This will be a randomized controlled pilot trial comparing usual care to a precision approach to dialysis potassium prescribing. The precision approach will incorporate point of care testing of blood potassium concentration prior to each dialysis session and adjustment of the dialysate K prescription with a blood-dialysate K gradient minimization strategy (PKRxHD).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
120
Intervention Adherence
Measured as the proportion of hemodialysis (HD) treatments in the experimental arm completed per protocol with both pre-HD point of care testing and appropriate adjustment of the dialysate prescription.
Time frame: Up to Week 24
Recruitment Feasibility
Measured as the proportion of eligible patients enrolled successfully.
Time frame: Baseline
Incidence Rate of Pre-HD Hyperkalemia
Hyperkalemia is defined as K≥ 6.4 mEq/L.
Time frame: Baseline
Post-HD Recovery Time
Measured as the average time to recovery following each HD session.
Time frame: Up to Week 24
Incidence Rate of Post-HD Hyperkalemia Incidence Rate
Hyperkalemia is defined as K≥ 6.4 mEq/L.
Time frame: Up to Week 24
Incidence Rate of Moderate Hyperkalemia
Hyperkalemia is defined as K≥ 3.0 mEq/L.
Time frame: Up to Week 24
Incidence Rate of Peri-Dialytic Cramping
Time frame: Up to Week 24
Incidence Rate of Intradialytic Hypotension
Intradialytic hypotension will be defined as the proportion of HD sessions with intradialytic systolic blood pressure\<90 mmHg, as this definition best captures associations with mortality according to current guidelines.
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Time frame: Up to Week 24