Comparative effectiveness of an individualized model of hemodialysis vs conventional hemodialysis: a study protocol for a multicenter randomized controlled trial (the TwoPlus trial)

被引:0
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作者
Murea, Mariana [1 ]
Raimann, Jochen G. [2 ]
Divers, Jasmin [3 ]
Maute, Harvey [3 ]
Kovach, Cassandra [4 ]
Abdel-Rahman, Emaad M. [5 ]
Awad, Alaa S. [6 ]
Flythe, Jennifer E. [7 ]
Gautam, Samir C. [8 ]
Niyyar, Vandana D. [9 ]
Roberts, Glenda V. [10 ,11 ]
Jefferson, Nichole M. [12 ]
Shahidul, Islam [3 ]
Nwaozuru, Ucheoma [13 ]
Foley, Kristie L. [13 ]
Trembath, Erica J. [2 ]
Rosales, Merlo L. [2 ]
Fletcher, Alison J. [1 ]
Hiba, Sheikh I. [1 ]
Huml, Anne [4 ]
Knicely, Daphne H. [5 ]
Hasan, Irtiza [6 ]
Makadia, Bhaktidevi [6 ]
Gaurav, Raman [8 ]
Lea, Janice [9 ]
Conway, Paul T. [14 ]
Daugirdas, John T. [15 ]
Kotanko, Peter [16 ]
机构
[1] Wake Forest Univ, Bowman Gray Sch Med, Dept Internal Med, Sect Nephrol, Med Ctr Blvd, Winston Salem, NC 27109 USA
[2] Renal Res Inst, New York, NY USA
[3] NYU Grossman Long Isl Sch Med, Dept Fdn Med, Ctr Populat & Hlth Serv Res, New York, NY USA
[4] Case Western Reserve Univ, Lerner Coll Med, Glickman Urol & Kidney Inst, Cleveland Clin,Dept Nephrol & Hypertens, Cleveland, OH 44195 USA
[5] Univ Virginia Hlth Syst, Div Nephrol, Charlottesville, VA USA
[6] Univ Florida, Div Nephrol, Jacksonville, FL USA
[7] Univ North Carolina UNC Kidney Ctr, UNC Sch Med, Dept Med, Div Nephrol & Hypertens, Chapel Hill, NC USA
[8] Johns Hopkins Sch Med, Dept Med, Div Nephrol, Baltimore, MD USA
[9] Emory Univ, Dept Med, Div Nephrol, Atlanta, GA USA
[10] Univ Washington, Kidney Res Inst, Dept Med, Div Nephrol,External Relat & Patient Engagement, Seattle, WA USA
[11] Univ Washington, Ctr Dialysis Innovat, Seattle, WA USA
[12] Home Dialyzors United, Columbia, MO USA
[13] Wake Forest Univ, Dept Implementat Sci, Bowman Gray Sch Med, Winston Salem, NC USA
[14] Amer Assoc Kidney Patients, Tampa, FL USA
[15] Univ Illinois, Dept Med, Div Nephrol, Coll Med, Chicago, IL USA
[16] LLC Icahn Sch Med Mt Sinai, Dept Internal Med, Sect Nephrol, New York, NY 10029 USA
关键词
End-stage kidney disease; Hemodialysis; Incremental; Randomized controlled trial; RESIDUAL RENAL-FUNCTION; TWICE-WEEKLY HEMODIALYSIS; SECONDARY END-POINTS; QUALITY-OF-LIFE; INCREMENTAL HEMODIALYSIS; KIDNEY-FUNCTION; FREQUENT HEMODIALYSIS; DIALYSIS OUTCOMES; HOME HEMODIALYSIS; SERUM BICARBONATE;
D O I
10.1186/s13063-024-08281-9
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
BackgroundMost patients starting chronic in-center hemodialysis (HD) receive conventional hemodialysis (CHD) with three sessions per week targeting specific biochemical clearance. Observational studies suggest that patients with residual kidney function can safely be treated with incremental prescriptions of HD, starting with less frequent sessions and later adjusting to thrice-weekly HD. This trial aims to show objectively that clinically matched incremental HD (CMIHD) is non-inferior to CHD in eligible patients.MethodsAn unblinded, parallel-group, randomized controlled trial will be conducted across diverse healthcare systems and dialysis organizations in the USA. Adult patients initiating chronic hemodialysis (HD) at participating centers will be screened. Eligibility criteria include receipt of fewer than 18 treatments of HD and residual kidney function defined as kidney urea clearance >= 3.5 mL/min/1.73 m2 and urine output >= 500 mL/24 h. The 1:1 randomization, stratified by site and dialysis vascular access type, assigns patients to either CMIHD (intervention group) or CHD (control group). The CMIHD group will be treated with twice-weekly HD and adjuvant pharmacologic therapy (i.e., oral loop diuretics, sodium bicarbonate, and potassium binders). The CHD group will receive thrice-weekly HD according to usual care. Throughout the study, patients undergo timed urine collection and fill out questionnaires. CMIHD will progress to thrice-weekly HD based on clinical manifestations or changes in residual kidney function. Caregivers of enrolled patients are invited to complete semi-annual questionnaires. The primary outcome is a composite of patients' all-cause death, hospitalizations, or emergency department visits at 2 years. Secondary outcomes include patient- and caregiver-reported outcomes. We aim to enroll 350 patients, which provides >= 85% power to detect an incidence rate ratio (IRR) of 0.9 between CMIHD and CHD with an IRR non-inferiority of 1.20 (alpha = 0.025, one-tailed test, 20% dropout rate, average of 2.06 years of HD per patient participant), and 150 caregiver participants (of enrolled patients).DiscussionOur proposal challenges the status quo of HD care delivery. Our overarching hypothesis posits that CMIHD is non-inferior to CHD. If successful, the results will positively impact one of the highest-burdened patient populations and their caregivers.Trial registrationClinicaltrials.gov NCT05828823. Registered on 25 April 2023.
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