ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-PO982

Pre-Dialysis Point-of-Care (POC) Chemistry-Guided Dialysate Adjustment: The Reducing Arrhythmia in hemoDialysis by Adjusting the Rx Electrolytes (RADAR) Pilot Trial

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Pun, Patrick H., Duke University School of Medicine, Durham, North Carolina, United States
  • Santacatterina, Michele, NYU Langone Health, New York, New York, United States
  • Al-Khatib, Sana, Duke University School of Medicine, Durham, North Carolina, United States
  • Chinitz, Larry Azriel, NYU Langone Health, New York, New York, United States
  • Charytan, David M., NYU Langone Health, New York, New York, United States
Background

Excessive dialytic potassium (K) and acid removal are risk factors for arrhythmia, suggesting a need to personalize HD prescriptions. We conducted a multicenter prospective blinded randomized cross-over study to test safety, feasibility, and efficacy of 4 POC chemistry-guided protocols to adjust dialysate K and bicarbonate (HCO3).

Methods

HD patients from 2 centers received implantable cardiac monitors. Subjects crossed over to four 4-week periods with dialysate K or HCO3 adjustment at each treatment according to preHD POC values: 1) K removal maximization (lower dialysate K); 2) K removal minimization (higher dialysate K); 3) Acidosis avoidance (higher dialysate HCO3); 4) Alkalosis avoidance (lower dialysate HCO3). Efficacy on clinically significant arrhythmia (CSA) rate was assessed.

Results

Of 19 subjects enrolled, 42% were Black and 16% female. Mean age was 59 and median HD time was 2.6 years. HD staff completed POC testing and correctly adjusted the dialysate in 604/708 (85%) of available HD treatments; missed POC testing accounted for most nonadherence. There was 1 K≤3 mEq/L, 29 HCO3<20 and 2 HCO3>32 mEq/L during respective intervention periods and no serious adverse events related to study interventions. There were no significant differences between POC results and standard monthly labs drawn on the same day. However, inter-treatment K and HCO3 variability was high (Figure). There were 45 total CSA events, the majority transient atrial fibrillation, with numerically fewer events during the alkalosis avoidance (8) and K-removal minimization (3) periods compared to other intervention periods (17).

Conclusion

Algorithm-guided K and HCO3 adjustment based on pre-treatment POC testing is feasible. The variability of inter-treatment K and HCO3 we observed suggests that a POC-lab guided algorithm could markedly alter dialysate-serum chemistry gradients. Definitive, endpoint-powered trials should be considered.

Funding

  • Other NIH Support