NEPTUNE
NEt ultrafiltration Prescription and Targeting versus Usual NEt ultrafiltration during continuous renal replacement therapy.
A multi-centre, cluster cross-over, phase 2b randomised clinical trial
Aim:
The primary aim is to determine whether targeting a moderate net ultrafiltration (NUF) rate in critically ill patients receiving continuous renal replacement therapy (CRRT) affects renal recovery and patient survival compared to usual care.
Rationale:
Acute kidney injury (AKI) is a common complication among patients in the intensive care unit (ICU). It is associated with substantial morbidity in the short- and long-term, and is an independent predictor of mortality. AKI severe enough to require the use of continuous renal replacement therapy (CRRT) affects approximately 5% of critically ill patients and carries a mortality risk of 50-60%.
Fluid removal during CRRT enables management of volume status and is supported by international clinical guidelines. Emerging evidence from epidemiologic studies of critically ill patients with acute kidney injury suggests that higher intensities of fluid removal (i.e., higher net ultrafiltration [NUF] rates) impair renal recovery and are associated with increased mortality. However, no randomised studies have compared patient outcomes achieved by targeting a moderate NUF rate compared to usual care.
Study Progress:
NEPTUNE commenced recruitment in December 2023, and there are currently 10 participating Intensive Care Units across Australia.
Funding:
Received unrestricted funding from Baxter Investigator Initiated Research Scheme and the NHMRC CRE-ICU (GNT2006514)