Clinical evaluation of Hemocontrol in hypotension-prone hemodialysis patients

ISRCTN ISRCTN96130697
DOI https://doi.org/10.1186/ISRCTN96130697
Secondary identifying numbers Hemo01_042011
Submission date
07/11/2011
Registration date
21/11/2011
Last edited
17/10/2017
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Urological and Genital Diseases
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
Hemodialysis (HD) is a process of purifying the blood of a person whose kidneys are not working normally. HD treatments may be complicated by a substantial drop in blood pressure, often accompanied by symptoms like cramps, nausea, dizziness, and fatigue. A provoking factor for this intradialytic hypotension (IDH) is an inability to cope with the prescribed fluid removal, leading to an extensive reduction in blood volume. Some patients are more susceptible, with cardiac (heart) dysfunction and anti-high blood pressure treatment being examples of significant risk factors. For patients who experience frequent IDH episodes it means distressing symptoms but also a risk of illness related to organ ischemia (lack of blood flow) during the IDH episodes. The Hemocontrol function of the Artis dialysis machine measures the blood volume reduction during dialysis and continuously adjusts to reduce the rate of IDH. The aim of this study is to find out what effect Hemocontrol has on the incidence of IDH and other symptoms of dialysis in Korean hypotension-prone HD patients.

Who can participate?
Hypotension-prone HD patients aged between 18 and 75

What does the study involve?
Over three study periods participants are treated with current best practice HD for 8 weeks (period A), with HD with Hemoscan blood volume monitoring for 2 weeks (period B0), and with Hemocontrol HD for 8 weeks (period B1). The incidence of hypotension is compared between Hemocontrol HD and current best practice HD.

What are the possible benefits and risks of participating?
There are no known risks to participants because all participants will be on hemodialysis as their usual practice.

Where is the study run from?
The study takes place at 9 hemodialysis rooms in hospitals in South Korea

When is the study starting and how long is it expected to run for?
July 2011 to November 2011

Who is funding the study?
Gambro Korea Ltd

Who is the main contact?
Jungmin Im
jungmin.im@gambro.com

Contact information

Ms Jungmin Im
Scientific

4F 145-9 KLC B/D
Samseong-dong
Kangnam-gu
Seoul
135-090
Korea, South

Phone +82 (0)22 240 0560
Email jungmin.im@gambro.com

Study information

Study designProspective open-label study
Primary study designInterventional
Secondary study designRandomised cross over trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet Not available in web format, please use the contact details to request patient information sheet
Scientific titleClinical evaluation of Hemocontrol in hypotension-prone hemodialysis patients: a multicenter prospective cross-over study
Study objectivesEvaluate what effect an automatic blood volume controlled treatment approach (Hemocontrol) has on the incidence of intradialytic hypotension and other symptoms of dialysis, the change in blood pressure from pre to post dialysis, and the control of dry weight in Korean hypotension-prone hemodialysis (HD) patients.
Ethics approval(s)Seoul St Mary's Hospital, 07/08/2011, ref: CIRB-00039_23-01
All other centres will seek ethics approval before recruitment of the first participant
Health condition(s) or problem(s) studiedChronic kidney disease
InterventionComparing A) current best practice HD (baseline) with B) Hemocontrol HD, in an AB cross-over design.

Study period A (baseline): Current best practice HD – 8 weeks evaluation
1. Regular treatment setup
2. Regular clinical assessment of dry weight
*Period A could be with any machine type (but it should be documented which machine)

Study period B0: HD with Hemoscan blood volume monitoring – 2 weeks with Artis machine
This is a preparation phase for the Hemocontrol period, required to establish the patients’ individual blood volume/ ultrafiltration (BV/UF) volume values that are required as input to Hemocontrol
1. Hemoscan function activated
2. Constant UF rate and constant dialysis fluid sodium setting throughout the HD treatment
3. Assessment of the blood volume (BV) curve shape
4. Assessment of the BV/UF vol parameter required by Hemocontrol

Study period B1: Hemocontrol HD treatments – 8 weeks evaluation with Artis machine
1. Hemocontrol activated throughout the period
2. Hemocontrol BV/UF vol parameter initially set as determined in period B0 and thereafter adjusted in accordance with Hemocontrol guidelines (see appendix to be prepared)
3. Hemocontrol Equivalent sodium (Na) parameter set individually to the same value as used for dialysis fluid Na in the baseline period-Is there any reference about standard Serum Sodium level
4. Hemocontrol Max UF Coefficient and Na Limits parameters set at 1.5 and Standard, respectively
5. Dry weight initially set as in baseline period and thereafter adjusted based on clinical assessments and the information provided by the Hemocontrol refill indicators
Intervention typeProcedure/Surgery
Primary outcome measure1. Incidence rate of dialysis treatments affected by one or more symptomatic hypotensive episodes, comparing Hemocontrol HD to current best practice HD
2. Hypotensive episodes defined as a decrease in systolic BP >=20 mmHg or a decrease in mean arterial pressure (MAP) by >=10 mmHg that is associated with characteristic symptoms and requires nurse intervention by any type
Secondary outcome measures1. Pre- and post-dialysis systolic and diastolic blood pressure (alternatively mean arterial blood pressure)
2. Post-dialysis body weight (dry weight)
3. Inter-dialytic weight gain
4. Symptoms during dialysis that appear without hypotension: muscular cramps, dizziness, nausea
5. Patients’ subjective assessment of tiredness after dialysis
6. Dialysis dose delivered – Urea Reduction Ratio (URR)
7. Blood biochemistry data for sodium, calcium, phosphorus, potassium, hemoglobin, and albumin
8. 48hrs blood pressure (BP) monitoring (describe BP medications during monitoring)
Overall study start date18/07/2011
Completion date15/11/2011

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexBoth
Target number of participants71
Key inclusion criteria1. Hypotension-prone patients, i.e. patients showing symptomatic hypotensive episodes in response to fluid removal by dialysis in 25% or more of treatments during 1 month preceding the study
2. Mostly showing an inter-dialytic weight gain of 1.5 kg or more
3. Age between 18 and 75 years
4. On dialysis for at least 3 months, on three dialysis per week schedule
Key exclusion criteria1. A regular pre-dialysis mean arterial blood pressure in supine position of <90 mmHg
2. Regular blood flow rate for dialysis lower than 200 ml/min
3. Ppre-dialysis hemoglobin level regularly above 13 g/dl
4. Treatment by hemodiafiltration (HDF)
5. Expected need for blood transfusions
Date of first enrolment18/07/2011
Date of final enrolment15/11/2011

Locations

Countries of recruitment

  • Korea, South

Study participating centre

Gambro Korea Ltd.
Seoul
135-090
Korea, South

Sponsor information

Gambro Korea Ltd. (Korea, South)
Industry

4F KLC B/D
Samseong-dong
Kangnam-gu
Seoul
135-090
Korea, South

Phone +82 (0)22 240 0560
Email jungmin.im@gambro.com
Website http://www.gambro.com
ROR logo "ROR" https://ror.org/00y1hj465

Funders

Funder type

Industry

Gambro Korea Ltd. (Korea, South) (Reference No.: Hemo01_042011)

No information available

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article results 01/06/2014 Yes No

Editorial Notes

17/10/2017: Plain English summary and publication reference added.