Table 2.

Adjuvant pharmacotherapy: suggested approach for the TwoPlus trial

Medication	CMIHD (intervention group)		CHD (control group)
Loop +/− thiazide diuretic	All participants. Goal to optimize volume status based on interdialytic weight gain and blood pressure		Per treating nephrologist
Sodium bicarbonate	All participants. Goal pre-HD serum TCO2 level 20–22 mEq/L		Per treating nephrologist
Potassium binder	When needed. At the discretion of the Site Investigators and treating nephrologists. Goal pre-HD serum K level <5.5 mEq/L		Per treating nephrologist
Suggested doses of adjuvant pharmacotherapy medications in CMIHD
Medication	Clinical context example	Suggested treatment	Dose titration
Loop diuretic	On diuretic prior to HD initiation	Double the dose, administer on non-HD days	Based on blood pressure, volume status, or other clinical parameters
	Not on diuretic prior to HD initiation	Start Furosemide (or equivalenta) 80 mg/day, non-HD days
Sodium bicarbonate	Pre-HD serum TCO02 19–18 mEq/L	1300 mg/day, non-HD days	Based on pre-HD serum TCO2 level to keep 20–22 mEq/L
	Pre-HD serum TCO02 ≤17 mEq/L	1300 mg twice per day, non-HD days
Potassium binder	Pre-HD serum K 5.0–5.4 mEq/L	Patiromer: 8.4 g, once per day, non-HD days Or Lokelma: 5 g, once per day, on non-HD days Or Any FDA-approved potassium binder at dose and frequency recommended by the site investigator and\or treating providers	Based on pre-HD serum K level to keep <5.5 mEq/L
	Pre-HD serum K 5.5–5.8 mEq/L	Patiromer: 16.8 g, once per day, non-HD days Or Lokelma: 10 g, once per day, on non-HD days Or Any FDA-approved potassium binder at dose and frequency recommended by the site investigator and\or treating providers

^aDose equivalence between oral loop diuretics:

Furosemide 40 mg = Torsemide 20 mg = Bumetanide 1 mg

K, potassium; TCO2, bicarbonate