Critical illness myopathy and trajectory of recovery in acute kidney injury requiring continuous renal replacement therapy: A prospective observational trial protocol

J. Pedro Teixeira, Benjamin R. Griffin, Chaitanya Anil Pal, Felipe González-Seguel, Nathanial Jenkins, Beth M. Jones, Yuri Yoshida, Naomi George, Hayley Puffer Israel, Lama Ghazi, Javier A. Neyra, Kirby P. Mayer

Research output: Contribution to journalArticlepeer-review


Introduction Acute kidney injury requiring renal replacement therapy (AKI-RRT) is common in the intensive care unit (ICU) and is associated with significant morbidity and mortality. Continuous RRT (CRRT) non-selectively removes large amounts of amino acids from plasma, lowering serum amino acid concentrations and potentially depleting total-body amino acid stores. Therefore, the morbidity and mortality associated with AKI-RRT may be partly mediated through accelerated skeletal muscle atrophy and resulting muscle weakness. However, the impact of AKI-RRT on skeletal muscle mass and function during and following critical illness remains unknown. We hypothesise that patients with AKI-RRT have higher degrees of acute muscle loss than patients without AKI-RRT and that AKI-RRT survivors are less likely to recover muscle mass and function when compared with other ICU survivors. Methods and analysis This protocol describes a prospective, multicentre, observational trial assessing skeletal muscle size, quality and function in ICU patients with AKI-RRT. We will perform musculoskeletal ultrasound to longitudinally evaluate rectus femoris size and quality at baseline (within 48 hours of CRRT initiation), day 3, day 7 or at ICU discharge, at hospital discharge, and 1-3 months postdischarge. Additional skeletal muscle and physical function tests will be performed at hospital discharge and postdischarge follow-up. We will analyse the effect of AKI-RRT by comparing the findings in enrolled subjects to historical controls of critically ill patients without AKI-RRT using multivariable modelling. Ethics and dissemination We anticipate our study will reveal that AKI-RRT is associated with greater degrees of muscle loss and dysfunction along with impaired postdischarge recovery of physical function. These findings could impact the in-hospital and postdischarge treatment plan for these patients to include focused attention on muscle strength and function. We intend to disseminate findings to participants, healthcare professionals, the public and other relevant groups via conference presentation and publication without any publication restrictions. Trial registration number NCT05287204.

Original languageEnglish
Article numbere072448
JournalBMJ Open
Issue number5
StatePublished - May 22 2023

Bibliographical note

Funding Information:
This work is supported by a Clinical and Translational Award (CTSA) Inter‐Institutional Pilot Project Award (U24TR002260 from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS). JAN is supported by grants from the NIH National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), including R01DK128208, U01DK12998, and P30DK079337. KPM is supported by the NIH National Institute of Arthritis and Musculoskeletal and Skin Disease under award number K23-AR079583.

Publisher Copyright:
© 2023 BMJ Publishing Group. All rights reserved.


  • acute renal failure
  • adult intensive & critical care
  • dialysis
  • neuromuscular disease
  • rehabilitation medicine
  • rehabilitation medicine

ASJC Scopus subject areas

  • Medicine (all)


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