Identifying neurocognitive outcomes and cerebral oxygenation in critically ill adults on acute kidney replacement therapy in the intensive care unit: the INCOGNITO-AKI study protocol

Abstract

IntroductionInitiation of acute kidney replacement therapy (KRT) is common in critically ill adults admitted to the intensive care unit (ICU), and associated with increased morbidity and mortality. KRT has been linked to poor neurocognitive outcomes, leading to reduced quality of life and increased utilisation of healthcare resources. Adults on dialysis in the ICU may be particularly at risk of neurocognitive impairment, as survivors of critical illness are already predisposed to developing cerebrovascular disease and cognitive dysfunction long-term relative to healthy controls. Regional cerebral oxygen saturation may provide a critical early marker of long-term neurocognitive impairment in this population. This study aims to understand cerebral oxygenation in patients undergoing KRT (continuous or intermittent) in the ICU. These findings will be correlated with long-term cognitive and functional outcomes, and structural brain pathology.Methods and analysis108 patients scheduled to undergo treatment for acute kidney injury with KRT in the Kingston Health Sciences Centre ICU will be recruited into this prospective observational study. Enrolled patients will be assessed with intradialytic cerebral oximetry using near infrared spectroscopy. Delirium will be assessed daily with the Confusion Assessment Method-ICU (CAM-ICU) and severity quantified as cumulative CAM-ICU-7 scores. Neurocognitive impairment will be assessed at 3 and 12 months after hospital discharge using the Kinarm and Repeatable Battery for the Assessment of Neuropsychological Status. Structural brain pathology on MRI will also be measured at the same timepoints. Driving safety, adverse events and medication adherence will be assessed at 12 months to evaluate the impact of neurocognitive impairment on functional outcomes.Ethics and disseminationThis study is approved by the Queen’s University Health Sciences/Affiliated Teaching Hospitals Research Ethics Board (DMED-2424-20). Results will be presented at critical care conferences, and a lay summary will be provided to patients in their preferred format.Trial registration numberNCT04722939

Advances in the Application of AI Robots in Critical Care: Scoping Review

“…A total of 104 patients in the ICU underwent sensorimotor and neurocognitive assessments using the KINARM 3 and 12 months after discharge. The team then performed a series of kinase evaluations on stroke survivors 3 and 12 months after discharge in patients who were critically ill and receiving acute renal replacement therapy and obtained a 0.3 correlation (90% strength in 89 patients) between regional cerebral oxygen saturation (a surrogate marker of cerebral autonomic regulation) and delirium in patients who were critically ill through KINARM scoring [ 65 ]. The tool has also been used to assess the correlation between brain tissue oxygenation (a surrogate marker of brain perfusion) during the acute phase of critical illness (ie, 24 hours) and long-term neurological dysfunction [ 66 , 103 ], as well as to evaluate sensorimotor deficits in patients with stroke and traumatic brain injury [ 67 , 104 ].…”

Neurological Impairment in Critically Ill Patients on Dialysis: Research Letter for the INCOGNITO-AKI Feasibility Study

“…The methodological details for the full study have been published. 8 Briefly, participants were eligible for inclusion if they met the following criteria: age ≥18 years; diagnosis of severe AKI Stage 2/3 requiring KRT (per KDIGO criteria); and within 12 hours of initiation of KRT via intermittent hemodialysis (IHD) or continuous kidney replacement therapy (CKRT). Exclusion criteria were as follows: acquired/congenital neurological disorders (impacting neurological function independent of kidney disease/KRT); contraindication to testing with cerebral oximetry, Kinarm, or magnetic resonance imaging (MRI) 30 ); KRT via peritoneal dialysis (uncommon in the critical care setting resulting in few participants for subgroup analysis); life expectancy <24 hours (impeding follow-up); clinical suspicion of renal obstruction, rapidly progressive glomerulonephritis or interstitial nephritis (which could independently affect outcomes); or prehospitalization estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m 2 (as chronic kidney disease independently affects neurological function).…”