Study Summary
This trial will test the feasibility of different regimens of hemodialysis, and the effects of those regimens on residual kidney function.
- End Stage Kidney Disease on Dialysis
Treatment Effectiveness
Phase-Based Effectiveness
Study Objectives
3 Primary · 7 Secondary · Reporting Duration: up to 24 months
Trial Safety
Phase-Based Safety
Awards & Highlights
Trial Design
2 Treatment Groups
Conventional Hemodialysis Regimen
1 of 2
Hemodialysis and Pharmacologic Therapy
1 of 2
Active Control
Experimental Treatment
56 Total Participants · 2 Treatment Groups
Primary Treatment: Hemodialysis · No Placebo Group · Phase 3
Trial Logistics
Trial Timeline
Who is running the clinical trial?
Eligibility Criteria
Age 18+ · All Participants · 1 Total Inclusion Criteria
Mark “Yes” if the following statements are true for you:Who else is applying?
How old are they?
18 - 65 | 100.0% |
What site did they apply to?
Wake Forest Baptist Medical Center | 100.0% |
What portion of applicants met pre-screening criteria?
Met criteria | 100.0% |
- Lo, Wai-Kei, Yiu-Wing Ho, Chun-Sang Li, Kin-Shing Wong, Tak-Mao Chan, Alex Wai-Yin Yu, Flora So-King Ng, and Ignatius Kum-Po Cheng. 2003. “Effect of Kt/v on Survival and Clinical Outcome in CAPD Patients in a Randomized Prospective Study”. Kidney International. Elsevier BV. doi:10.1046/j.1523-1755.2003.00098.x.
- Li, Yun, Yan Jin, Alissa Kapke, Jeffrey Pearson, Rajiv Saran, Friedrich K. Port, and Bruce M. Robinson. 2017. “Explaining Trends and Variation in Timing of Dialysis Initiation in the United States”. Medicine. Ovid Technologies (Wolters Kluwer Health). doi:10.1097/md.0000000000006911.
- Weir, Matthew R., George L. Bakris, David A. Bushinsky, Martha R. Mayo, Dahlia Garza, Yuri Stasiv, Janet Wittes, Heidi Christ-Schmidt, Lance Berman, and Bertram Pitt. 2015. “Patiromer in Patients with Kidney Disease and Hyperkalemia Receiving RAAS Inhibitors”. New England Journal of Medicine. Massachusetts Medical Society. doi:10.1056/nejmoa1410853.
- Daugirdas, John T. 2016. “Estimating Time-averaged Serum Urea Nitrogen Concentration During Various Urine Collection Periods: A Prediction Equation for Thrice Weekly and Biweekly Dialysis Schedules”. Seminars in Dialysis. Wiley. doi:10.1111/sdi.12554.
- Shafi, Tariq, Bernard G. Jaar, Laura C. Plantinga, Nancy E. Fink, John H. Sadler, Rulan S. Parekh, Neil R. Powe, and Josef Coresh. 2010. “Association of Residual Urine Output with Mortality, Quality of Life, and Inflammation in Incident Hemodialysis Patients: The Choices for Healthy Outcomes in Caring for End-stage Renal Disease (CHOICE) Study”. American Journal of Kidney Diseases. Elsevier BV. doi:10.1053/j.ajkd.2010.03.020.
- Kovesdy, Csaba P., Deborah L. Regidor, Rajnish Mehrotra, Jennie Jing, Charles J. McAllister, Sander Greenland, Joel D. Kopple, and Kamyar Kalantar-Zadeh. 2007. “Serum and Dialysate Potassium Concentrations and Survival in Hemodialysis Patients”. Clinical Journal of the American Society of Nephrology. American Society of Nephrology (ASN). doi:10.2215/cjn.04451206.
- Murea, Mariana, Shahriar Moossavi, Alison J Fletcher, Deanna N Jones, Hiba I Sheikh, Gregory Russell, and Kamyar Kalantar-Zadeh. 2021. “Renal Replacement Treatment Initiation with Twice-weekly Versus Thrice-weekly Haemodialysis in Patients with Incident Dialysis-dependent Kidney Disease: Rationale and Design of the TWOPLUS Pilot Clinical Trial”. BMJ Open. BMJ. doi:10.1136/bmjopen-2020-047596.
