Clinical Research Directory

Inclusion Criteria: * • Adult Patients (18 years or older) who are admitted in ICU. * AKI (either de novo or superimposed on CKD) as defined by (KDIGO 2023) criteria: an increase in serum creatinine (SCr) by ≥0.3 mg/dL within 48 hours, an increase in SCr to ≥1.5 times baseline within the prior 7 days, or a urine output of \<0.5 mL/kg/h for 6 hours. * Hemodynamic instability and they need vasopressor to maintain their mean blood pressure above 65 mmHg for ≥1-2 h before initiation of HD. * Indicated for intermittent acute hemodialysis (IHD) per treating team (e.g., refractory hyperkalemia, severe acidosis, uremic complications, or fluid overload). Exclusion Criteria: * • Patients with hemodynamic instability who are not responsive to vasopressors and not candidate for intermittent hemodialysis. * ESRD on regular HD. * Patient judged unsafe for IHD as Severe uncontrolled arrhythmia, active myocardial ischemia active intracranial pathology at risk from osmotic/sodium shifts. * Severe dysnatremia: serum Na ≤125 or ≥150 mmol/L.