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Days-Off Versus Daily Initial Peritoneal Dialysis Prescription

2. november 2026 oppdatert av: Bruce M Robinson, University of Michigan

Comparative Effectiveness of Days-Off Versus Daily Initial Peritoneal Dialysis Prescription

The purpose of this study is to compare days-off (5 or 6 days a week) with daily (7 days a week) peritoneal dialysis (PD) in adults who are starting PD to treat kidney failure and make at least 16 ounces (two cups) of urine a day. Once enrolled, participants will be placed into one of two groups by chance, like flipping a coin: days-off PD or daily PD. Participants will be asked to stay on the assigned PD schedule (days-off or daily) for at least 6 months. After that, participants will continue this schedule for as long as it continues to be right for their health. Participants will be followed for as long as they remain on PD, up to 24 months. Most participants assigned to the days-off schedule will switch to daily PD at some point between 6 and 24 months because of further drop in urine output. Other than days per week, all parts of participant's PD prescription will be decided by their care team at their regular monthly PD clinic visits, just as if they were not in the study. Study visits will happen around the time of these regular clinic visits. No extra trips are required. Participants will be asked to complete surveys. Most other study data will be collected from the medical chart. No blood or biological samples will be taken for the study.

Studieoversikt

Status

Har ikke rekruttert ennå

Forhold

Intervensjon / Behandling

Studietype

Intervensjonell

Registrering (Antatt)

450

Fase

  • Ikke aktuelt

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiekontakt

Studiesteder

    • California
      • Torrance, California, Forente stater, 90502
        • Lundquist Institute at Harbor-UCLA Medical Center
        • Hovedetterforsker:
          • Jenny Shen, MD
    • Georgia
      • Atlanta, Georgia, Forente stater, 30322
        • Emory University
        • Hovedetterforsker:
          • Jason Cobb, MD
    • Illinois
      • Evanston, Illinois, Forente stater, 60208
        • Northwestern University
    • Indiana
      • Bloomington, Indiana, Forente stater, 47405
        • University of Indiana
        • Hovedetterforsker:
          • Nupur Gupta, MD
    • Michigan
      • Ann Arbor, Michigan, Forente stater, 48109
        • University of Michigan
        • Hovedetterforsker:
          • Balazs Szamosfalvi, MD
    • New York
      • New York, New York, Forente stater, 10021
        • Rogosin Institute, Inc (New York-Presbyterian Hospital/Weill Cornell Medicine)
        • Hovedetterforsker:
          • Daniil Shimonov, MD
      • New York, New York, Forente stater, 10029
        • Mount Sinai School of Medicine (MSSM)
        • Hovedetterforsker:
          • Sharma Shuchita, MD
    • North Carolina
      • Winston-Salem, North Carolina, Forente stater, 27109
        • Wake Forest University School of Medicine (WFUSM)
        • Hovedetterforsker:
          • Mariana Murea, MD
    • Texas
      • Dallas, Texas, Forente stater, 75390
        • University of Texas Southwestern (UTSW)
    • Washington
      • Seattle, Washington, Forente stater, 98195
        • University of Washington (UW)
        • Hovedetterforsker:
          • Rajnish Mehrotra, MD, MS

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år og eldre (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Beskrivelse

Inclusion Criteria:

  1. Willingness to give written informed consent prior to any study-related procedures being performed.
  2. End-stage kidney disease, with first maintenance dialysis (PD or HD) initiated within 120 days prior to randomization.
  3. Home PD initiated within 30 days prior to randomization, defined as first PD exchange performed at home following completion of PD training.
  4. Residual kidney function, measured on a clinically obtained 24-hour urine collection within 45 days prior to randomization, demonstrating both (a) urine volume ≥500mL/24 hours and (b) urine clearance (mean of urea and creatinine clearance) ≥6 to <12 L/min/1.73m2
  5. In the judgment of the treating nephrologist, expected to remain on PD for at least 6 months following randomization
  6. Expected to receive ongoing PD care at the study enrollment site for the duration of study follow-up.
  7. Willingness to accept either randomized treatment assignment, adhere to the treatment schedule, and adhere to protocol schedule of activities.
  8. Sufficient fluency in English or Spanish to understand study materials and complete study assessments.