- Eknoyan, Garabed, Gerald J. Beck, Alfred K. Cheung, John T. Daugirdas, Tom Greene, John W. Kusek, Michael Allon, et al.. 2002. “Effect of Dialysis Dose and Membrane Flux in Maintenance Hemodialysis”. New England Journal of Medicine. Massachusetts Medical Society. doi:10.1056/nejmoa021583.
- Termorshuizen, F.. 2004. “Relative Contribution of Residual Renal Function and Different Measures of Adequacy to Survival in Hemodialysis Patients: An Analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD)-2”. Journal of the American Society of Nephrology. American Society of Nephrology (ASN). doi:10.1097/01.asn.0000117976.29592.93.
- Jansen, Maarten A.M., Augustinus A.M. Hart, Johanna C. Korevaar, Friedo W. Dekker, Elisabeth W. Boeschoten, and Raymond T. Krediet. 2002. “Predictors of the Rate of Decline of Residual Renal Function in Incident Dialysis Patients”. Kidney International. Elsevier BV. doi:10.1046/j.1523-1755.2002.00505.x.
- Paniagua, Ramón, Dante Amato, Edward Vonesh, Ricardo Correa-Rotter, Alfonso Ramos, John Moran, and Salim Mujais. 2002. “Effects of Increased Peritoneal Clearances on Mortality Rates in Peritoneal Dialysis: ADEMEX, a Prospective, Randomized, Controlled Trial”. Journal of the American Society of Nephrology. American Society of Nephrology (ASN). doi:10.1681/asn.v1351307.
- LIN, YU-FENG, JENG-WEN HUANG, MING-SHIOU WU, TZONG-SHINN CHU, SHUEI-LIONG LIN, YUNG-MING CHEN, TUN-JUN TSAI, and KWAN-DUN WU. 2009. “Comparison of Residual Renal Function in Patients Undergoing Twice-weekly Versus Three-times-weekly Haemodialysis”. Nephrology. Wiley. doi:10.1111/j.1440-1797.2008.01016.x.
- Daugirdas, John T., Thomas A. Depner, Jula Inrig, Rajnish Mehrotra, Michael V. Rocco, Rita S. Suri, Daniel E. Weiner, et al.. 2015. “KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update”. American Journal of Kidney Diseases. Elsevier BV. doi:10.1053/j.ajkd.2015.07.015.
- Lowrie, E. G., N. M. Laird, T. F. Parker, and J. A. Sargent. 1981. “Effect of the Hemodialysis Prescription on Patient Morbidity”. New England Journal of Medicine. Massachusetts Medical Society. doi:10.1056/nejm198111123052003.
- Chin, Andrew I., Suresh Appasamy, Robert J. Carey, and Niti Madan. 2017. “Feasibility of Incremental 2-times Weekly Hemodialysis in Incident Patients with Residual Kidney Function”. Kidney International Reports. Elsevier BV. doi:10.1016/j.ekir.2017.06.005.
- Murea, Mariana. 2021. “Precision Medicine Approach to Dialysis Including Incremental and Decremental Dialysis Regimens”. Current Opinion in Nephrology & Hypertension. Ovid Technologies (Wolters Kluwer Health). doi:10.1097/mnh.0000000000000667.
- Wu, Dennis Y., Christian S. Shinaberger, Deborah L. Regidor, Charles J. McAllister, Joel D. Kopple, and Kamyar Kalantar-Zadeh. 2005. “Association Between Serum Bicarbonate and Death in Hemodialysis Patients: Is It Better to Be Acidotic or Alkalotic?”. Clinical Journal of the American Society of Nephrology. American Society of Nephrology (ASN). doi:10.2215/cjn.00010505.
- Zhang, Minmin, Mengjing Wang, Haiming Li, Ping Yu, Li Yuan, Chuanming Hao, Jing Chen, and Kamyar Kalantar-Zadeh. 2014. “Association of Initial Twice-weekly Hemodialysis Treatment with Preservation of Residual Kidney Function in ESRD Patients”. American Journal of Nephrology. S. Karger AG. doi:10.1159/000365819.
