{"id":23011,"date":"2022-12-08T04:31:00","date_gmt":"2022-12-07T20:31:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=23011"},"modified":"2022-12-08T05:48:35","modified_gmt":"2022-12-07T21:48:35","slug":"lancet%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%8e%a5%e5%8f%97%e7%bb%b4%e6%8c%81%e8%a1%80%e6%b6%b2%e9%80%8f%e6%9e%90%e6%82%a3%e8%80%85%e7%9a%84%e4%b8%aa%e4%bd%93%e5%8c%96%e5%86%b7%e5%8d%b4","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=23011","title":{"rendered":"[Lancet\u53d1\u8868\u8bba\u6587]\uff1a\u63a5\u53d7\u7ef4\u6301\u8840\u6db2\u900f\u6790\u60a3\u8005\u7684\u4e2a\u4f53\u5316\u51b7\u5374\u900f\u6790\u6db2"},"content":{"rendered":"\n

ARTICLES|ONLINE FIRST<\/a><\/p>\n\n\n\n

Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic, cluster-randomised trial<\/h1>\n\n\n\n

The MyTEMP writing committee<\/h3>\n\n\n\n

Lancet Published: November 04, 2022<\/h3>\n\n\n\n

DOI:https:\/\/doi.org\/10.1016\/S0140-6736(22)01805-0<\/a><\/h3>\n\n\n\n

Summary<\/h2>\n\n\n\n

Background<\/h3>\n\n\n\n

Haemodialysis centres have conventionally provided maintenance haemodialysis using a standard dialysate temperature (eg, 36\u00b75\u00b0C) for all patients. Many centres now use cooler dialysate (eg, 36\u00b70\u00b0C or lower) for potential cardiovascular benefits. We aimed to assess whether personalised cooler dialysate, implemented as centre-wide policy, reduced the risk of cardiovascular-related death or hospital admission compared with standard temperature dialysate.<\/p>\n\n\n\n

Methods<\/h3>\n\n\n\n

MyTEMP was a pragmatic, two-arm, parallel-group, registry-based, open-label, cluster-randomised, superiority trial done at haemodialysis centres in Ontario, Canada. Eligible centres provided maintenance haemodialysis to at least 15 patients a week, and the medical director of each centre had to confirm that their centre would deliver the assigned intervention. Using covariate-constrained randomisation, we allocated 84 centres (1:1) to use either personalised cooler dialysate (nurses set the dialysate temperature 0\u00b75\u20130\u00b79\u00b0C below each patient's measured pre-dialysis body temperature, with a lowest recommended dialysate temperature of 35\u00b75\u00b0C), or standard temperature dialysate (36\u00b75\u00b0C for all patients and treatments). Patients and health-care providers were not masked to the group assignment; however, the primary outcome was recorded in provincial databases by medical coders who were unaware of the trial or the centres\u2019 group assignment. The primary composite outcome was cardiovascular-related death or hospital admission with myocardial infarction, ischaemic stroke, or congestive heart failure during the 4-year trial period. Analysis was by intention to treat. The study is registered at ClinicalTrials.gov<\/a>, NCT02628366<\/a>.<\/p>\n\n\n\n

Findings<\/h3>\n\n\n\n

We assessed all of Ontario's 97 centres for inclusion into the study. Nine centres had less than 15 patients and one director requested that four of their seven centres not participate. 84 centres were recruited and on Feb 1, 2017, these centres were randomly assigned to administer personalised cooler dialysate (42 centres) or standard temperature dialysate (42 centres). The intervention period was from April 3, 2017, to March 31, 2021, and during this time the trial centres provided outpatient maintenance haemodialysis to 15 413 patients (about 4\u00b73 million haemodialysis treatments). The mean dialysate temperature was 35\u00b78\u00b0C in the cooler dialysate group and 36\u00b74\u00b0C in the standard temperature group. The primary outcome occurred in 1711 (21\u00b74%) of 8000 patients in the cooler dialysate group versus 1658 (22\u00b74%) of 7413 patients in the standard temperature group (adjusted hazard ratio 1\u00b700, 96% CI 0\u00b789 to 1\u00b711; p=0\u00b793). The mean drop in intradialytic systolic blood pressure was 26\u00b76 mm Hg in the cooler dialysate group and 27\u00b71 mm Hg in the standard temperature group (mean difference \u20130\u00b75 mm Hg, 99% CI \u20131\u00b74 to 0\u00b74; p=0\u00b714).<\/p>\n\n\n\n

Interpretation<\/h3>\n\n\n\n

Centre-wide delivery of personalised cooler dialysate did not significantly reduce the risk of major cardiovascular events compared with standard temperature dialysate. The rising popularity of cooler dialysate is called into question by this study, and the risks and benefits of cooler dialysate in some patient populations should be clarified in future trials.<\/p>\n\n\n\n

Funding<\/h3>\n\n\n\n

Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Ontario Renal Network, Ontario Strategy for Patient-Oriented Research Support Unit, Dialysis Clinic, Inc., ICES (formerly known as the Institute for Clinical Evaluative Sciences), Lawson Health Research Institute, and Western University.<\/p>\n","protected":false},"excerpt":{"rendered":"

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