Exclusion Criteria:

  1. A laboratory-documented decline of ≥50% in residual kidney function (24-hour urine volume or mean of urea and creatinine clearance) since initiation of maintenance dialysis (HD or PD).
  2. Initiated maintenance dialysis due to kidney transplant failure.
  3. During the run-in period, requirement of either of the following for clinical purposes: (a) 7-day-per-week PD prescription or (b) a daytime dwell, if receiving automated peritoneal dialysis (APD).
  4. Any other condition that, in the judgment of the investigator, would make the participant unsuitable for days-off PD for at least 6 months following randomization.
  5. Concurrent participation in another interventional clinical trial.
  6. Known pregnancy or nursing at the time of screening, or of child-bearing potential and planning for possible pregnancy during the study period.
  7. Any condition that, in the judgment of the investigator, would make the participant unsuitable for the study or preclude participation for at least 6 months following randomization (e.g., anticipated kidney transplantation, anticipated transfer of dialysis care outside a participating study site, life expectancy <6 months, or other significant medical, psychiatric, or social circumstances).

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Behandling
  • Tildeling: Randomisert
  • Intervensjonsmodell: Parallell tildeling
  • Masking: Ingen (Open Label)

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Aktiv komparator: Daily Peritoneal Dialysis (7 days/week)

Approximately 225 participants

After a 7-15 day run-in period of daily PD, participants remain on a daily PD prescription for the duration of follow-up. Other elements of the PD prescription are at the discretion of the clinical team.

Participants will be followed until death, long-term transfer to HD, kidney transplantation, recovery of kidney function such that maintenance dialysis is no longer required, participant withdrawal, or completion of 24 months of follow-up, whichever occurs first.

Eksperimentell: Days-off Peritoneal Dialysis (5-6 days/week)

Approximately 225 participants

After a 7-15 day run-in period of daily PD, participants switch to PD prescription 5 or 6 days per week. Other elements of the PD prescription are at the discretion of the clinical team. The treatment assignment is continued for at least 6 months and then for as long as possible until clinically indicated otherwise. Many participants are expected to eventually switch to daily PD, intended as a long-term switch, to compensate for decline in residual kidney function over time.

Duration of follow-up is as in the active comparator arm.

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Total number of composite clinical events during follow up
Tidsramme: Day 1 (start of randomized treatment) through Month 24 of follow-up

Each occurrence of the following during follow-up: (1) death, all cause; (2) long-term transfer to hemodialysis (HD), defined as transfer identified as long-term or identified as short-term but lasting ≥ 90 days; (3) peritoneal dialysis (PD)-related infection, defined as PD-associated peritonitis meeting International Society for Peritoneal Dialysis (ISPD) diagnostic criteria; and (4) hospitalization lasting ≥ 24 hours.

Day 1 (start of randomized treatment) through Month 24 of follow-up

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Standardized Outcomes in Nephrology - Life Participation (SONG-LP) score (Patient reported outcome)
Tidsramme: Months 0, 1, 3, 9, 12, 18, and 24; Key secondary outcome is Month 0 to Month 6.

The SONG-LP instrument is a 4-item patient-reported outcome measure developed by the SONG initiative to assess life participation, i.e. the ability to take part in meaningful activities. The four items cover leisure activities, family activities, work (including employment, housework, and study), and social activities. Participants rate how often they were able to take part in each activity over the past month on a 5-point scale from 0 ("never") to 4 ("always"). The summary score is the mean of the four item scores and ranges from 0 to 4. Higher scores indicate greater life participation (better outcome).

Months 0, 1, 3, 9, 12, 18, and 24; Key secondary outcome is Month 0 to Month 6.
Illness Intrusiveness Ratings Scale (IIRS) score (Patient reported outcome)
Tidsramme: Months 0, 1, 3, 6, 9, 12, 18, and 24

The IIRS is a 13-item self-report instrument. It measures how much a person's illness and its treatment interfere with 13 life domains that are important to quality of life. The domains are health, diet, work, active recreation, passive recreation, financial situation, relationship with spouse or partner, sex life, family relations, other social relations, self-expression and self-improvement, religious expression, and community and civic involvement. Each item is rated on a 7-point scale from 1 ("not very much") to 7 ("very much"). The total score is the sum of the 13 item ratings and ranges from 13 to 91. Higher scores indicate greater illness intrusiveness (worse outcome).

