Solute clearances and fluid removal in the frequent hemodialysis network trials.
Am J Kidney Dis
; 53(5): 835-44, 2009 May.
Article
em En
| MEDLINE
| ID: mdl-19339093
ABSTRACT
BACKGROUND:
The Frequent Hemodialysis Network (FHN) is conducting 2 randomized clinical trials, a daytime in-center trial ("daily") comparing 6 versus 3 treatments/wk, and a home nocturnal trial comparing 6 nocturnal treatments versus 3 conventional treatments/wk. The goal of this study was to project separation between the treatment and control arms of these studies for measures of dialysis dose by using simulations based on 2-compartment variable-volume models. SETTING &PARTICIPANTS:
Data from the most recent hemodialysis treatment in 100 patients dialyzed 3 times/wk at facilities of the Renal Research Institute in New York and from 2 data sets (n = 154 and 115 patients) from the Hemodialysis (HEMO) trial.DESIGN:
Observational study. PREDICTOR Dialysis prescriptions for the treatment and control arms in the FHN trials. DIALYSIS REGIMENOUTCOMES:
Treatment time, ultrafiltration rate, standard Kt/V/wk for urea (stdKt/V(urea)), and continuous clearance estimates based on ratios of urea, creatinine, and normalized beta(2)-microglobulin generation rates (denoted by Gn) to time-averaged concentrations (TACs) of these solutes during 1 treatment week.RESULTS:
The expected differences between median values in the experimental and control groups were weekly treatment time daily trial, 29%; nocturnal trial, 234%; ultrafiltration rate daily, -20%; nocturnal, -69%; stdKt/V(urea) daily, 52%; nocturnal, 133%; Gn(urea)/TAC(urea) daily, 34%; nocturnal, 130%; Gn(cr)/TAC(cr) daily, 31%; nocturnal, 135%; and Gn(beta2)/TAC(beta2) daily, 8%; nocturnal, 67%.LIMITATIONS:
Use of simulated data and assumption of equivalent volumes and ultrafiltration rates between treatment arms.CONCLUSIONS:
The nocturnal 6-times-weekly regimen produces substantially greater separation between the treatment and control arms than the daytime 6-times-weekly regimen for a wide range of treatment parameters. However, the 6-times-weekly interventions in both FHN trials will produce substantially greater separation than in the HEMO trial, where separations in median weekly treatment time and stdKt/V(urea) between the 3-times-weekly high- and standard-dose groups were 18% and 17%, respectively. The FHN trials will test whether substantial increases in solute clearance and other effects of frequent hemodialysis materially influence selected intermediate outcome measures.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Soluções para Diálise
/
Falência Renal Crônica
Tipo de estudo:
Clinical_trials
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Observational_studies
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Prognostic_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Am J Kidney Dis
Ano de publicação:
2009
Tipo de documento:
Article
País de afiliação:
Estados Unidos