注册 | 登录 | 充值

首页-> 学术资讯 -> 文献解读

柳叶刀:接受维持性血液透析患者的个性化冷却透析分析

文献解读

2022-11-21      

546 0


血液透析中心通常使用标准透析液温度(如36·5°C)为所有患者提供维持式血液透析。许多中心现在使用较冷的透析液(如36·0°C或更低),以获得潜在的心血管益处。我们的目的是评估作为中心范围政策实施的个性化低温透析,与标准温度透析相比,是否降低了心血管相关死亡或住院的风险。


在此期间,试验中心为15 413例患者提供了门诊维持性血液透析(约430万次血液透析治疗)。在较冷透析液组和标准温度组中,平均透析液温度分别为35.8℃和36.4℃。较低温透析液组8,000例患者中的1,711例(21.4%)发生了主要结局,而标准体温组7,413例患者中的1,658例(22.4%)发生了主要结局(校正后的风险比1.00,96% CI 0.89 ~ 1.11;p = 0·93)。在较冷透析液组和标准温度组中,透析中收缩压的平均降幅分别为26.6 mmhg和27.1 mmhg(平均差- 0.5 mmhg, 99% CI - 1.4 ~ 0.4;p = 0·14)


与标准温度透析相比,在中心范围内提供个性化较冷的透析液并没有显著降低主要心血管事件的风险。本研究对低温透析液的日益流行提出了质疑,在一些患者人群中低温透析液的风险和好处应在未来的试验中澄清。


Abstract

Background: Haemodialysis centres have conventionally provided maintenance haemodialysis using a standard dialysate temperature (eg, 36·5°C) for all patients. Many centres now use cooler dialysate (eg, 36·0°C or lower) for potential cardiovascular benefits. We aimed to assess whether personalised cooler dialysate, implemented as centre-wide policy, reduced the risk of cardiovascular-related death or hospital admission compared with standard temperature dialysate.


Methods: MyTEMP was a pragmatic, two-arm, parallel-group, registry-based, open-label, cluster-randomised, superiority trial done at haemodialysis centres in Ontario, Canada. Eligible centres provided maintenance haemodialysis to at least 15 patients a week, and the medical director of each centre had to confirm that their centre would deliver the assigned intervention. Using covariate-constrained randomisation, we allocated 84 centres (1:1) to use either personalised cooler dialysate (nurses set the dialysate temperature 0·5-0·9°C below each patient's measured pre-dialysis body temperature, with a lowest recommended dialysate temperature of 35·5°C), or standard temperature dialysate (36·5°C for all patients and treatments). Patients and health-care providers were not masked to the group assignment; however, the primary outcome was recorded in provincial databases by medical coders who were unaware of the trial or the centres' group assignment. The primary composite outcome was cardiovascular-related death or hospital admission with myocardial infarction, ischaemic stroke, or congestive heart failure during the 4-year trial period. Analysis was by intention to treat. The study is registered at ClinicalTrials.gov, NCT02628366.


Findings: We assessed all of Ontario's 97 centres for inclusion into the study. Nine centres had less than 15 patients and one director requested that four of their seven centres not participate. 84 centres were recruited and on Feb 1, 2017, these centres were randomly assigned to administer personalised cooler dialysate (42 centres) or standard temperature dialysate (42 centres). The intervention period was from April 3, 2017, to March 31, 2021, and during this time the trial centres provided outpatient maintenance haemodialysis to 15 413 patients (about 4·3 million haemodialysis treatments). The mean dialysate temperature was 35·8°C in the cooler dialysate group and 36·4°C in the standard temperature group. The primary outcome occurred in 1711 (21·4%) of 8000 patients in the cooler dialysate group versus 1658 (22·4%) of 7413 patients in the standard temperature group (adjusted hazard ratio 1·00, 96% CI 0·89 to 1·11; p=0·93). The mean drop in intradialytic systolic blood pressure was 26·6 mm Hg in the cooler dialysate group and 27·1 mm Hg in the standard temperature group (mean difference -0·5 mm Hg, 99% CI -1·4 to 0·4; p=0·14).


Interpretation: Centre-wide delivery of personalised cooler dialysate did not significantly reduce the risk of major cardiovascular events compared with standard temperature dialysate. The rising popularity of cooler dialysate is called into question by this study, and the risks and benefits of cooler dialysate in some patient populations should be clarified in future trials.


Funding: Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Ontario Renal Network, Ontario Strategy for Patient-Oriented Research Support Unit, Dialysis Clinic, Inc., ICES (formerly known as the Institute for Clinical Evaluative Sciences), Lawson Health Research Institute, and Western University.


文章连接:

www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01805-0/fulltext



科研资讯(站内):

  1. 张核子团队或涉学术不端华大基因回应核酸检测不准被举报..

  2. 北京多区最新通知:很多人不用再做核酸检测啦

  3. “阳性居家隔离不去方舱”行不行?

  4. 张文宏发声:新冠病毒逐渐进入稳定期…感染后千万不要慌!准备好这些东西..

  5. 港大病毒专家金冬雁:即便80岁老人,打好疫苗后危险性也低于流感..

  6. 国自然热点:M1型还是M2型?巨噬细胞该何去何从

  7. 国自然热点:肿瘤细胞通过铁死亡实现免疫逃逸

  8. 武汉市中心医院一医生因违反防疫政策被罚

百度浏览   来源 : 医微客   


版权声明:本网站所有注明来源“医微客”的文字、图片和音视频资料,版权均属于医微客所有,非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源:”医微客”。本网所有转载文章系出于传递更多信息之目的,且明确注明来源和作者,转载仅作观点分享,版权归原作者所有。不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。 本站拥有对此声明的最终解释权。

科研搜索(百度):医学科研





发表评论

注册或登后即可发表评论

登录注册

全部评论(0)

没有更多评论了哦~

科研资讯 更多>>
  • 得了新冠几天能好?全国各地阳性..
  • 注意!世卫组织最新版《新冠个人..
  • 顶尖大学校长学术不端被查!科研..
  • 张核子团队或涉学术不端 华大基..
  • 推荐阅读 更多>>
  • 柳叶刀:球囊导管与阴道前列腺素..
  • 柳叶刀:Q-122作为一种新型非激..
  • ENJM:PD-1阻断法治疗错配修复缺..
  • ENJM:德喜曲妥珠单抗 vs 恩美曲..
    • 相关阅读
    • 热门专题
    • 推荐期刊
    • 学院课程
    • 医药卫生
      期刊级别:国家级期刊
      发行周期:暂无数据
      出版地区:其他
      影响因子:暂无数据
    • 中华肿瘤
      期刊级别:北大核心期刊
      发行周期:月刊
      出版地区:北京
      影响因子:1.90
    • 中华医学
      期刊级别:CSCD核心期刊
      发行周期:周刊
      出版地区:北京
      影响因子:0.94