The effect of filter lifespan in continuous renal replacement therapy on the rate of new infections in critically ill patients: a prospective multicenter observational trial

• Grant number: 23/00552-5
• Support Opportunities: Regular Research Grants
• Start date: July 01, 2023
• End date: June 30, 2025
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Agreement: University of Münster (WWU)
• Mobility Program: SPRINT - Projetos de pesquisa - Mobilidade
• Principal Investigator: Lucia da Conceição Andrade
• Grantee: Lucia da Conceição Andrade
• Principal researcher abroad: Alexander Zarbock
• Institution abroad: University of Munster, Germany
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil
• Associated researchers: Talita Rojas Cunha Sanches
• Associated research grant: 19/19433-0 - Pollution is the motor of premature ageing of the kidney, AP.TEM

Abstract

Filter lifespan in critically ill patients requiring CRRT patients correlates with the rate of infections. The only supportive therapy for patients with AKI is continuous renal replacement therapy (CRRT). In a post-hoc analysis, previous study has recently shown that the filter life span is associated with an increased rate of new infection (filler life span: OR per 10 hours increase: 1.21 (1.11-1.31)). Increasing the filler life span by 10 hours increases infection rate by 21%. However, the type of anticoagulants did not directly affect the infection rate. Unfortunately, the mechanism of this infection rate is unknown. Primary Endpoint New infection since start of dialysis (defined as new infection in patients with pre-existing infection but with another pathogen than baseline or without baseline infection but after initiation of kidney replacement therapy up to the end of ICU stay or day 28 (whichever occurs first); all infections need to be culture proven and all sources are included). Secondary Endpoints: New pneumonia since start of dialysis up to the end of ICU or day 28, whichever occurs first; New bloodstream infection since start of dialysis up to the end of ICU or day 28, whichever occurs first; New urinary tract infection since start of dialysis up to the end of ICU or day 28, whichever occurs first; New catheter blood stream infection since start of dialysis up to the end of ICU or day 28, whichever occurs first; Other infections since start of dialysis up to the end of ICU or day 28, whichever occurs first; Filter lifespan; Detection of bacterial contamination of the CRRT circuit proven by culture; Down-time; Days on RRT; Duration of mechanical ventilation; Bleeding complications (defined as bleeding with the need for at least 1 RBC); Number of transfused patients; Recovery of kidney function (defined as complete recovery: serum-creatinine 0.5 mg/dl higher than baseline; partial recovery: serum creatinine >0.5 mg/dl higher than baseline but no dialysis-dependence, non-recovery: patients who remained dialysis-<:dependent at days 28, 60, and 90); Need for kidney replacement therapy at days 28, 60, and 90; Overall survival, all-