- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01528800
Vitamin K to Attenuate Coronary Artery Calcification in Hemodialysis Patients (iPACK-HD)
Inhibit Progression of Coronary Artery Calcification With Vitamin K in HemoDialysis Patients: The iPACK-HD Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
Ontario
-
Kingston, Ontario, Canada, K7L 2V7
- Kingston Health Sciences Centre: Kingston General Hospital Site
-
London, Ontario, Canada, N6A 5W9
- London Health Sciences Centre
-
Ottawa, Ontario, Canada, K1H 8L6
- The Ottawa Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Able to provide signed informed consent
- ≥18 years of age
- Expected to survive one year
- Have end-stage kidney disease and require hemodialysis
- Have a baseline coronary artery calcification score ≥30 Agatston units (AUs)
Exclusion Criteria:
- Have a medical condition that requires warfarin
- Require hemodialysis for acute kidney injury
- Are Pregnant
- Have other severe co-morbid conditions (e.g. malignancy, disabling stroke) with life expectancy less than one year
- Have undergone coronary artery bypass grafting or have stents placed in their coronary arteries
- Are currently enrolled in another interventional trial
Study Plan
How is the study designed?
Design Details
- Primary Purpose: PREVENTION
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: QUADRUPLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
PLACEBO_COMPARATOR: Placebo
Microcrystalline Methylcellulose
|
10mg orally three times a week for 12 months
|
ACTIVE_COMPARATOR: Vitamin K1
|
10mg orally three times a week for 12 months
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Recruitment rate
Time Frame: 12 months
|
Number of participants recruited per month at each site) and an overall crude average of each site's rate.
|
12 months
|
Compliance with study medication
Time Frame: 12 months
|
Proportion of prescribed doses received.
|
12 months
|
Dropout rate
Time Frame: 12 months
|
Proportion of participants who dropped out from the trial.
|
12 months
|
Adherence to study protocol
Time Frame: 12 months
|
Proportion of participants who adhered to the study protocol.
|
12 months
|
Rates of eligible patients consented and randomized
Time Frame: 12 months
|
Proportion of eligible patients consented and randomized.
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Coronary artery calcification (Agatston calcium scores) progression
Time Frame: 12 months
|
A)The percent and absolute change of the Agatston calcium scores (CT scan) will be assessed at study exit vs. baseline. Included measures will be: Total CAC, Left Main CAC, Right Coronary Artery CAC, Left Anterior Descending CAC, Circumflex CAC, and Posterior Descending Artery CAC. B) The proportion of participants with a 15% or greater increase in Agatston calcium scores will be assessed at study exit vs baseline. |
12 months
|
Coronary artery calcification (volume calcium scores) progression
Time Frame: 12 months
|
A) The percent and absolute change of the volume calcium scores (CT scan) will be assessed at study exit vs. baseline. Included measures will be: Total CAC, Left Main CAC, Right Coronary Artery CAC, Left Anterior Descending CAC, Circumflex CAC, and Posterior Descending Artery CAC. B) The proportion of participants with a 15% or greater increase in volume calcium scores will be assessed at study exit vs baseline. |
12 months
|
Coronary artery calcification (Agatston calcium scores) regression
Time Frame: 12 months
|
The proportion of participants with a 10% or greater decrease in Agatston calcium scores will be assessed at study exit vs baseline.
|
12 months
|
Coronary artery calcification (volume calcium scores) regression
Time Frame: 12 months
|
The proportion of participants with a 10% or greater decrease in volume calcium scores will be assessed at study exit vs baseline.
|
12 months
|
Aortic valve calcification (Agatston calcium scores) progression
Time Frame: 12 months
|
The absolute and percentage change of the Agatston calcium scores (CT scan) will be assessed at study exit vs. baseline.
|
12 months
|
Aortic valve calcification (volume calcium scores) progression
Time Frame: 12 months
|
The absolute and percentage change of the volume calcium scores (CT scan) will be assessed at study exit vs. baseline.
|
12 months
|
Mitral valve calcification (Agatston calcium scores) progression
Time Frame: 12 months
|
The absolute and percentage change of the Agatston calcium scores (CT scan) will be assessed at study exit vs. baseline.
|
12 months
|
Mitral valve calcification (volume calcium scores) progression
Time Frame: 12 months
|
The absolute and percentage change of the volume calcium scores (CT scan) will be assessed at study exit vs. baseline.
|
12 months
|
Abdominal aortic calcification (AAC) scores
Time Frame: 12 months
|
The AAC score (mean score in L1-L4, mean number of positive segments, mean total severity using lateral lumbar spine radiographs) will be assessed at study exit vs. baseline.
|
12 months
|
Levels of biomarkers of vitamin K status
Time Frame: 12 months
|
Gas6, PK, MK4, osteocalcin Gla, osteocalcin Glu, osteocalcin Gla to Glu ratio, percent of osteocalcin undercarboxylated, and dpucMGP will be assessed at baseline, four, eight and study exit.
