Critical illness myopathy and trajectory of recovery in acute kidney injury requiring continuous renal replacement therapy: a prospective observational trial protocol
Journal
BMJ Open
ISSN
2044-6055
2044-6055
Date Issued
2023
Author(s)
J Pedro Teixeira
Benjamin R Griffin
Chaitanya Anil Pal
David Felipe Márquez González
Nathanial Jenkins
Beth M Jones
Yuri Yoshida
Naomi George
Hayley Puffer Israel
Lama Ghazi
Javier A Neyra
Kirby P Mayer
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:sec><jats:title>Introduction</jats:title><jats:p>Acute kidney injury requiring renal replacement therapy (AKI-RRT) is common in the intensive care unit (ICU) and is associated with significant morbidity and mortality. Continuous RRT (CRRT) non-selectively removes large amounts of amino acids from plasma, lowering serum amino acid concentrations and potentially depleting total-body amino acid stores. Therefore, the morbidity and mortality associated with AKI-RRT may be partly mediated through accelerated skeletal muscle atrophy and resulting muscle weakness. However, the impact of AKI-RRT on skeletal muscle mass and function during and following critical illness remains unknown. We hypothesise that patients with AKI-RRT have higher degrees of acute muscle loss than patients without AKI-RRT and that AKI-RRT survivors are less likely to recover muscle mass and function when compared with other ICU survivors.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>This protocol describes a prospective, multicentre, observational trial assessing skeletal muscle size, quality and function in ICU patients with AKI-RRT. We will perform musculoskeletal ultrasound to longitudinally evaluate rectus femoris size and quality at baseline (within 48 hours of CRRT initiation), day 3, day 7 or at ICU discharge, at hospital discharge, and 1–3 months postdischarge. Additional skeletal muscle and physical function tests will be performed at hospital discharge and postdischarge follow-up. We will analyse the effect of AKI-RRT by comparing the findings in enrolled subjects to historical controls of critically ill patients without AKI-RRT using multivariable modelling.</jats:p></jats:sec><jats:sec><jats:title>Ethics and dissemination</jats:title><jats:p>We anticipate our study will reveal that AKI-RRT is associated with greater degrees of muscle loss and dysfunction along with impaired postdischarge recovery of physical function. These findings could impact the in-hospital and postdischarge treatment plan for these patients to include focused attention on muscle strength and function. We intend to disseminate findings to participants, healthcare professionals, the public and other relevant groups via conference presentation and publication without any publication restrictions.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="clintrialgov" xlink:href="NCT05287204">NCT05287204</jats:ext-link>.</jats:p></jats:sec>
Subjects
acute renal failure
;
adult intensive & critical care
;
dialysis
;
neuromuscular disease
;
rehabilitation medicine
;
rehabilitation medicine
;
acute kidney injury
;
aftercare
;
continuous renal replacement therapy
;
critical illness
;
humans
;
intensive care units
;
multicenter studies as topic
;
muscular diseases
;
observational studies as topic
;
patient discharge
;
prospective studies
;
renal replacement therapy
;
acute kidney failure
;
adult
;
article
;
attention
;
clinical frailty scale
;
continuous renal replacement therapy
;
controlled study
;
critical illness myopathy
;
critically ill patient
;
dynamometry
;
european quality of life 5 dimensions questionnaire
;
female
;
follow up
;
function test
;
functional assessment
;
functional assessment of chronic illness therapy
;
health care personnel
;
hospital discharge
;
human
;
human tissue
;
intensive care
;
intensive care unit
;
male
;
multicenter study
;
muscle function
;
muscle mass
;
muscle strength
;
neuromuscular disease
;
rectus femoris muscle
;
rehabilitation medicine
;
renal replacement therapy
;
short physical performance battery
;
six minute walk test
;
skeletal muscle
;
sonographer
;
survivor
;
acute kidney failure
;
aftercare
;
critical illness
;
multicenter study (topic)
;
muscle disease
;
observational study
;
procedures
;
prospective study
;
renal replacement therapy