A Pilot Randomized Controlled Trial of Ultrasound Evaluation of Fluid Tolerance for Acute Kidney Injury (USE-the-FORCE-for-AKI trial)

BACKGROUND: Indiscriminate fluid administration in acute kidney injury (AKI) can be harmful and point-of-care ultrasound (POCUS) could be used to assess for fluid tolerance. The objective of pilot study is to determine the feasibility of a randomized trial comparing a fluid management strategy including POCUS to usual care. METHODS: This is a single centre open-label pilot randomized controlled trial that recruited non-critically ill patients with AKI for whom fluid administration had begun or was considered. The intervention consisted in the transmission to the nephrology team of a POCUS report on fluid tolerance (assessment of pulmonary B-lines and systemic venous congestion with the Venous Excess Ultrasound (VExUS) score). The control was usual care without POCUS. The primary outcome was feasibility, defined as protocol adherence. RESULTS: Eighty patients underwent randomization, 40 were randomized in the POCUS group and 40 in the usual care group, but one withdrew consent before initiating trial procedures. Protocol adherence was achieved in all patients. In the intervention arm, 50% of initial ultrasound reports led to a change in clinical conduct and the provided information was perceived as useful by clinicians (median 4.5/5 (interquartile range: 4.0-5.0)). The intervention led to a higher use of diuretics during the first day after randomization (40% vs 15%, p=0.01) but did not result in difference in cumulative fluid balance or diuretic use at five days, progression to higher stages of AKI, or composite outcome of death and escalation of care. CONCLUSIONS: This pilot trial demonstrate the feasibility of a randomized trial investigating the clinical impact of providing a POCUS fluid tolerance evaluation in AKI. Its impact on clinical management and perceived usefulness support the rationale for future, larger-scale studies.