Protein induced by vitamin K absence or antagonist II (PIVKA-II) will be assessed at baseline and study exit.
|
12 months
|
Prevalence and incidence of thoracic vertebral fractures
Time Frame: 12 months
|
The prevalence and incidence of thoracic vertebral fractures (anterior and lateral radiographs) will be assessed at baseline and study exit.
|
12 months
|
Prevalence and incidence of lumbar vertebral fractures
Time Frame: 12 months
|
The prevalence and incidence of lumbar vertebral fractures (anterior and lateral radiographs) will be assessed at baseline and study exit.
|
12 months
|
Presence/absence and total hospitalizations
Time Frame: 12 months
|
The presence or absence and total hospitalizations will be assessed across the study duration per patient.
|
12 months
|
Presence/absence and total cardiovascular events
Time Frame: 12 months
|
The presence or absence and total cardiovascular events (acute coronary syndrome, congestive heart failure, stroke, transient ischemic attack, amputation, and cardiac [symptom-driven] [cerebral or peripheral] revascularization procedure, or cardiac arrest) will be assessed across the study duration per patient.
|
12 months
|
Presence/absence and total thrombotic events
Time Frame: 12 months
|
The presence or absence and total thrombotic events (deep vein thrombosis and pulmonary embolism) will be assessed across the study duration per patient.
|
12 months
|
Presence/absence and total hemodialysis access thrombotic events
Time Frame: 12 months
|
The presence or absence and total hemodialysis access thrombotic events (fistula and/or graft thrombosis or dialysis catheter thrombosis) will be assessed across the study duration per patient.
|
12 months
|
Presence/absence and total mortality
Time Frame: 12 months
|
The presence or absence and total all-cause and cardiovascular cause mortality will be assessed across the study duration per patient.
|
12 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Levels of biomarkers of inflammation
Time Frame: 12 months
|
C-reactive protein (CRP), interleukin 6 (IL-6), leptin, insulin, glucose, homeostasis model assessment-insulin resistance (HOMA-IR) will be assessed at baseline, four months, eight months, and study exit.
|
12 months
|
Levels of clinical lab values
Time Frame: 12 months
|
Hemoglobin, albumin, Kt/V, creatinine, lipid profile (HDL, LDL, triglycerides, and total cholesterol), and parameters of mineral metabolism (phosphate, calcium, PTH, and ALP) will be assessed monthly.
Serum FGF-23 will be assessed at baseline, four months, eight, and study exit.
|
12 months
|
Concomitant medication assessment (presence/absence/dosage)
Time Frame: 12 months
|
Prescription of concomitant medications (listed below) will be assessed monthly.
Average dosage and total exposure across study exit will be assessed for calcitriol, other vitamin D drugs, and calcium-based phosphate binders. |
12 months
|
Changes in body composition measures
Time Frame: 12 months
|
Muscle atrophy and adipose tissue will be assessed using an L3 slice (CT scan) at study exit vs. baseline.
Specifically, muscle, normalized muscle, intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and total adipose tissue (TAT) cross-sectional area (cm2 or cm2/m2) and muscle, IMAT, VAT and SAT radiodensity (HUs) measurements will be included.
|
12 months
|
Levels of vascular inflammation variables
Time Frame: 12 months
|
Myoglobin, calciprotectin, neutrophil gelatinase-associated lipocalin, matrix-metalloproteinase 2, osteopontin, myeloperoxidase, serum amyloid A, insulin-like growth factor binding protein-4, intercellular adhesion molecule 1, vascular cell adhesion protein 1, matrix-metalloproteinase 9, and cystatin C will be assessed at baseline, four months, eight months and study exit.
|
12 months
|
Levels of vitamin D metabolites
Time Frame: 12 months
|
1,25-OH-D3, 25-OH-D2, percent 25D that is D2, Total 25D, 24,25(OH)2D3, 25D3:24,25D3, 24,25D3:25D3, 3epi25-OH-D3, 3epi25-OH-D3(%), 1,25(OH)2D3, 1,24,25(OH)3D3, 1,25(OH)2D3:1,24,25(OH)3D3, 1,25(OH)2D3:1,24,25(OH)3D3 will be assessed at baseline, four months, eight months and study exit.
|
12 months
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Rachel Holden, Queens University/Kingston Health Sciences Centre: Kingston General Hospital
Publications and helpful links
General Publications
- Holden RM, Booth SL, Zimmerman D, Moist L, Norman P, Day AG, Menard A, Fu X, Shea MK, Babiolakis CS, Nolan R, Turner ME, Ward E, Kaufmann M, Adams MA, Heyland DK. Inhibit progression of coronary artery calcification with vitamin k in hemodialysis patients (the iPACK-HD study): a randomized, placebo-controlled multi-centre, pilot trial. Nephrol Dial Transplant. 2022 May 31:gfac191. doi: 10.1093/ndt/gfac191. Online ahead of print.
- Holden RM, Booth SL, Day AG, Clase CM, Zimmerman D, Moist L, Shea MK, McCabe KM, Jamal SA, Tobe S, Weinstein J, Madhumathi R, Adams MA, Heyland DK. Inhibiting the progression of arterial calcification with vitamin K in HemoDialysis patients (iPACK-HD) trial: rationale and study design for a randomized trial of vitamin K in patients with end stage kidney disease. Can J Kidney Health Dis. 2015 May 1;2:17. doi: 10.1186/s40697-015-0053-x. eCollection 2015.
Study record dates
Study Major Dates
Study Start
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Metabolic Diseases
- Urologic Diseases
- Renal Insufficiency
- Renal Insufficiency, Chronic
- Calcium Metabolism Disorders
- Kidney Diseases
- Kidney Failure, Chronic
- Calcinosis
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Fibrin Modulating Agents
- Micronutrients
- Vitamins
- Antifibrinolytic Agents
- Hemostatics
- Coagulants
- Vitamin K
- Vitamin K 1
Other Study ID Numbers
- iPACK-HD
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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