Supported Research

Lay Summary

Individuals who becomes critically ill and are admitted to the intensive care unit often develop kidney injury which can be severe enough to impair the ability to produce urine. In this setting, fluid is likely to accumulate and this may cause important complications, including potentially reducing the chances of kidney recovery in the long term. Renal replacement therapy (i.e. Dialysis) enable mechanical fluid removal which is used to maintain fluid balance. However, the prescription of fluid removal is challenging for physician. A rapid fluid removal rate may increase the risk of instability in critically ill individuals, carrying a risk for serious adverse events, while slow fluid removal promote fluid accumulation leading to aforementioned complications. Despite being a daily decision clinicians must make, there is a large variability in the fluid removal prescription and few concrete source of evidence to define what is the optimal approach. In a recent international survey among 2567 health practitioners, significant variations in fluid removal practices were noted. Most practitioners (81.4%) indicated that a protocol outlining how fluid removal should be prescribed would be useful although the precise nature of such a protocol is unknown. The objective of my research program is to generate practical data that would help physician and nurses to safely optimize fluid removal using renal replacement therapy in the intensive care unit. First, using large databases, I will describe the element that predicts which patients will tolerate fluid removal and the factors associated with a failure to achieve the desired fluid removal. This is likely to help physician to personalize their fluid removal prescription based of the characteristics of their patients, thereby reducing the risk of blood pressure drops while optimizing the efficacy of fluid removal. Secondly, I will conduct a pilot clinical trial to determine whether it is feasible to implement protocolized fluid removal and compare it to standard care. A protocolized fluid removal prescription is likely to improve safety and efficacy of fluid removal. However, no trial has demonstrated this so far. Demonstrating the feasibility of this approach would support the need to perform a large clinical trial to determine if protocolized fluid removal can improve outcome including reducing the risk of death or end-stage chronic kidney disease in the long term.