- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02164318
Effects of Exercise and Improved Nitric Oxide Bioavailability on Arteriovenous Fistula Maturation
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This project will examine if enhancing Nitric Oxide (NO) bioavailability increases the rates of arteriovenous fistula (AVF) maturation in end stage renal disease patients requiring vascular access for hemodialysis. To enhance NO bioavailability the study team will utilize a program of forearm exercise training, application of nitroglycerin ointment or both.
Following entry into the study, approximately 4 weeks prior to surgery subjects will undergo a series of non-invasive tests of vascular function in the arm of fistula creation. Following this vascular function testing, subjects will follow the intervention treatment for 4 weeks. After 4 weeks of intervention treatment and prior to surgery, the vascular function analysis will be repeated to determine if the interventions had an effect on arm vascular function. Surgery to create the AVF will follow the second vascular function analysis. A discard sample of the vein used to create the AVF and a blood sample will be collected during surgery to assess potential biologic differences between intervention groups. The interventions will be continued until 4 weeks following surgery. Subjects will be followed to determine if the AVF matured and was successfully used for dialysis.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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-
North Carolina
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Durham, North Carolina, United States, 27710
- Duke University Health System
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Life expectancy of at least 6 months
- Chronic kidney disease with anticipated start of hemodialysis within six months or current hemodialysis dependence.
- Ability to understand and comply with the requirements of the entire study and communicate with the study team.
- Written informed consent using a document that has been approved by the Duke Human Institutional Review Board.
- If female and of childbearing potential (premenopausal and not surgically sterile) must have a negative pregnancy test and be willing to use contraception until completion of 8 weeks of intervention. This will include abstinence, barrier methods, hormones, or intra-uterine device.
Exclusion Criteria:
- Patients currently on medication that is contraindicated with nitropaste, including isosorbide nitrate therapy, nitroglycerin, minoxidil, or PDE inhibitors (i.e. Sildenafil).
- Patients with a diastolic blood pressure below 65 or a systolic blood pressure below 90.
- Patients with a history of illicit drug use in the previous 5 years.
- Patients who would require AVF placement before completion of the initial 4 weeks of intervention therapy
- Patients who are otherwise are not suitable for 8 weeks of handgrip training or nitropaste therapy.
- Patients under the 18 of age are not eligible for nitropaste interventions
Study Plan
How is the study designed?
Design Details
- Primary Purpose: OTHER
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Control group
Standard of care
|
|
Experimental: Handgrip training group
Perform isometric handgrip exercises for 15 minutes twice per day for a total of 30 minutes
|
|
Experimental: Nitroglycerin ointment group
Apply 15mg of nitroglycerin ointment to the back of the hand of the surgical arm nightly
|
Other Names:
|
Experimental: Combined handgrip training /Nitroglycerin ointment group
Perform isometric handgrip exercises for 15 minutes twice each day for a total of 30 minutes and apply 15mg of nitroglycerin ointment to the back of the hand of the surgical arm nightly
|
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Count of Participants With Mature Arteriovenous Fistula (AVF)
Time Frame: 3 month post surgery to create AVF
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Use of AVF for dialysis for dialysis dependent participants, or fistula deemed mature based on physical exam in predialysis participants (diameter >6 mm, blood flow >600 ml by ultrasound or estimated by physical exam).
|
3 month post surgery to create AVF
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Count of Participants With a Patent Fistula
Time Frame: 3 months post surgery
|
Determination that AVF is patent (has blood flow, no occlusion).
|
3 months post surgery
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Count of Participants Using Their AVF for Dialysis
Time Frame: 12 months post surgery
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Successful use of AVF at 12 months in dialysis dependent patients.
Not relevant in participants that are predialysis or that discontinue dialysis prior to AVF use.
|
12 months post surgery
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Jeffrey H Lawson, MD/PhD, Duke Health
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
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Kidney Diseases
- Urologic Diseases
- Congenital Abnormalities
- Renal Insufficiency
- Pathological Conditions, Anatomical
- Renal Insufficiency, Chronic
- Cardiovascular Abnormalities
- Vascular Malformations
- Arteriovenous Malformations
- Vascular Fistula
- Kidney Failure, Chronic
- Fistula
- Arteriovenous Fistula
- Vasodilator Agents
- Nitroglycerin
Other Study ID Numbers
- Pro00054388
- R21DK103082 (U.S. NIH Grant/Contract)
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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