Venous Return Pressure Gradient as a Predictor of Acute Kidney Injury

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Conditions studied: AKI - Acute Kidney Injury

In brief

Acute kidney injury (AKI) is a common and serious complication in the ICU. Current diagnostic indicators (such as creatinine and urine output) exhibit significant lag, and specific hemodynamic predictive markers are lacking. The venous return pressure gradient (Pmsf-CVP), based on Guyton's theory, reflects the driving pressure for venous return; however, its value in the early warning of AKI remains unclear. This study aims to investigate the predictive value of the venous return pressure gradient for the onset and progression of AKI in ICU patients, and to clarify its effectiveness as an AKI risk warning indicator. Patients admitted to the ICU within 48 hours with risk factors for AKI (including sepsis, shock, major surgery, underlying diseases, etc.) who have radial artery catheterization and can undergo hemodynamic monitoring will be enrolled. Those undergoing maintenance dialysis/CRRT, ECMO support, or with missing core data precluding calculation of Pmsf-CVP or AKI assessment will be excluded. The venous return pressure gradient (Pmsf-CVP, mmHg) will be measured within 48 hours of ICU admission using the transient stop-flow arm arterial-venous equilibrium pressure method. The primary outcome is to evaluate the association between the venous return pressure gradient level and AKI occurrence. Secondary outcomes include correlation analyses between the venous return pressure gradient level and serum creatinine and urine output within 48 hours of ICU admission, among others.

Key facts

Study ID

NCT07722325

Run by

Sichuan Academy of Medical Sciences

People needed

180

Starts

2026-07-05

Expected to finish

2027-05-01

Last updated by the study team

2026-07-23

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Age ≥18 years
• Admitted to the intensive care unit (ICU) within 48 hours
• Central venous catheter in place for continuous central venous pressure (CVP) monitoring
• Radial artery catheter in place for hemodynamic monitoring including mean systemic filling pressure (Pmsf)
• No acute kidney injury (AKI) at ICU admission according to KDIGO criteria

You may not qualify if…

• Maintenance hemodialysis or continuous renal replacement therapy (CRRT) prior to ICU admission
• Previous kidney transplantation
• Pregnancy
• Extracorporeal membrane oxygenation (ECMO) support at ICU admission
• Incomplete core hemodynamic data precluding calculation of venous return pressure gradient (Pmsf-CVP) or AKI assessment

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