Randomized trials using point of care-guided manipulation of dialysate potassium, dialysate bicarbonate, and ultrafiltration rate to prevent hemodilaysis-associated arrythmia

使用护理点指导控制透析液钾、透析液碳酸氢盐和超滤率来预防血液透析相关心律失常的随机试验

基本信息

项目摘要

Dialytic removal of fluid, potassium and acid is life-saving in individuals with hemodialysis (HD)-dependent end stage renal disease. However, there is compelling evidence that the dialysis procedure contributes to the risk of serious arrhythmias including sudden cardiac arrest (SCA)—which accounts for roughly 25% of all deaths in HD patients and occurs at a rate 20x that in the general population—and atrial fibrillation (AF)—a highly prevalent condition in HD strongly associated with cardiovascular morbidity, mortality and stroke. Specifically, there are strong and consistent observations linking the dialytic fluid ultrafiltration (UF) rate as well as serum and dialysate potassium and bicarbonate concentrations to fatal and non-fatal arrhythmia. Given the high rates of cardiovascular morbidity and mortality in HD patients and the evidence that standard cardiovascular therapies are ineffective, designing prospective, randomized trials to investigate whether changes to current treatment paradigms regarding modifiable facets of the dialysis prescription will reduce the risk of arrhythmic events represents a novel approach with the strong potential to reduce mortality. Historically, such studies have been unfeasible due to the limits of long-term electrocardiographic monitoring, but new technologies have overcome this challenge: Our unique experience with novel implantable loop recording (ILR) technology in HD patients, and our expertise in HD patient-oriented studies place us in the optimal position to conduct randomized, crossover trials leveraging point of care (POC) electrolyte testing with ILR technology in order to compare the long-term impact of 3 randomized manipulations of the dialysis prescription on arrhythmia: low vs. high serum to dialysate potassium gradient, low vs. high serum-dialysate bicarbonate gradient, and low vs. high ultrafiltration (UF) rates. Our proposed trials will transform understanding of how dialysis prescriptions impact HD-associated arrhythmia and will directly influence clinical care. The current application seeks support under the R34 mechanism to conduct pilot trials designed to: Test the feasibility of POC-guided dialysate potassium and bicarbonate prescriptions as well as the feasibility of limiting UF rate in an HD trial (Aim 1); Analyze recruitment feasibility for trials combining ILR insertion to monitor arrhythmia with POC-guided bicarbonate or potassium prescriptions or UF rate manipulation (Aim 2); and Refine effect estimates for change in arrhythmia frequency with each intervention (Aim 3). These studies will provide unique data on the causal role of dialysis in HD-associated arrhythmia and the information necessary for the design of definitive, large- scale interventional trials with the potential to transform dialysis.
透析清除液体、钾和酸可挽救血液透析(HD)依赖性终末期患者的生命 肾病分期然而,有令人信服的证据表明,透析程序有助于风险 严重的心律失常,包括心脏骤停(SCA)-约占所有死亡的25%, HD患者的发生率是普通人群的20倍,而房颤(AF)是一种高度 HD中的流行疾病与心血管发病率、死亡率和卒中密切相关。具体地说, 存在与透析液超滤(UF)率以及血清相关的强有力且一致的观察结果 以及透析液钾和碳酸氢盐浓度与致命性和非致命性心律失常的关系。鉴于高利率 血液透析患者心血管疾病发病率和死亡率,以及标准心血管疾病 治疗无效,设计前瞻性,随机试验,以调查是否改变目前的治疗方法, 关于透析处方的可修改方面的治疗范例将降低透析的风险。 事件代表了一种新的方法,具有降低死亡率的强大潜力。从历史上看,这些研究 由于长期心电图监测的限制,这些方法是不可行的,但新技术 克服这一挑战:我们在HD中使用新型植入式环路记录(ILR)技术的独特经验 我们在HD患者导向研究方面的专业知识使我们处于开展 利用ILR技术进行床旁(POC)电解质检测的随机交叉试验, 比较透析处方的3种随机操作对心律失常的长期影响:低vs. 高血清-透析液钾梯度、低与高血清-透析液碳酸氢盐梯度以及低与高血清-透析液碳酸氢盐梯度 高超滤(UF)速率。我们提议的试验将改变对透析处方如何 影响HD相关心律失常,并将直接影响临床护理。目前的申请寻求支持 在R34机制下进行试点试验,旨在:测试POC引导透析液的可行性 钾和碳酸氢盐处方以及在HD试验中限制UF率的可行性(目标1); 分析结合ILR插入监测心律失常与POC引导的试验的招募可行性 碳酸氢盐或钾处方或超滤率操作(目标2);以及细化变化的效果估计 每次干预的心律失常频率(目标3)。这些研究将提供关于因果关系的独特数据。 透析在HD相关心律失常中的作用以及设计确定性、大型 大规模的干预性试验,有可能改变透析。

