Curcumin to Prevent Complications After Elective Abdominal Aortic Aneurysm (AAA) Repair

Curcumin to Prevent Perioperative Complications After Elective Abdominal Aortic Aneurysm Repair: a Randomized Controlled Trial

The purpose of this program of research is to determine whether curcumin, a natural health product, can prevent acute kidney injury and other complications after elective AAA repair. If proven safe and effective, curcumin is an inexpensive intervention which can be readily applied to almost 50,000 AAA repairs performed worldwide each year. New knowledge about this intervention may also guide its use in other surgical and medical settings to prevent complications to the kidneys, heart and other organs.

Study Overview

• Status: Completed
• Conditions: Acute Kidney Injury; Abdominal Aortic Aneurysm
• Intervention / Treatment: Drug: curcumin; Other: placebo

Detailed Description

An abdominal aortic aneurysm (AAA) is a ballooning of the abdominal aorta, the major blood vessel of the body. AAA occurs in up to 2% of adults. Surgeons will plan an AAA repair when the aneurysm grows bigger than 5.5cm, because the AAA might burst without repair. Over 47,000 AAA repairs are performed each year. Despite the benefits of AAA repair there are risks, and the kidneys can be severely injured. We will test whether the natural health product curcumin has an effect on biomarkers of inflammation, kidney injury and heart injury from AAA repair. Curcumin appears to fight oxidation and inflammation, which are ways that the body can be injured by surgery. We will study 600 patients who have elective AAA repair. The patients will receive either curcumin or a matching placebo. We will recruit the 600 patients from 10 centres in Ontario. This study will help us determine whether curcumin exerts any biological effect on biomarkers and whether it is well tolerated. If there is evidence of beneficial effects in this 600 patient trial, this will justify a future larger trial to assess the effects of curcumin on outcomes most important to patients, families and their healthcare providers.

• Study Type: Interventional
• Enrollment (Actual): 606
• Phase: Phase 2; Phase 3

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Calgary, Alberta, Canada, T3B 6A8
      • University of Calgary
    • Edmonton, Alberta, Canada, T6G 2B7
      • University of Alberta Hospital
  • Manitoba
    • Winnipeg, Manitoba, Canada, R2H 2A6
      • St. Boniface Hospital
  • Ontario
    • Hamilton, Ontario, Canada, L8L 2X2
      • Hamilton General Hospital
    • London, Ontario, Canada, N6G 5W9
      • London Health Sciences Centre
    • Ottawa, Ontario, Canada, K1Y4E9
      • The Ottawa Hospital, Civic Campus
    • Sudbury, Ontario, Canada, P3E5J1
      • Sudbury Regional Hospital
    • Toronto, Ontario, Canada, M4N3M5
      • Sunnybrook Health Sciences Centre
    • Toronto, Ontario, Canada, M5B1W8
      • St. Michael's Hospital
  • Quebec
    • Montreal, Quebec, Canada, H1T 2M4
      • Maisonneuve-Rosemont Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Elective repair of an AAA (excludes thoracic or thoracoabdominal aneurysms)
• 18 years of age or older
• Able to provide informed consent
• Has one or more of the following criteria at time of preoperative assessment:
• x Open repair OR
• x Endovascular repair with ≥ 1 of the following criteria:
• o diabetes mellitus treated with insulin or oral hypoglycemic agents
• o age > 70 years
• o pre-existing renal impairment (baseline serum creatinine level >177 μmol/L for men or >146 μmol/L for women)
• If diabetic, is able and willing to collect and record glucose levels at home

Exclusion Criteria:

• emergent or urgent repair (repair < 3 days from pre-admission visit; ruptured AAA)
• prior renal transplantation
• pregnant or breastfeeding
• active gastrointestinal reflux disease, gastrointestinal ulcers or hepatobiliary disease (including gallstones)
• has active liver disease
• evidence of AKI (> 50% increase in serum creatinine) in the 30 days prior to repair
• enrolled in another randomized controlled trial
• receipt of ≥ 1 dialysis treatment in the past week
• previous participation in this trial
• repair is scheduled > 90 days from date of informed consent
• unable to provide written consent
• allergy(ies) to any member of the Zingiberaceae family: turmeric, ginger, curry, cumin, cardamom)
• allergy(ies) to ingredients of the study product or placebo: yellow or red food coloring, gelatin or cellulose
• have a history of major bleeding event in the previous 6 months
• bleeding disorders: a diagnosis of hemophilia, von Willebrand disease, platelets less than 70 for any reason
• history of hypoglycemia in the past 6 months: blood sugar less than or equal to 3.5 mmol/L

