Is Myocardial Stunning Induced by Continuous Renal Replacement Therapy a Reality in Critically Ill Patients? (MS-CRRT)

Is Myocardial Stunning Induced by Continuous Renal Replacement Therapy a Reality in Critically Ill Patients?

Is Myocardial Stunning Induced by Continuous Renal Replacement Therapy a Reality in Critically Ill Patients?

Myocardial stunning during chronic intermittent hemodialysis is a well-described phenomenon. Little case series of patients presenting myocardial stunning during renal replacement therapy for acute kidney injury in critically ill patients are reported, with intermittent hemodialysis and continuous renal replacement therapy. However, the small sample sizes and the absence of a control arm limit their interpretation, mainly whether the myocardial stunning may be related to cardiac loading conditions variations and whether it may impact the hemodynamic. The investigator hypothesize that myocardial stunning induced by renal replacement therapy is frequent, independent from cardiac loading conditions and associated with peripheral hypoperfusion.

Acute Kidney Injury KDIGO 3, Continuous Renal Replacement Therapy Initiated by the Clinician in Charge Without Emergency, Myocardial Stunning

Acute kidney injury,, continuous renal replacement therapy, myocardial stunning, regional wall motion abnormalities, 2D speckle tracking echocardiography

Echocardiographic evaluation (with 2D speckle tracking analysis of left ventricular segmental function) 1 hour before and 3 hours after the initiation of continuous renal replacement therapy (continuous veno venous hemofiltration) initiation

Two echocardiographic evaluations (with 2D speckle tracking analysis of left ventricular segmental function) at an interval of 4 hours, before the continuous renal replacement therapy initiation.

Continuous renal replacement therapy (veno venous hemofiltration) without net ultrafiltration, through a dedicated central venous catheter

Continuous renal replacement therapy is differed from 6 hours to allowed 2 control echocardiographic evaluations

Numbers of segments of the left ventricle (by patient) with a decrease greater than 20% of the peak systolic longitudinal strain (2D speckle tracking) on the second echocardiography as compared to baseline.

Inclusion Criteria: Age > 18 years old Acute Kidney Injury grade 3 (KDIGO) Indication for renal replacement therapy for the clinician in charge Exclusion Criteria: Emergency indication to renal replacement therapy (pH<7.15, Kaliemia > 6mmol/L, refractory pulmonary oedema) Poor echogenicity with speckle tracking analysis failure Chronic hemodialysis Extra corporeal membrane oxygenation, left ventricular assist device.