Point-of-Care Chemistry-Guided Dialysate Adjustment to Reduce Arrhythmias: A Pilot Trial.
Point-of-Care Chemistry-Guided Dialysate Adjustment to Reduce Arrhythmias: A Pilot Trial.
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护理点化学引导透析液调整以减少心律失常：试点试验。
DOI：
10.1016/j.ekir.2023.07.039
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发表时间：
2023-11
影响因子：
6
通讯作者：
Charytan, David M.
中科院分区：
文献类型：
--
作者：
Pun, Patrick H.;Santacatterina, Michele;Ways, Javaughn;Redd, Cynthia;Al-Khatib, Sana M.;Smyth-Melsky, Jane;Chinitz, Larry;Charytan, David M.
过多的透析钾(K)和酸移除是心律失常的危险因素；然而，很少进行治疗对治疗透析液的修改。我们进行了一项多中心的先导性随机研究，以测试在门诊血液透析(HD)诊所调整透析液K和碳酸氢盐(HCO3)的4种护理点(POC)化学指导方案的安全性、可行性和有效性。受试者接受植入式心脏环监测仪，并在每次治疗时根据HD前的POC值调整透析液K或HCO3的4个4周周期：(I)最小化K-清除，(Ii)最大化K-清除，(Iii)酸中毒避免，和(Iv)碱中毒避免。主要终点是坚持干预算法的治疗百分比。次要终点包括HD前K和HCO变异性、不良事件和临床显著心律失常的发生率(CSA)。19名受试者参加了这项研究。HD工作人员完成了POC测试，并在708例HD治疗中的604例(85%)中正确调整了透析液。≤3组1例，HCO3组29例，HCO3组20例，HCO3组2例，均为32mEq/L，无与研究干预相关的严重不良事件。尽管POC结果与同时进行的常规实验室测量结果没有显著差异，但处理间K和HCO3的变异性很高。有45例CSA事件；大多数是一过性心房颤动(AF)，与其他干预期(17例)相比，碱中毒避免期(8例)和钾清除最大化期(3例)发生的事件较少。不同干预措施的CSA持续时间无显著差异。基于POC测试的算法引导K/HCO3校正是可行的。相互处理K和HCO3的可变性表明，POC实验室指导的算法可以显著改变透析液-血清化学梯度。应考虑进行终结性终点动力试验。
Excessive dialytic potassium (K) and acid removal are risk factors for arrhythmias; however, treatment-to-treatment dialysate modification is rarely performed. We conducted a multicenter, pilot randomized study to test the safety, feasibility, and efficacy of 4 point-of-care (POC) chemistry-guided protocols to adjust dialysate K and bicarbonate (HCO3) in outpatient hemodialysis (HD) clinics. Participants received implantable cardiac loop monitors and crossed over to four 4-week periods with adjustment of dialysate K or HCO3 at each treatment according to pre-HD POC values: (i) K-removal minimization, (ii) K-removal maximization, (iii) Acidosis avoidance, and (iv) Alkalosis avoidance. The primary end point was percentage of treatments adhering to the intervention algorithm. Secondary endpoints included pre-HD K and HCO variability, adverse events, and rates of clinically significant arrhythmias (CSAs). Nineteen subjects were enrolled in the study. HD staff completed POC testing and correctly adjusted the dialysate in 604 of 708 (85%) of available HD treatments. There was 1 K ≤3, 29 HCO3 <20 and 2 HCO3 >32 mEq/l and no serious adverse events related to study interventions. Although there were no significant differences between POC results and conventional laboratory measures drawn concurrently, intertreatment K and HCO3 variability was high. There were 45 CSA events; most were transient atrial fibrillation (AF), with numerically fewer events during the alkalosis avoidance period (8) and K-removal maximization period (3) compared to other intervention periods (17). There were no significant differences in CSA duration among interventions. Algorithm-guided K/HCO3 adjustment based on POC testing is feasible. The variability of intertreatment K and HCO3 suggests that a POC-laboratory-guided algorithm could markedly alter dialysate-serum chemistry gradients. Definitive end point-powered trials should be considered.
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影响因子：
6.1
作者：
Heguilén, RM;Sclurano, C;Bernasconi, AR
通讯作者：
Bernasconi, AR
影响因子：
19.6
作者：
Bleyer, AJ;Russell, GB;Satko, SG
通讯作者：
Satko, SG
影响因子：
37.8
作者：
Goldstein BA;Arce CM;Hlatky MA;Turakhia M;Setoguchi S;Winkelmayer WC
通讯作者：
Winkelmayer WC
影响因子：
158.5
作者：
Foley, Robert N.;Gilbertson, David T.;Collins, Allan J.
通讯作者：
Collins, Allan J.
影响因子：
19.6
作者：
Flythe, Jennifer E.;Kimmel, Stephen E.;Brunelli, Steven M.
通讯作者：
Brunelli, Steven M.