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Renal replacement treatment initiation with twice-weekly versus thrice-weekly haemodialysis in patients with incident dialysis-dependent kidney disease: rationale and design of the TWOPLUS pilot clinical trial.
Murea, Mariana; Moossavi, Shahriar; Fletcher, Alison J; Jones, Deanna N; Sheikh, Hiba I; Russell, Gregory; Kalantar-Zadeh, Kamyar.
  • Murea M; Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA mmurea@wakehealth.edu.
  • Moossavi S; Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
  • Fletcher AJ; Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
  • Jones DN; Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
  • Sheikh HI; Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
  • Russell G; Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
  • Kalantar-Zadeh K; Division of Nephrology, University of California Irvine School of Medicine, Irvine, California, USA.
BMJ Open ; 11(5): e047596, 2021 05 24.
Article in English | MEDLINE | ID: covidwho-1242206
ABSTRACT

INTRODUCTION:

The optimal haemodialysis (HD) prescription-frequency and dose-for patients with incident dialysis-dependent kidney disease (DDKD) and substantial residual kidney function (RKF)-that is, renal urea clearance ≥2 mL/min/1.73 m2 and urine volume ≥500 mL/day-is not known. The aim of the present study is to test the feasibility and safety of a simple, reliable prescription of incremental HD in patients with incident DDKD and RKF. METHODS AND

ANALYSIS:

This parallel-group, open-label randomised pilot trial will enrol 50 patients from 14 outpatient dialysis units. Participants will be randomised (11) to receive twice-weekly HD with adjuvant pharmacological therapy for 6 weeks followed by thrice-weekly HD (incremental HD group) or outright thrice-weekly HD (standard HD group). Age ≥18 years, chronic kidney disease progressing to DDKD and urine output ≥500 mL/day are key inclusion criteria; patients with left ventricular ejection fraction <30% and acute kidney injury requiring dialysis will be excluded. Adjuvant pharmacological therapy (ie, effective diuretic regimen, patiromer and sodium bicarbonate) will complement twice-weekly HD. The primary feasibility end points are recruitment rate, adherence to the assigned HD regimen, adherence to serial timed urine collections and treatment contamination. Incidence rate of clinically significant volume overload and metabolic imbalances in the first 3 months after randomisation will be used to assess intervention safety. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Institutional Review Board of Wake Forest School of Medicine in North Carolina, USA. Patient recruitment began on 14 June 2019, was paused between 13 March 2020 and 31 May 2020 due to COVID-19 pandemic, resumed on 01 June 2020 and will last until the required sample size has been attained. Participants will be followed in usual care fashion for a minimum of 6 months from last individual enrolled. All regulations and measures of ethics and confidentiality are handled in accordance with the Declaration of Helsinki. TRIAL REGISTRATION NUMBER NCT03740048; Pre-results.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Kidney Diseases / Kidney Failure, Chronic Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adolescent / Humans Country/Region as subject: North America Language: English Journal: BMJ Open Year: 2021 Document Type: Article Affiliation country: Bmjopen-2020-047596

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Kidney Diseases / Kidney Failure, Chronic Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adolescent / Humans Country/Region as subject: North America Language: English Journal: BMJ Open Year: 2021 Document Type: Article Affiliation country: Bmjopen-2020-047596