项目成果

期刊论文数量(2)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
Point-of-Care Chemistry-Guided Dialysate Adjustment to Reduce Arrhythmias: A Pilot Trial.
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
  • 发表时间:
    2023-11
  • 期刊:
  • 影响因子:
    6
  • 作者:
    Pun, Patrick H.;Santacatterina, Michele;Ways, Javaughn;Redd, Cynthia;Al-Khatib, Sana M.;Smyth-Melsky, Jane;Chinitz, Larry;Charytan, David M.
  • 通讯作者:
    Charytan, David M.
{{ item.title }}
{{ item.translation_title }}
  • DOI:
    {{ item.doi }}
  • 发表时间:
    {{ item.publish_year }}
  • 期刊:
  • 影响因子:
    {{ item.factor }}
  • 作者:
    {{ item.authors }}
  • 通讯作者:
    {{ item.author }}

数据更新时间:{{ journalArticles.updateTime }}

{{ item.title }}
  • 作者:
    {{ item.author }}

数据更新时间:{{ monograph.updateTime }}

{{ item.title }}
  • 作者:
    {{ item.author }}

数据更新时间:{{ sciAawards.updateTime }}

{{ item.title }}
  • 作者:
    {{ item.author }}

数据更新时间:{{ conferencePapers.updateTime }}

{{ item.title }}
  • 作者:
    {{ item.author }}

数据更新时间:{{ patent.updateTime }}

David M Charytan其他文献

David M Charytan的其他文献

{{ item.title }}
{{ item.translation_title }}
  • DOI:
    {{ item.doi }}
  • 发表时间:
    {{ item.publish_year }}
  • 期刊:
  • 影响因子:
    {{ item.factor }}
  • 作者:
    {{ item.authors }}
  • 通讯作者:
    {{ item.author }}

{{ truncateString('David M Charytan', 18)}}的其他基金

Deep learning on ECGs to improve outcomes in patients on dialysis
心电图深度学习可改善透析患者的预后
  • 批准号:
    10734856
  • 财政年份:
    2023
  • 资助金额:
    $ 36.72万
  • 项目类别:
Safety and Efficacy of Empagliflozin Main intenance HD (SEED)
Empagliflozin Main Intenance HD (SEED) 的安全性和功效
  • 批准号:
    10660436
  • 财政年份:
    2023
  • 资助金额:
    $ 36.72万
  • 项目类别:
Intradialytic Myocardial Stunning in Hemodialysis Patients - a Novel Cardiovascular Risk Factor
血液透析患者透析中心肌顿抑——一种新的心血管危险因素
  • 批准号:
    10367558
  • 财政年份:
    2021
  • 资助金额:
    $ 36.72万
  • 项目类别:
Intradialytic Myocardial Stunning in Hemodialysis Patients - a Novel Cardiovascular Risk Factor
血液透析患者透析中心肌顿抑——一种新的心血管危险因素
  • 批准号:
    10544017
  • 财政年份:
    2021
  • 资助金额:
    $ 36.72万
  • 项目类别:
Pain, Opioids, and ESRD risk reduction with Mindfulness and Buprenorphine (POEM-B): A 3-arm multi-site randomized trial in hemodialysis patients
正念和丁丙诺啡可降低疼痛、阿片类药物和 ESRD 风险 (POEM-B):针对血液透析患者的 3 组多中心随机试验
  • 批准号:
    9901871
  • 财政年份:
    2019
  • 资助金额:
    $ 36.72万
  • 项目类别:
NO, myocardial fibrosis, and microvascular rarefaction in ESRD: Pilot Studies
ESRD 中的 NO、心肌纤维化和微血管稀疏:试点研究
  • 批准号:
    8623052
  • 财政年份:
    2014
  • 资助金额:
    $ 36.72万
  • 项目类别:
Optimizing Revascularization of Coronary Artery Disease in Chronic Kidney Disease
优化慢性肾脏病冠状动脉疾病的血运重建
  • 批准号:
    8631538
  • 财政年份:
    2014
  • 资助金额:
    $ 36.72万
  • 项目类别:
Optimizing Revascularization of Coronary Artery Disease in Chronic Kidney Disease
优化慢性肾脏病冠状动脉疾病的血运重建
  • 批准号:
    8787487
  • 财政年份:
    2014
  • 资助金额:
    $ 36.72万
  • 项目类别:
Aldosterone, nitric oxide, myocardial fibrosis, and capillary loss in ESRD
ESRD 中的醛固酮、一氧化氮、心肌纤维化和毛细血管损失
  • 批准号:
    8506326
  • 财政年份:
    2013
  • 资助金额:
    $ 36.72万
  • 项目类别:
Aldosterone, nitric oxide, myocardial fibrosis, and capillary loss in ESRD
ESRD 中的醛固酮、一氧化氮、心肌纤维化和毛细血管损失
  • 批准号:
    8723818
  • 财政年份:
    2013
  • 资助金额:
    $ 36.72万
  • 项目类别:

