WISDOM

LoW Dose-Intensity vs. Standard Dose-Intensity COntinuous Renal ReplaceMent Therapy in Critically Ill Patients (WISDOM): A Pilot Randomized Trial

Objective

The WISDOM research program aims to address whether a lower CRRT dose-intensity (10-15 mL/kg/hr) in critically ill patients with acute kidney injury (AKI) is non-inferior for 90-day mortality compared to the current guideline-directed standard CRRT dose-intensity (25-30 mL/kg/hr) and will secondarily determine if lower CRRT dose-intensity can shorten RRT duration and improve kidney recovery versus the guideline-directed standard.

Detailed Description

The 2012 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines (CPG) for AKI (https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-AKI-Guideline-English.pdf) recommend delivering a CRRT dose-intensity of 20-25 mL/kg/hr. This recommendation is derived from prior RCTs evaluating higher dose-intensity (35-40 mL/kg/hr vs. 20-25 mL/kg/hr) that did not show survival advantage. These findings translated to a dose-intensity of 20-25 mL/kg/hr becoming the de facto dose-intensity standard for patients receiving CRRT. To date, no RCT has focused on evaluating or defining a minimally acceptable and safe CRRT dose-intensity threshold. Specifically, it is not clear whether a lower dose-intensity (10-15 mL/kg/hr) may be equally acceptable or even superior to the current guideline-directed standard (25-30 mL/kg/hr).

Design

The LoW Dose-Intensity vs. Standard Dose-Intensity COntinuous Renal ReplaceMent Therapy in Critically Ill Patients (WISDOM) trial is a multi-centre prospective, randomized, open-label, blinded endpoint (PROBE) pilot trial in adult ICU patients with AKI receiving CRRT.

Study Population

Critically ill patients admitted to ICU with AKI in whom the clinical team has decided to start CRRT or who are within 24 hours of having started CRRT will be potentially eligible.

WISDOM Announcements

WISDOM Pilot Study presented and endorsed at the 2024 fall Canadian Critical Care Trials Group Scientific Meeting