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: curcumin; Patients will take the study medication (500 mg x 4 capsules, twice daily [BID]) for two days leading up to repair, totaling 4000 mg per day. They will take a dose (2000 mg) the morning of repair, at the same time as regular medications not held for surgery. While they are on call to the operating room, they will take another dose of 2000 mg., and then another 2000 mg dose 6 hours after the repair. Final dose (2000 mg)is administered morning after repair.	Drug: curcumin; Patients will take the study medication (500 mg x 4 capsules, twice daily [BID]) for two days leading up to repair, totaling 4000 mg per day. They will take a dose (2000 mg) the morning of repair, at the same time as regular medications not held for surgery. While they are on call to the operating room, they will take another dose of 2000 mg and then another 2000 mg dose 6 hours after the repair. Final dose is administered the morning after repair.; Other Names: NHPID name: curcumin
Placebo Comparator: placebo; The placebo will look, smell, taste, and in every way be identical to the active drug. Patients will take the study medication in the exact same manner as the curcumin regimen.	Other: placebo; The placebo will look, smell, taste, and in every way be identical to the active drug. Patients will take the study medication in the exact same manner as the curcumin regimen.; Other Names: No brand name applicable.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Urine IL-18	We will examine the evidence of curcumin on biomarkers and whether it is well tolerated	Post op value
NT-ProBNP		Change in post-operative minus pre-operative plasma NT-Pro BNP
hsCRP		Change in post-operative minus pre-operative plasma hsCRP
Serum creatinine		Change in peak post-operative serum creatinine (umol/L) in the 7 days following AAA repair minus pre-op value

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Binary measures of continuous biomarker outcomes	e.g acute kidney injury defined using accepted criteria	Continuous
Safety outcomes	Anemia, hypoglycemia, diarrhea, bleeding, peptic ulcer, nausea	Peri-operative period
Composite clinical outcomes adjudicated by investigators unaware of treatment outcomes	New acute dialysis, myocardial infarction, receipt of coronary revascularization, sepsis, pneumonia, non-fatal cardiac arrest, stroke, deep vein thrombosis, pulmonary embolism, lower limb amputation, ischemic bowel, congestive heart failure, death	Within 30 days of AA repair

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Other outcome measures	Study medication adherence, length of hospital stay, pain, blood pressure 3 hours after repair, urine output 3 hours after repair, other urine and blood biomarkers, tracer outcomes	Peri-operative period

Collaborators and Investigators

• Sponsor: Lawson Health Research Institute
• Collaborators: Canadian Institutes of Health Research (CIHR)
• Investigators: Principal Investigator: Amit X Garg, MD, PhD, Lawson Health Research Institute

Publications and helpful links

General Publications

• Garg AX, Devereaux PJ, Hill A, Sood M, Aggarwal B, Dubois L, Hiremath S, Guzman R, Iyer V, James M, McArthur E, Moist L, Ouellet G, Parikh CR, Schumann V, Sharan S, Thiessen-Philbrook H, Tobe S, Wald R, Walsh M, Weir M, Pannu N; Curcumin AAA AKI Investigators. Oral curcumin in elective abdominal aortic aneurysm repair: a multicentre randomized controlled trial. CMAJ. 2018 Oct 29;190(43):E1273-E1280. doi: 10.1503/cmaj.180510. Erratum In: CMAJ. 2018 Dec 3;190(48):E1425.

Helpful Links

• U.S. FDA Resources
• Medline Plus related topics: Aneurysms Aortic Aneurysm
• Genetic and Rare Diseases Information Center resources: Abdominal Aortic Aneurysm

Study record dates

Study Major Dates

• Study Start: November 1, 2011
• Primary Completion (Actual): November 1, 2014
• Study Completion (Actual): August 1, 2016

Study Registration Dates

• First Submitted: October 19, 2010
• First Submitted That Met QC Criteria: October 19, 2010
• First Posted (Estimate): October 20, 2010

Study Record Updates

• Last Update Posted (Actual): March 7, 2017
• Last Update Submitted That Met QC Criteria: March 6, 2017
• Last Verified: March 1, 2017

More Information

Terms related to this study

• Keywords: acute kidney injury; ischemia-reperfusion; AAA; abdominal aortic aneurysm
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Kidney Diseases; Urologic Diseases; Renal Insufficiency; Aortic Diseases; Acute Kidney Injury; Aneurysm; Aortic Aneurysm; Aortic Aneurysm, Abdominal; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Peripheral Nervous System Agents; Enzyme Inhibitors; Analgesics; Sensory System Agents; Anti-Inflammatory Agents, Non-Steroidal; Analgesics, Non-Narcotic; Anti-Inflammatory Agents; Antirheumatic Agents; Antineoplastic Agents; Curcumin
• Other Study ID Numbers: 16593