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Vernooij RW, Hockham C, Barth C, Canaud B, Cromm K, Davenport A, Hegbrant J, Rose M, Strippoli G, Török M, Woodward M, Bots M, Blankestijn P. High-Target Hemodiafiltration Convective Dose Achieved in Most Patients in a 6-Month Intermediary Analysis of the CONVINCE Randomized Controlled Trial. Kidney Int Rep 2023; 8:2276-2283. [PMID: 38025213 PMCID: PMC10658200 DOI: 10.1016/j.ekir.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction High convection volumes in hemodiafiltration (HDF) result in improved survival; however, it remains unclear whether it is achievable in all patients. Methods CONVINCE, a randomized controlled trial, randomized patients with end-stage kidney disease 1:1 to high-dose HDF versus high-flux hemodialysis (HD) continuation. We evaluated the proportion of patients achieving high-dose HDF target: convection volume per visit of ≥23 l (range ±1 l) at baseline, month 3, and month 6. We compared baseline characteristics in the following 2 ways: (i) patients on target for all 3 visits versus patients who missed target on ≥1 visits and (ii) patients on target for all 3 visits or missing it once versus patients who missed target on ≥2 visits. Results A total of 653 patients were randomized to HDF. Their mean age was 62.2 (SD 13.5) years, 36% were female, 81% had fistula vascular access, and 33% had diabetes. Across the 3 visits, 75 patients (11%), 27 patients (4%), and 11 patients (2%) missed the convection volume target once, twice, and thrice, respectively. Apart from diabetes, there were no apparent differences in patient characteristics between patients who always achieved the high-dose target (83%) and those who missed the target either once or more (17%) or twice or more (6%). Conclusion Achieving high-dose HDF is feasible for nearly all patients in CONVINCE and could be maintained during the 6-month follow-up period. Apart from diabetes, there were no other indications for confounding by indication on multivariable analyses that may explain the potential survival advantage for patients receiving high-dose HDF.
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Affiliation(s)
- Robin W.M. Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - C. Hockham
- George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - C. Barth
- B. Braun Avitum AG, Medical Scientific Affairs, Melsungen, Germany
| | - B. Canaud
- Montpellier University, School of Medicine, Montpellier, France and Global Medical Office, FMC Deutschland, Bad Homburg, Germany
| | - K. Cromm
- Fresenius Medical Care Deutschland GmbH, Global Medical Office, Bad Homburg, Germany
| | - A. Davenport
- UCL Center for Nephrology, Royal Free Hospital, Division of Medicine, University College London, London, UK
| | - J. Hegbrant
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - M. Rose
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Center of Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Berlin Institute of Health, Berlin, Germany
| | - G.F.M. Strippoli
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
- School of Public Health, University of Sydney, Sydney, Australia
| | - M. Török
- Corporate Medical Office Diaverum, Malmö, Sweden
| | - M. Woodward
- George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - M.L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - P.J. Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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McGree JM, Hockham C, Kotwal S, Wilcox A, Bassi A, Pollock C, Burrell LM, Snelling T, Jha V, Jardine M, Jones M. Controlled evaLuation of Angiotensin Receptor Blockers for COVID-19 respIraTorY disease (CLARITY): statistical analysis plan for a randomised controlled Bayesian adaptive sample size trial. Trials 2022; 23:361. [PMID: 35477480 PMCID: PMC9044378 DOI: 10.1186/s13063-022-06167-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
The CLARITY trial (Controlled evaLuation of Angiotensin Receptor Blockers for COVID-19 respIraTorY disease) is a two-arm, multi-centre, randomised controlled trial being run in India and Australia that investigates the effectiveness of angiotensin receptor blockers in addition to standard care compared to placebo (in Indian sites) with standard care in reducing the duration and severity of lung failure in patients with COVID-19. The trial was designed as a Bayesian adaptive sample size trial with regular planned analyses where pre-specified decision rules will be assessed to determine whether the trial should be stopped due to sufficient evidence of treatment effectiveness or futility. Here, we describe the statistical analysis plan for the trial and define the pre-specified decision rules, including those that could lead to the trial being halted. The primary outcome is clinical status on a 7-point ordinal scale adapted from the WHO Clinical Progression scale assessed at day 14. The primary analysis will follow the intention-to-treat principle. A Bayesian adaptive trial design was selected because there is considerable uncertainty about the extent of potential benefit of this treatment. Trial registration ClinicalTrials.gov NCT04394117. Registered on 19 May 2020Clinical Trial Registry of India CTRI/2020/07/026831 Version and revisions Version 1.0. No revisions.
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Affiliation(s)
- J M McGree
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia.
| | - C Hockham
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,The George Institute for Global Health, Imperial College London, London, UK
| | - S Kotwal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Prince of Wales Hospital, Sydney, Australia
| | - A Wilcox
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - A Bassi
- The George Institute for Global Health, New Delhi, India
| | - C Pollock
- Royal North Shore Hospital, Sydney, Australia.,Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - L M Burrell
- Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - T Snelling
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,The Sydney Children's Hospitals Network, Westmead, Australia
| | - V Jha
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,The George Institute for Global Health, New Delhi, India
| | - M Jardine
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.,Concord Repatriation General Hospital, Sydney, Australia
| | - M Jones
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
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YOUNG T, Hockham C, Sukkar L, Kang A, Jun M, Baker J, Rogers K, Cass A, Jardine M. SAT-288 Trends in pharmacotherapy for diabetes in a large Australian cohort: results from the EXTEND45 study. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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