Pragmatic trials in maintenance dialysis: Perspectives from the kidney health initiative

Laura M. Dember, Patrick Archdeacon, Mahesh Krishnan, Eduardo Lacson, Shari M. Ling, Prabir Roy-Chaudhury, Kimberly A. Smith, Michael F. Flessner

Research output: Contribution to journalReview articlepeer-review

27 Scopus citations


Pragmatic clinical trials are conducted under the real-world conditions of clinical care delivery. As a result, these trials yield findings that are highly generalizable to the nonresearch setting, identify interventions that are readily translatable into clinical practice, and cost less than trials that require extensive research infrastructures. Maintenance dialysis is a setting especially well suited for pragmatic trials because of inherently frequent and predictable patient encounters, highly granular and uniform data collection, use of electronic data systems, and delivery of care by a small number of provider organizations to approximately 90%of patients nationally. Recognizing the potential for pragmatic trials to generatemuch needed evidence to guide the care of patients receiving maintenance dialysis, the Kidney Health Initiative assembled a group of individuals with relevant expertise from academia, industry, and government to provide the nephrology community with information about the design and conduct of such trials, with a specific focus on the dialysis setting. Here, we review this information, and where applicable, use experience fromthe ongoing Time to Reduce Mortality in End Stage Renal Disease Trial, a large cluster-randomized, pragmatic trial evaluating hemodialysis session duration, to illustrate challenges and solutions to operational, ethical, and regulatory issues.

Original languageEnglish (US)
Pages (from-to)2955-2963
Number of pages9
JournalJournal of the American Society of Nephrology
Issue number10
StatePublished - 2016

ASJC Scopus subject areas

  • Nephrology


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