#971 Dialysis less frequently in the elderly: the D-LITE pilot trial
Bibliographic record
Abstract
Abstract Background and Aims The elderly represent the most rapidly growing end stage kidney disease age group world-wide. The hemodialysis (HD) prescription that provides the best outcomes for this distinct population with reduced life expectancy is unknown. Observational data suggest that quality of life (QOL) could be improved with less frequent HD without increasing mortality in this unique population. The primary aim of the D-LITE pilot trial was to determine the feasibility and safety of conducting a trial designed to determine whether twice versus thrice weekly HD improves QOL in incident elderly HD patients. Method We conducted a pilot randomized open controlled single centre trial in Kingston, Canada. Eligible subjects were incident HD patients ≥ 70 years of age 3 months post HD initiation planning to continue in-centre HD. Forty subjects were randomized to twice weekly versus thrice weekly HD stratified by residual kidney function and were followed for 9 months. The primary outcomes were those of feasibility and safety. Secondary outcomes included patient-reported QOL assessments, hyperkalemic events, mortality and requirement for emergency dialysis. Results Figure 1 shows patient flow. Consent rate of eligible subjects was high (77%), adherence approached 100%, and 78% of randomized patients completed study. Subjects randomized to the twice weekly arm had similar pre-HD normokalemia rates (90%) to the thrice weekly arm and fewer than 10% of HD post weights exceeded prescribed target weight by 1.0 kg. Urgent HD treatments for hypervolemia and hyperkalemia was infrequent and similar between arms as were hospitalizations and death. Conclusion The results of this pilot randomized controlled study of twice and thrice weekly HD in an elderly incident HD population reveal that the study was both feasible and safe. These results will inform the design of a multi-center RCT with QOL and safety endpoints.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".