PCORI Funds Personal Dialysis Model Assessment

Kidney illustration (Sheldahl, Wikimedia Commons)

10 Mar. 2023. A team from an academic medical center and research institute are evaluating a personalized dialysis model for people with kidney disease, but with still some kidney functions. The two-year project is funded by a $10.2 million grant from the Patient-Centered Outcomes Research Institute or PCORI, a not-for profit group supporting comparative clinical effectiveness research in the U.S.

The study is conducted by Atrium Health Wake Forest Baptist medical center in Winston-Salem, North Carolina and Renal Research Institute in New York to assess a more individualized approach to delivering kidney dialysis. Chronic kidney disease occurs when kidneys are damaged, preventing their normal filtering of blood. The disorder is often marked by anemia, higher risk and occurrence of infection, elevated potassium and phosphorus in blood coupled with lower calcium levels, loss of appetite, and mental health effects such as depression. Centers for Disease Control and Prevention says some 37 million people in the U.S. have chronic kidney disease or about 15 percent of the adult population.

Dialysis, also called hemodialysis, is often needed by people with failing kidneys. The treatment filters a person’s blood through an external machine, replacing the functions of normal kidneys, and cleaning out waste matter in blood, as well as balancing levels of key minerals such as potassium and calcium. For people with advanced kidney disease, dialysis is a life-saving procedure, carried out three times per week. Yet according to the researchers, most people with kidney disease at any stage are also prescribed that same schedule of dialysis treatments, even if their kidneys still have some residual functions.

“Continuously tailor hemodialysis treatments to each individual’s medical needs”

“We must recognize that each individual with advanced kidney disease has unique needs, especially when hemodialysis is introduced to their care,” says Mariana Murea, a nephology professor at Wake Forest University and a lead investigator on the project in an Atrium Health statement. “In our study, we implement an individualized approach to hemodialysis care where we continuously tailor hemodialysis treatments to each individual’s medical needs.”

In the study, Murea and colleagues are testing twice-a-week dialysis sessions, supported by kidney-enhancing drugs, for individuals retaining some kidney functions. The team is enrolling 350 patients, randomly assigned to received dialysis on a personalized schedule or the usual three-day-a-week schedule. (Participants in the test group whose conditions deteriorate will receive conventional dialysis care.) The researchers are collecting urine samples and monitoring kidney functions, as well as comparing indicators such as hospitalizations, emergency room visits, and deaths, as well as health-related quality of life.

Murea and colleagues at Atrium Wake Forest reported in Sept. 2022 on a pilot clinical trial of individualized dialysis care with 50 kidney disease patients. The researchers found participants receiving the twice-a-week dialysis sessions show fewer indications of anxiety and depression than similar patients receiving dialysis on the conventional schedule.

“This project was selected for PCORI funding,” says Nakela Cook, executive director of PCORI, “not only for its scientific merit and commitment to engaging patients and other health care stakeholders, but also for its conduct in real-world settings. It has the potential to answer an important question about kidney function-based individualized hemodialysis and fill a crucial evidence gap.”

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