Preventing low blood pressure during ICU dialysis using a Hypotension Prediction Index
Hypotension Prediction Index Guided Prevention of Intradialytic Hypotension During Intermittent Renal Replacement Therapy in Intensive Care Units
This trial tests whether using a Hypotension Prediction Index to guide care during prolonged dialysis can reduce episodes of low blood pressure in critically ill adults who have an arterial line.
Quick facts
| Phase | Not applicable |
|---|---|
| Study type | Interventional |
| Enrollment | 46 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | Chulalongkorn University Academic / other |
| Locations | 1 site (Bangkok) |
| Trial ID | NCT07179705 on ClinicalTrials.gov |
What this trial studies
This single-center, randomized crossover trial enrolls critically ill adults with acute kidney injury or end-stage kidney disease who are scheduled for prolonged intermittent renal replacement therapy (PIRRT). Participants are randomized in blocks stratified by kidney status and vasopressor use to receive either management guided by the Hypotension Prediction Index (HPI) displayed on the Hemosphere monitor or standard hemodynamic monitoring. Continuous arterial waveform data are monitored in real time and clinical responses are reassessed after each intervention during PIRRT sessions. The primary question is whether HPI guidance reduces the frequency or severity of intradialytic hypotension compared with usual care.
Who should consider this trial
Good fit: Ideal candidates are adults in the medical ICU with AKI or ESKD who are scheduled for PIRRT and already have an indwelling arterial catheter for continuous monitoring.
Not a fit: Patients with severe right heart dysfunction, significant valvular disease, arrhythmias, on mechanical circulatory support, without arterial access, lacking an ultrafiltration prescription, under palliative care, or expected to leave the ICU within 72 hours are unlikely to benefit.
Why it matters
Potential benefit: If successful, this approach could reduce episodes of low blood pressure during dialysis, improving dialysis tolerance and potentially lowering organ injury and vasopressor needs.
How similar studies have performed: HPI-guided management has shown promise in operating room and some critical care studies, but applying it specifically to PIRRT in ICU patients is relatively novel and not yet widely validated.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * Adults \>18 years old * Diagnosed with acute kidney injury (AKI) or end-stage kidney disease (ESKD) * Admitted to medical ICU * Scheduled for PIRRT * Have an indwelling arterial catheter Exclusion Criteria: * Severe right heart dysfunction, significant valvular disease, arrhythmias, mechanical circulatory support, absence of arterial access, no UF prescription, palliative care, or expected ICU stay \<72 hours.
Where this trial is running
Bangkok
- Division of Nephrology, Faculty of Medicine, Chulalongkorn University — Bangkok, Thailand (Recruiting)
Study contacts
- Study coordinator: Nattapakorn Mai-on
- Email: nattapakorn.m@gmail.com
- Phone: 66970051116
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.