■过多的透析钾(K)和酸去除是心律失常的危险因素;但是,治疗对治疗透析液的修改很少进行。我们进行了一个多中心,试验随机研究以测试安全性,可行性,以及在门诊血液透析(HD)诊所中调整透析液K和碳酸氢盐(HCO3)的4种护理(POC)化学指导方案的有效性。
■参与者接受植入式心脏回路监测仪,并根据HD前POC值在每次治疗时调整透析液K或HCO3,跨越四个4周的时间:(i)K去除最小化,(ii)K去除最大化,(iii)避免酸中毒,和(iv)避免碱中毒。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,和临床上显着的心律失常(CSAs)的发生率。
■19名受试者被纳入研究。HD工作人员完成了POC测试,并在708个可用HD治疗中的604个(85%)中正确调整了透析液。有1K≤3,29HCO3<20和2HCO3>32mEq/l,没有与研究干预相关的严重不良事件。尽管POC结果与同时绘制的常规实验室测量结果之间没有显着差异,处理间K和HCO3变异性高。有45例CSA事件;大多数是短暂性心房颤动(AF),与其他干预期(17)相比,在碱中毒避免期(8)和K去除最大化期(3)期间发生的事件数量较少。干预措施之间的CSA持续时间没有显着差异。
■基于POC测试的算法指导的K/HCO3调整是可行的。治疗K和HCO3的变异性表明,POC实验室指导的算法可以显着改变透析液-血清化学梯度。应考虑明确的终点驱动试验。
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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.
UNASSIGNED: 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.