학술논문
Major Outcomes With Personalized Dialysate TEMPerature (MyTEMP): Rationale and Design of a Pragmatic, Registry-Based, Cluster Randomized Controlled Trial
Document Type
article
Author
Ahmed A. Al-Jaishi; Christopher W. McIntyre; Jessica M. Sontrop; Stephanie N. Dixon; Sierra Anderson; Amit Bagga; Derek Benjamin; David Berry; Peter G. Blake; Laura Chambers; Patricia C. K. Chan; Nicole Delbrouck; P. J. Devereaux; Luis F. Ferreira-Divino; Richard Goluch; Laura Gregor; Jeremy M. Grimshaw; Garth Hanson; Eduard Iliescu; Arsh K. Jain; Charmaine E. Lok; Reem A. Mustafa; Bharat Nathoo; Gihad E. Nesrallah; Matthew J. Oliver; Sanjay Pandeya; Malvinder S. Parmar; David Perkins; Justin Presseau; Eli Rabin; Joanna Sasal; Tanya Shulman; Manish M. Sood; Andrew Steele; Paul Tam; Daniel Tascona; Davinder Wadehra; Ron Wald; Michael Walsh; Paul Watson; Walter Wodchis; Phillip Zager; Merrick Zwarenstein; Amit X. Garg
Source
Canadian Journal of Kidney Health and Disease, Vol 7 (2020)
Subject
Language
English
ISSN
2054-3581
20543581
20543581
Abstract
Background: Small randomized trials demonstrated that a lower compared with higher dialysate temperature reduced the average drop in intradialytic blood pressure. Some observational studies demonstrated that a lower compared with higher dialysate temperature was associated with a lower risk of all-cause mortality and cardiovascular mortality. There is now the need for a large randomized trial that compares the effect of a low vs high dialysate temperature on major cardiovascular outcomes. Objective: The purpose of this study is to test the effect of outpatient hemodialysis centers randomized to (1) a personalized temperature-reduced dialysate protocol or (2) a standard-temperature dialysate protocol for 4 years on cardiovascular-related death and hospitalizations. Design: The design of the study is a pragmatic, registry-based, open-label, cluster randomized controlled trial. Setting: Hemodialysis centers in Ontario, Canada, were randomized on February 1, 2017, for a trial start date of April 3, 2017, and end date of March 31, 2021. Participants: In total, 84 hemodialysis centers will care for approximately 15 500 patients and provide over 4 million dialysis sessions over a 4-year follow-up. Intervention: Hemodialysis centers were randomized (1:1) to provide (1) a personalized temperature-reduced dialysate protocol or (2) a standard-temperature dialysate protocol of 36.5°C. For the personalized protocol, nurses set the dialysate temperature between 0.5°C and 0.9°C below the patient’s predialysis body temperature for each dialysis session, to a minimum dialysate temperature of 35.5°C. Primary outcome: A composite of cardiovascular-related death or major cardiovascular-related hospitalization (a hospital admission with myocardial infarction, congestive heart failure, or ischemic stroke) captured in Ontario health care administrative databases. Planned primary analysis: The primary analysis will follow an intent-to-treat approach. The hazard ratio of time-to-first event will be estimated from a Cox model. Within-center correlation will be considered using a robust sandwich estimator. Observation time will be censored on the trial end date or when patients die from a noncardiovascular event. Trial Registration: www.clinicaltrials.gov ; identifier: NCT02628366.