Incremental Hemodialysis: The TwoPlus Trial

NCT ID: NCT05828823

Last Updated: 2025-10-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

350 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-02-26

Study Completion Date

2028-03-31

Brief Summary

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This study is to prospectively compare clinical effectiveness between clinically- matched incremental hemodialysis and conventional hemodialysis in patients with incident kidney dysfunction requiring dialysis and residual kidney function.

The study will enroll 350 patients on chronic hemodialysis and 140 caregivers of enrolled patients. Patients will be randomized in 1:1 ratio to either incremental start hemodialysis or conventional hemodialysis. Caregivers will be followed along with patients for an average period of 2 years post randomization.

Detailed Description

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This study will analyze the effects of differentiated care with individualized hemodialysis on patient health related quality of life, fatigue, employment, and caregiver burden in patients with Kidney dysfunction requiring dialysis (KDRD) and appreciable kidney function.

This study will compare the outcomes in survival, hospitalization, preservation of the kidney function and quality of life between hemodialysis tailored to each patient needs (incremental) and conventional hemodialysis.

Conditions

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End-Stage Kidney Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This study is a randomized parallel-group type 1 hybrid study
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Clinically-matched Incremental Hemodialysis ( CMIHD)

Randomized group to have hemodialysis prescription tailored based on residual kidney function and clinical manifestations starting at twice weekly.

Group Type EXPERIMENTAL

Hemodialysis twice weekly

Intervention Type DEVICE

Frequency and duration of hemodialysis is tailored to the patient. Adjuvant pharmacotherapy is prescribed to maintain volume, electrolyte and acid-base homeostasis ( e.g., diuretics, sodium bicarbonate and potassium binding patiromer)

Conventional Hemodialysis (CHD)

Randomized group to conventional three times a week hemodialysis.

Group Type ACTIVE_COMPARATOR

Hemodialysis thrice weekly

Intervention Type OTHER

Conventional hemodialysis regimen

Interventions

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Hemodialysis twice weekly

Frequency and duration of hemodialysis is tailored to the patient. Adjuvant pharmacotherapy is prescribed to maintain volume, electrolyte and acid-base homeostasis ( e.g., diuretics, sodium bicarbonate and potassium binding patiromer)

Intervention Type DEVICE

Hemodialysis thrice weekly

Conventional hemodialysis regimen

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Age ≥ 18 years
* Incident kidney dysfunction requiring dialysis (KDRD) started on maintenance, in-center hemodialysis (HD), or anticipated to be started on maintenance, in-center HD within the next 12 weeks
* Has received ≤36 sessions of intermittent HD (i.e., on HD for ≤12 weeks) at the time patient is approached for potential study participation


* Kidney urea clearance \<2.0 mL/min
* Urine volume# of ≥500 mL/24 h

Exclusion Criteria

* Pre-HD serum K ≥5.8 mEq/L, Na ≤125 mEq/L, or bicarbonate level ≤17 mEq/L
* Requirement or anticipated requirement of high-volume ultrafiltration
* Unable or unwilling to follow the study protocol for any reason
* Known pregnancy or planning to attempt to become pregnant or lactating women
* Estimated survival or dialysis modality change or center transfer \<6 months

Caregiver Eligibility Criteria:

* be at least 18 years old
* be the main caregiver (at patient's choice)
* be a close relative of the patient (spouse, child, sibling, parent, grandchild)
* have no known psychiatric and neurologic disorders (through direct inquiry from the person)
* not be a member of the medical or healthcare team
* not be the caregiver for another patient with chronic illness
* not have experienced severe life events within prior 3 months of enrollment (through direct inquiry from the person)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Patient-Centered Outcomes Research Institute

OTHER

Sponsor Role collaborator

Wake Forest University Health Sciences

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mariana Murea, MD

Role: PRINCIPAL_INVESTIGATOR

Wake Forest Health Sciences

Peter Kotanko

Role: PRINCIPAL_INVESTIGATOR

Renal Research Institute

Locations

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University of Florida

Jacksonville, Florida, United States

Site Status RECRUITING

Emory University

Atlanta, Georgia, United States

Site Status RECRUITING

Johns Hopkins University School of Medicine (JHUSM)

Baltimore, Maryland, United States

Site Status RECRUITING

Massachusetts General Hospital

Boston, Massachusetts, United States

Site Status RECRUITING

University of Mississippi Medical Center

Jackson, Mississippi, United States

Site Status RECRUITING

Renal Research Institute (RRI)

New York, New York, United States

Site Status RECRUITING

Northwell Health

Queens, New York, United States

Site Status RECRUITING

University of North Carolina Chapel Hill

Chapel Hill, North Carolina, United States

Site Status RECRUITING

Atrium Health Wake Forest Baptist

Winston-Salem, North Carolina, United States

Site Status RECRUITING

University of Virginia (UVA)

Charlottesville, Virginia, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Brenda Burciu

Role: CONTACT

336-716-8671

Ben Bagwell

Role: CONTACT

Facility Contacts

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Alaa Awad, MD

Role: primary

Vandana Dua Niyyar

Role: primary

Sagar Nigwekar

Role: primary

617-726-5050

Yoshitsugu Obi, MD

Role: primary

601-815-2677

Steven Fishbane

Role: primary

516-465-8200

References

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Murea M, Raimann JG, Divers J, Maute H, Kovach C, Abdel-Rahman EM, Awad AS, Flythe JE, Gautam SC, Niyyar VD, Roberts GV, Jefferson NM, Shahidul I, Nwaozuru U, Foley KL, Trembath EJ, Rosales ML, Fletcher AJ, Hiba SI, Huml A, Knicely DH, Hasan I, Makadia B, Gaurav R, Lea J, Conway PT, Daugirdas JT, Kotanko P; Two Plus Research Consortium. Comparative effectiveness of an individualized model of hemodialysis vs conventional hemodialysis: a study protocol for a multicenter randomized controlled trial (the TwoPlus trial). Trials. 2024 Jun 28;25(1):424. doi: 10.1186/s13063-024-08281-9.

Reference Type DERIVED
PMID: 38943204 (View on PubMed)

Other Identifiers

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CER-2022C1-26300

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

IRB00092986

Identifier Type: -

Identifier Source: org_study_id

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