Guided fluid removal using VeXUS score for patients with acute kidney injury after heart surgery

Feasibility of a Randomised Trial Comparing a Fluid-removal Guided by VeXUS Score With Usual Care in Patients With Acute Kidney Injury After Cardiac Surgery: a Pilot Randomised Trial.

This study is testing if using the VeXUS score to manage fluid levels can help patients with acute kidney injury after heart surgery recover better than standard care.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 40 (estimated)
• Ages: 18 Years to 85 Years
• Sex: All
• Sponsor: Hospices Civils de Lyon (other)
• Locations: 2 sites (Bron, Bron and 1 other locations)
• Trial ID: NCT06251713 on ClinicalTrials.gov

What this trial studies

This study investigates the use of the VeXUS score, an ultrasound-based assessment of venous congestion, to guide fluid management in patients who have developed acute kidney injury following cardiac surgery. The goal is to determine if this targeted approach can improve patient outcomes compared to standard care. Participants will be those admitted to the intensive care unit within 72 hours post-surgery and diagnosed with acute kidney injury. The study aims to address the challenges of fluid management in this vulnerable population, where both dehydration and fluid overload can be harmful.

Who should consider this trial

Good fit: Ideal candidates are patients admitted to the ICU within 72 hours of cardiac surgery who meet the KDIGO criteria for acute kidney injury.

Not a fit: Patients with severe pre-existing kidney disease or those requiring immediate renal replacement therapy may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could lead to improved kidney recovery and reduced mortality in patients after cardiac surgery.

How similar studies have performed: While the use of ultrasound scores in fluid management is gaining traction, this specific application of the VeXUS score is relatively novel and has not been extensively tested in prior studies.

Eligibility criteria

Inclusion Criteria:

* Intensive care unit admission within 72 hours of cardiac surgery with extracorporeal circulation
* Acute kidney injury defined by KDIGO criteria
* Vasoactive inotropic score \<45 and capillary refill time \<3s
* Informed written consent

Exclusion Criteria:

* Hypokalaemia \<3.5mmol/L
* Hyponatremia\<125mmol/L
* Hypernatremia \>145mmol/L
* Metabolic alkalosis with pH \>7.50
* Impossibility to measure capillary refill time
* Chronic liver disease
* Cirrhosis with portal hypertension
* Known thrombus of the inferior vena cava
* Mechanical circulatory assistance (ECMO or mono left ventricular assistance)
* Severe pre-operative chronic kidney disease (GFR \< 30mL/min/1.73m2)
* Need for renal replacement therapy anticipated by the attending physician within 24 hours
* Known hypersensitivity to Furosemide and/or hydrochlorothiazide
* Severe allergy to wheat
* Patient already included in another interventional study with an exclusion period still in progress
* Pregnant, breast-feeding or women of childbearing age without suitable contraception
* Patients under guardianship, curatorship or safeguard of justice
* Patients under psychiatric care
* Patients not affiliated to a social security scheme or beneficiaries of a similar scheme

Where this trial is running

Bron, Bron and 1 other locations

• Hôpital Louis Pradel, Groupement Hospitalier Est, Hospices Civils de Lyon — Bron, Bron, France (NOT_YET_RECRUITING)
• Hopital cardiologique Louis Pradel — Bron, France (RECRUITING)

Study contacts

• Study coordinator: Jean-Luc Fellahi, MD

Conditions: Acute Kidney Injury, Cardiac Surgery, Venous Congestion, Hemodynamic Stability, Acute kidney injury, Cardiac surgery, VeXUS score, diuretic