- Bakris, George L., Bertram Pitt, Matthew R. Weir, Mason W. Freeman, Martha R. Mayo, Dahlia Garza, Yuri Stasiv, Rezi Zawadzki, Lance Berman, and David A. Bushinsky. 2015. “Effect of Patiromer on Serum Potassium Level in Patients with Hyperkalemia and Diabetic Kidney Disease”. Jama. American Medical Association (AMA). doi:10.1001/jama.2015.7446.
- Daugirdas, John T., Thomas A. Depner, Tom Greene, Nathan W. Levin, Glenn M. Chertow, and Michael V. Rocco. 2010. “Standard Kt/vurea: A Method of Calculation That Includes Effects of Fluid Removal and Residual Kidney Clearance”. Kidney International. Elsevier BV. doi:10.1038/ki.2009.525.
- Marquez, Ilian O., Shouieb Tambra, Frank Y. Luo, You Li, Natalie S. Plummer, Thomas H. Hostetter, and Timothy W. Meyer. 2010. “Contribution of Residual Function to Removal of Protein-bound Solutes in Hemodialysis”. Clinical Journal of the American Society of Nephrology. American Society of Nephrology (ASN). doi:10.2215/cjn.06100710.
- Pitt, Bertram, George L. Bakris, David A. Bushinsky, Dahlia Garza, Martha R. Mayo, Yuri Stasiv, Heidi Christ‐Schmidt, Lance Berman, and Matthew R. Weir. 2015. “Effect of Patiromer on Reducing Serum Potassium and Preventing Recurrent Hyperkalaemia in Patients with Heart Failure and Chronic Kidney Disease Onraasinhibitors”. European Journal of Heart Failure. Wiley. doi:10.1002/ejhf.402.
- Murea, Mariana. 2021. “Precision Medicine Approach to Dialysis Including Incremental and Decremental Dialysis Regimens”. Current Opinion in Nephrology & Hypertension. Ovid Technologies (Wolters Kluwer Health). doi:10.1097/mnh.0000000000000667.
- Murea, Mariana, Ashish Patel, Benjamin R. Highland, Wesley Yang, Alison J. Fletcher, Kamyar Kalantar-Zadeh, Emily Dressler, and Gregory B. Russell. 2022. “Twice-weekly Hemodialysis with Adjuvant Pharmacotherapy and Transition to Thrice-weekly Hemodialysis: A Pilot Study”. American Journal of Kidney Diseases. Elsevier BV. doi:10.1053/j.ajkd.2021.12.001.
- Murea, Mariana, Ashish Patel, Benjamin R. Highland, Wesley Yang, Alison J. Fletcher, Kamyar Kalantar-Zadeh, Emily Dressler, and Gregory B. Russell. 2022. “Twice-weekly Hemodialysis with Adjuvant Pharmacotherapy and Transition to Thrice-weekly Hemodialysis: A Pilot Study”. American Journal of Kidney Diseases. Elsevier BV. doi:10.1053/j.ajkd.2021.12.001.
- Murea M, Highland BR, Yang W, Dressler E, Russell GB. Patient-reported outcomes in a pilot clinical trial of twice-weekly hemodialysis start with adjuvant pharmacotherapy and transition to thrice-weekly hemodialysis vs conventional hemodialysis. BMC Nephrol. 2022 Sep 27;23(1):322. doi: 10.1186/s12882-022-02946-w.
- National Kidney Foundation. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update. Am J Kidney Dis. 2015 Nov;66(5):884-930. doi: 10.1053/j.ajkd.2015.07.015. Erratum In: Am J Kidney Dis. 2016 Mar;67(3):534.
- Jansen MA, Hart AA, Korevaar JC, Dekker FW, Boeschoten EW, Krediet RT; NECOSAD Study Group. Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney Int. 2002 Sep;62(3):1046-53. doi: 10.1046/j.1523-1755.2002.00505.x.
- Lowrie EG, Laird NM, Parker TF, Sargent JA. Effect of the hemodialysis prescription of patient morbidity: report from the National Cooperative Dialysis Study. N Engl J Med. 1981 Nov 12;305(20):1176-81. doi: 10.1056/NEJM198111123052003.
