End Stage Kidney Disease, End Stage Renal Disease, Renal Dialysis, Renal Replacement Therapy, Uremia
Conditions
Keywords
Randomized Controlled Trial, Clinical Trial, Controlled Clinical Trial, Clinical Trial, Phase IV, Multicenter Study, End Stage Kidney Disease, Hemodialysis, Renal Dialysis, Renal Replacement Therapy, Nocturnal Dialysis, Extended dialysis, Quality of Life, Quality Adjusted Life Year, Hypertrophy, Left Ventricular, Blood Pressure, Hypertension, Anemia, Hematinics, Erythropoiesis Stimulating Agents, Cost-utility Analysis, Economic Evaluation, Health Care Utilisation, Health Care Costs, Health Expenditures, Hospitalization, Cost Analysis, Cardiovascular Diseases, Acute Coronary Syndrome, Myocardial Infarction, Stroke, Cerebrovascular Disorders, Mortality, Arteriovenous Fistula, Arteriovenous Shunt, Surgical, Thrombosis, Infection
Brief summary
This study will assess clinical outcomes of extended weekly hours of haemodialysis (\>= 24 hours per week) compared with standard hours of haemodialysis (\<=18 hours/week) in people with ESKD.
Detailed description
A rapidly increasing volume of observational data suggests substantial benefits may be associated with an increased duration of dialysis. As well as improved quality of life, improved functioning and beneficial changes in a variety of laboratory parameters, it has been suggested that extended dialysis sessions might reduce mortality and major morbidity. Uncontrolled data from centres that have been providing extended dialysis shows dramatically lower mortality rates compared to those observed in centres providing standard duration dialysis. Recent analyses of extended dialysis conclude that the savings achieved in drug and hospitalization costs may lead to an overall reduction in costs compared with traditional forms of dialysis. In this trial, we propose to examine the effects of extended dialysis (24 hours weekly or more) compared to standard dialysis (18 hours or less weekly) in patients with ESKD. The proposed study is a multi-centre, open label, randomised, controlled trial. The study began with a pilot phase which was converted to the current main study on the receipt of peer-reviewed funding for the full study.
Interventions
PROCEDUREhaemodialysis
Comparison of different weekly duration of haemodialysis treatment
Sponsors
National Health and Medical Research Council, Australia
Baxter Healthcare Corporation
The George Institute
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Incident or prevalent patients requiring maintenance haemodialysis therapy for ESKD 2. Aged 18 years or older 3. Undergoing dialysis for 18 hours per week or less 4. Suitable for either extended or standard dialysis in the view of the treating physician 5. Agreeable to randomisation
Exclusion criteria
1. Life expectancy of less than 6 months 2. Definite plans to undergo renal transplantation within 12 months of entry to the study 3. Inability to complete quality of life questionnaire 4. Concomitant major illness that would limit assessments and followup 5. High chance that the patient will not adhere to study treatment and follow up in the view of the treating physician.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The primary end-point for this study is the difference in the change in quality of life between the two groups from randomisation to the 12 month follow-up as measured by the EQ-5D instrument. | 12 months from randomisation |
Secondary
| Measure | Time frame |
|---|---|
| Survival and cardiovascular analyses | 12 months |
| Quality of life and patient acceptability | 12 months |
| Safety outcomes | 12 months |
| Costs associated with each intervention | 12 months |
| Changes in biochemical and haematological parameters | 12 months |
Countries
Australia, Canada, China, New Zealand
Outcome results
None listed