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

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
批准号:
9815883
负责人:
David M Charytan
金额:
$36.72万
依托单位国家:
美国
项目类别:
财政年份:
2018
资助国家:
美国
项目状态:
已结题
起止时间:
2018-03-01 至 2022-02-28

项目摘要

项目成果

David M Charytan的其他基金

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相关文献

中文摘要
翻译
透析去除液体、钾和酸对于血液透析(HD)依赖的个体来说是挽救生命的
英文摘要
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.
期刊论文(2)
专著(0)
科研奖励(0)
会议论文
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: KIDNEY INTERNATIONAL REPORTS
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.
Deep learning on ECGs to improve outcomes in patients on dialysis
Safety and Efficacy of Empagliflozin Main intenance HD (SEED)
Intradialytic Myocardial Stunning in Hemodialysis Patients - a Novel Cardiovascular Risk Factor
Intradialytic Myocardial Stunning in Hemodialysis Patients - a Novel Cardiovascular Risk Factor
国内基金
海外基金
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
  • 项目类别:
    青年科学基金项目
  • 资助金额:
    23.0万元
  • 批准年份:
    2013
  • 负责人:
    吴昊
  • 依托单位: