Acute kidney injury (AKI) is common in critically ill patients and is frequently associated with fluid overload, which can worsen clinical outcomes. Continuous renal replacement therapy (CRRT) allows fluid removal through net ultrafiltration (UFNET), but some patients develop hemodynamic instability or signs of poor tissue perfusion during this process.
The purpose of this prospective observational study is to evaluate tolerance to net ultrafiltration in critically ill patients with AKI receiving CRRT. The study will assess clinical, hemodynamic, ultrasound, perfusion, and biochemical parameters before and during fluid removal to identify factors associated with ultrafiltration intolerance.
The investigators hypothesize that alterations in hemodynamic, perfusion, and congestion-related parameters can identify patients at increased risk of ultrafiltration intolerance before the development of overt hypotension. The results may help improve individualized fluid removal strategies and optimize the safety of CRRT in critically ill patients.
Age ≥18 years
Admission to an Intensive Care Unit
Acute kidney injury according to KDIGO criteria
Prescription of continuous renal replacement therapy (CRRT) with net ultrafiltration
Chronic kidney replacement therapy prior to ICU admission
Pregnancy
Limitation of therapeutic effort or goals-of-care decisions at admission or during the observation period
Inability to perform hemodynamic or perfusion assessment
Adult critically ill patients admitted to participating intensive care units with acute kidney injury requiring continuous renal replacement therapy and prescribed net ultrafiltration as part of routine clinical care.
Case-control
Prospective
Not listed
Development of Ultrafiltration Intolerance
Proportion of patients who develop ultrafiltration intolerance according to the protocol-defined composite criteria, including hypotension, increased vasopressor requirements, worsening peripheral perfusion, tissue hypoperfusion, or reduction/interruption of ultrafiltration due to instability.
Incidence of Ultrafiltration Intolerance
Percentage of participants who develop ultrafiltration intolerance during the observation period.
Net Ultrafiltration Rate (mL/kg/h)
Prescribed and achieved net ultrafiltration rate during continuous renal replacement therapy.
Time to First Ultrafiltration Intolerance Event (hours)
Time from UFNET initiation to the first occurrence of ultrafiltration intolerance.
Severity Category of Ultrafiltration Intolerance
Proportion of participants classified as having mild, moderate, or severe ultrafiltration intolerance according to protocol-defined criteria. Higher categories indicate greater severity of intolerance.
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