Use of Vasopressin in Patients at High Risk of Acute Kidney Injury Admitted to the ICU

This is a multicenter, placebo-controlled, double-blind, randomized feasibility clinical trial with a proposal to include 60 patients across 3 to 4 research centers.

This study will be conducted in Brazilian hospitals, covering both public and private healthcare profiles across various states of Brazil. Most of these hospitals are academic and teaching institutions, ensuring a wide diversity of data and perspectives for the research.

The objective of this study is to assess the feasibility of conducting a larger subsequent trial to analyze whether the use of vasopressin in patients prone to developing acute kidney dysfunction after admission to intensive care units (ICUs) can prevent the condition (acute kidney dysfunction).

This study is based on the null hypothesis (H0) that there will be no significant difference in the development of acute kidney injury between the group treated with vasopressin and the control group, while the alternative hypothesis (H1) proposes that the administration of vasopressin may reduce the risk of acute kidney injury in high-risk patients admitted to ICUs. The primary objective is to evaluate the feasibility of the study, specifically adherence to the established protocol and the monitoring of potential adverse effects during its conduct.

• Vasopressin (Drug): To dilute vasopressin, an ampoule containing 20 IU/ml (1 ml) of vasopressin will be used, which will be mixed with 100 ml of 0.9% physiological solution, resulting in a solution with a concentration of 0.2 IU/ ml. In this study, both central and peripheral vein infusion will be permitted. The vasopressin administration protocol will consist of an initial dose of 0.02 IU/min (equivalent to 6 ml/h), which can be increased to 0.03 IU/min (9 ml/h) if the mean arterial pressure (MAP) is less than or equal to 65 mmHg. On the other hand, if MAP exceeds 90 mmHg, the dose can be reduced to 0.01 IU/min (3 ml/h). The minimum period for adjusting the drug dosage should be one hour.
• 0,9% saline solution (Other): Similar to the intervention protocol, but using a placebo composed of 0.9% saline solution.

Primary outcomes

• Feasibility [6 months]: Defined by the inclusion of 60 patients in 3 or more ICUs over a period of 6 months

Secondary outcomes

• Creatinine, in mg/dL [7 days]: Creatinine will be defined by laboratory analysis

Other outcomes

• Mortality [30 days]: Mortality will be defined by medical records

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Adult patients (≥18 years old);
* Admitted to intensive care units;
* Predicted risk of acute kidney injury calculated based on clinical and laboratory data at ICU admission and is considered eligible if the value in the calculator is equal or greater than 5 points;

Exclusion Criteria:

* Time since admission to the ICU greater than 24 hours;
* Use of vasopressors at the time of inclusion;
* MAP >90 mmHg;
* Hyponatremia (<130 mmol/L);
* Severe TBI with Glasgow Coma Scale < 8;
* Elective surgeries;
* Dialysis chronic kidney disease or acute kidney injury who received renal replacement therapy upon admission or are expected to receive renal replacement therapy within the next 24 hours;
* Suspected or confirmed acute mesenteric ischemia;
* Prospect of death in less than 24 hours;
* Medical team not committed to full investment at the time of inclusion;
* Prior inclusion in the study;
* Pregnancy.

• Matheus Silva, Principal investigator, Hospital do Coracao