Months 0, 1, 3, 6, 9, 12, 18, and 24
Kidney Disease Quality of Life 36-Item Short Form Summary Score (KDQOL-36 KSS) (Patient reported outcome)
Tidsramme: Months 0, 3, 6, 12, and 24

The KDQOL-36 is a 36-item, kidney disease-specific health-related quality of life instrument. Higher scores indicate better health related quality of life instrument. Items 1-12 make up the SF-12 generic core. The remaining 24 items form three kidney disease-specific subscales. Higher scores on the KDQOL-36 KSS indicate better health related quality of life.

Months 0, 3, 6, 12, and 24
Change in Kidney Disease Quality of Life 36-Item Short Form Survey (KDQOL-36) kidney disease-specific subscale scores (Patient reported outcome)
Tidsramme: Months 0, 3, 6, 12, and 24

Subscales include Burden of Kidney Disease (items 13-16), Symptoms and Problems of Kidney Disease (items 17-28), and Effects of Kidney Disease on Daily Life (items 29-36). Each kidney disease-specific subscale is scored from 0 to 100 according to the RAND scoring manual. Higher scores indicate better subscale-specific quality of life.

Months 0, 3, 6, 12, and 24
Number of episodes of low small-solute clearance (weekly Kt/V [peritoneal + renal] < 1.7).
Tidsramme: Day 1 through Month 24 of follow-up

Counts, for episodes of weekly urea clearance (peritoneal + renal) normalized to total body water (Kt/V [P+R]) < 1.7.

Day 1 through Month 24 of follow-up
Number of episodes of serum potassium ≥ 6.0 mEq/L
Tidsramme: Day 1 through Month 24 of follow-up

Counts, for episodes of hyperkalemia, defined as serum potassium ≥6.0 mEq/L

Day 1 through Month 24 of follow-up
Number of episodes of serum phosphate ≥ 7.0 mg/dL
Tidsramme: Day 1 through Month 24 of follow-up

Counts, for episodes of hyperphosphatemia, defined as serum phosphate ≥7.0 mg/dL

Day 1 through Month 24 of follow-up
Number of episodes of serum CO2 ≤17 mmol/L
Tidsramme: Day 1 through Month 24 of follow-up

Counts, for episodes of serum total carbon dioxide (CO2; bicarbonate) ≤ 17 mmol/L

Day 1 through Month 24 of follow-up
Number of episodes of serum sodium < 130 mEq/L
Tidsramme: Day 1 through Month 24 of follow-up

Counts, for episodes of hyponatremia, defined as serum sodium < 130 mEq/L.

Day 1 through Month 24 of follow-up

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

Samarbeidspartnere

Etterforskere

  • Hovedetterforsker: Bruce Robinson, MD, MS, University of Michigan

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Antatt)

1. februar 2027

Primær fullføring (Antatt)

1. november 2030

Studiet fullført (Antatt)

1. november 2030

Datoer for studieregistrering

Først innsendt

2. november 2026

Først innsendt som oppfylte QC-kriteriene

2. november 2026

Først lagt ut (Faktiske)

6. november 2026

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

6. november 2026

Siste oppdatering sendt inn som oppfylte QC-kriteriene

2. november 2026

Sist bekreftet

1. november 2026

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Andre studie-ID-numre

  • HUM00302656
  • BPS-2025C1-44706 (Annet stipend/finansieringsnummer: Patient-Centered Outcomes Research Institute)

Plan for individuelle deltakerdata (IPD)

Planlegger du å dele individuelle deltakerdata (IPD)?

JA

IPD-planbeskrivelse

De-identified study data will be deposited in the Patient-Centered Outcomes Data Repository (PCODR) at ICPSR.

IPD-delingstidsramme

From date of final research report submission to PCORI for at least 7 years.

Tilgangskriterier for IPD-deling

Third party requests contact PCORI

IPD-deling Støtteinformasjonstype

  • STUDY_PROTOCOL

Legemiddel- og utstyrsinformasjon, studiedokumenter

Studerer et amerikansk FDA-regulert medikamentprodukt

Nei

Studerer et amerikansk FDA-regulert enhetsprodukt

Nei

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