU;
Compare between the two groups (acetate- vs citrate-based dialysate) the length of stay in Intensive Care Unit.
Length of stay in Intensive Care Unit
Compare between the two groups (acetate- vs citrate-based dialysate) the Length of stay in hospital.
Length of stay in hospital;
Compare between the two groups (acetate- vs citrate-based dialysate) the Number of days without dialysis in Intensive Care Unit.
Number of days without dialysis in Intensive Care Unit
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Centre Hospitalier de Bethune
Lead sponsor
CHU de Lille
Collaborator
