CAPITAL OFFLOAD-SHOCK

The trial will evaluate the in-hospital mortality between starting renal replacement therapy (RRT) immediately upon confirmation of eligibility and consent and using standard medical therapy without RRT unless one of the following occurs:

• clinical volume overload refractory to diuresis with high-dose intravenous furosemide plus either thiazide-like diuretic and/or acetazolamide, resulting in pulmonary edema, necessitation ventilation with F1O2 > 50%
• hyperkalemia with serum potassium >6mmol/L
• Severe metabolic acidosis with pH <7.2 and bicarb <12 mmol/L thought to be due to renal insufficiency.

Inclusion criteria

• adult patients >/= 18 years of age admitted to an intensive care unit
• Diagnosed clinically with Society for Cardiovascular Angiography and Interventions (SCAI) Class C or D cardiogenic shock
• Clinical or hemodynamic evidence of volume overload

Exclusion criteria

• Patients whose care plan, as determined by the treating clinical team, will not include renal replacement therapy
• Decision has already been made by the treating clinical team to initiate renal replacement therapy
• Hyperkalemia with serum potassium >/= 6mmol/L at the time of screening
• Severe metabolic acidosis with serum bicarbonate </= 12 mmol/L at the time of screening
• Severe azotemia with serum urea >/= 40 mmol/L at the time of screening
• Acute intoxication necessitating use of renal replacement therapy
• Recent renal replacement therapy (within 30 days)
• Known end-stage renal disease (defined as an estimated glomerular filtration rate <15 ml/min/1.73m2
• presentation with out-of-hospital cardiac arrest