相似国自然基金

肿瘤微环境因子Lactic acidosis在肿瘤细胞耐受葡萄糖剥夺中的作用机制研究
  • 批准号:
    81301707
  • 批准年份:
    2013
  • 资助金额:
    23.0 万元
  • 项目类别:
    青年科学基金项目

相似海外基金

Identification of factor to induce lactic acidosis in pre-metastatic niche
转移前微环境中诱导乳酸性酸中毒的因素的鉴定
  • 批准号:
    23K06620
  • 财政年份:
    2023
  • 资助金额:
    $ 36.72万
  • 项目类别:
    Grant-in-Aid for Scientific Research (C)
Carbonic Anhydrase IX Acts as a Novel CO2/HCO3- Sensor and Protects the Pulmonary Endothelial Barrier from Acidosis
碳酸酐酶 IX 作为新型 CO2/HCO3- 传感器并保护肺内皮屏障免受酸中毒的影响
  • 批准号:
    10678442
  • 财政年份:
    2023
  • 资助金额:
    $ 36.72万
  • 项目类别:
Investigation based on both basic and clinical study about acidosis caused by piganide, SGLT2 inhibitor and surgical stress
皮甘尼、SGLT2抑制剂和手术应激引起的酸中毒的基础和临床研究
  • 批准号:
    23K08372
  • 财政年份:
    2023
  • 资助金额:
    $ 36.72万
  • 项目类别:
    Grant-in-Aid for Scientific Research (C)
Role of proton-sensing G-protein-coupled receptors in the regulation of microglia and microvessel endothelial cell function in brain acidosis in a mouse ischemia reperfusion model.
质子感应 G 蛋白偶联受体在小鼠缺血再灌注模型脑酸中毒中调节小胶质细胞和微血管内皮细胞功能的作用。
  • 批准号:
    22K07342
  • 财政年份:
    2022
  • 资助金额:
    $ 36.72万
  • 项目类别:
    Grant-in-Aid for Scientific Research (C)
Magnetic Resonance Fingerprinting of Tumor Vascular Perfusion and Acidosis
肿瘤血管灌注和酸中毒的磁共振指纹图谱
  • 批准号:
    10593285
  • 财政年份:
    2022
  • 资助金额:
    $ 36.72万
  • 项目类别:
Acidosis in pulmonary endothelial injury and repair
酸中毒与肺内皮损伤与修复
  • 批准号:
    10341493
  • 财政年份:
    2022
  • 资助金额:
    $ 36.72万
  • 项目类别:
Acidosis in pulmonary endothelial injury and repair
酸中毒与肺内皮损伤与修复
  • 批准号:
    10558528
  • 财政年份:
    2022
  • 资助金额:
    $ 36.72万
  • 项目类别:
Characterization of an abundant lactate-utilizing Campylobacter involved in mitigating rumen acidosis
参与减轻瘤胃酸中毒的丰富乳酸利用弯曲杆菌的表征
  • 批准号:
    557929-2021
  • 财政年份:
    2022
  • 资助金额:
    $ 36.72万
  • 项目类别:
    Postgraduate Scholarships - Doctoral
Impact of metabolic acidosis on muscle mitochondrial energetics, metabolic health and physical endurance in persons with chronic kidney disease
代谢性酸中毒对慢性肾病患者肌肉线粒体能量学、代谢健康和身体耐力的影响
  • 批准号:
    10278747
  • 财政年份:
    2021
  • 资助金额:
    $ 36.72万
  • 项目类别:
Impact of metabolic acidosis on muscle mitochondrial energetics, metabolic health and physical endurance in persons with chronic kidney disease
代谢性酸中毒对慢性肾病患者肌肉线粒体能量学、代谢健康和身体耐力的影响
  • 批准号:
    10671682
  • 财政年份:
    2021
  • 资助金额:
    $ 36.72万
  • 项目类别:
{{ showInfoDetail.title }}

作者:{{ showInfoDetail.author }}

知道了