- Eknoyan G, Beck GJ, Cheung AK, Daugirdas JT, Greene T, Kusek JW, Allon M, Bailey J, Delmez JA, Depner TA, Dwyer JT, Levey AS, Levin NW, Milford E, Ornt DB, Rocco MV, Schulman G, Schwab SJ, Teehan BP, Toto R; Hemodialysis (HEMO) Study Group. Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med. 2002 Dec 19;347(25):2010-9. doi: 10.1056/NEJMoa021583.
- Kovesdy CP, Regidor DL, Mehrotra R, Jing J, McAllister CJ, Greenland S, Kopple JD, Kalantar-Zadeh K. Serum and dialysate potassium concentrations and survival in hemodialysis patients. Clin J Am Soc Nephrol. 2007 Sep;2(5):999-1007. doi: 10.2215/CJN.04451206. Epub 2007 Aug 16.
- Bakris GL, Pitt B, Weir MR, Freeman MW, Mayo MR, Garza D, Stasiv Y, Zawadzki R, Berman L, Bushinsky DA; AMETHYST-DN Investigators. Effect of Patiromer on Serum Potassium Level in Patients With Hyperkalemia and Diabetic Kidney Disease: The AMETHYST-DN Randomized Clinical Trial. JAMA. 2015 Jul 14;314(2):151-61. doi: 10.1001/jama.2015.7446. Erratum In: JAMA. 2015 Aug 18;314(7):731. Dosage error in article text.
- Termorshuizen F, Dekker FW, van Manen JG, Korevaar JC, Boeschoten EW, Krediet RT; NECOSAD Study Group. Relative contribution of residual renal function and different measures of adequacy to survival in hemodialysis patients: an analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD)-2. J Am Soc Nephrol. 2004 Apr;15(4):1061-70. doi: 10.1097/01.asn.0000117976.29592.93.
- Wu DY, Shinaberger CS, Regidor DL, McAllister CJ, Kopple JD, Kalantar-Zadeh K. Association between serum bicarbonate and death in hemodialysis patients: is it better to be acidotic or alkalotic? Clin J Am Soc Nephrol. 2006 Jan;1(1):70-8. doi: 10.2215/CJN.00010505. Epub 2005 Nov 23.
- Lo WK, Ho YW, Li CS, Wong KS, Chan TM, Yu AW, Ng FS, Cheng IK. Effect of Kt/V on survival and clinical outcome in CAPD patients in a randomized prospective study. Kidney Int. 2003 Aug;64(2):649-56. doi: 10.1046/j.1523-1755.2003.00098.x.
- 2019. "A Pilot Trial of Twice-weekly Versus Thrice-weekly Hemodialysis in Patients With Incident End-stage Kidney Disease". ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT03740048.
Frequently Asked Questions
Are we currently enrolling participants for this drug trial?
"This trial, which was originally posted on June 19th 2019 and last updated on June 22nd 2022, is actively searching for candidates." - Anonymous Online Contributor
What are the guidelines for this clinical trial's success?
"The aim of this experiment, which will last for a maximum of 24 months, is to study the Recruitment rate. Additionally, this trial will compare Monthly spKt/Vurea and stdKt/Vurea in the first quarter of hemodialysis between two treatment groups as a secondary outcome. Quality of Life- KDQOL-SF36 questionnaire will also be utilized as a metric to measure kidney disease burden, symptoms, and effects while Change in residual kidney function tracks renal urea clearance over time." - Anonymous Online Contributor
How many people are in this experiment?
"The listings on clinicaltrials.gov show that this study is still recruiting patients. This particular trial was first posted on June 19th, 2019 and was last updated June 22nd, 2020. They are looking for a total of 50 participants across 1 location." - Anonymous Online Contributor
Are there any similar studies to this one that have already been completed?
"4 clinical trials concerning hemodialysis are currently underway. Out of those 4, 2 have reached Phase 3. Although the majority of these trials take place in Durham, North Carolina, 25 total locations across the country are running similar studies." - Anonymous Online Contributor
Has Hemodialysis been cleared by the FDA?
"Hemodialysis received a score of 3 because, while this is only a Phase 3 trial, there is both some efficacy data and multiple rounds of safety data." - Anonymous Online Contributor