- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04474262
Efficacy of Albumin Plus Midodrine v/s Albumin Alone in Reducing Incidence of Paracentesis Induced Circulatory Dysfunctions in ACLF Patients.
Efficacy of Albumin Plus Midodrine v/s Albumin Alone in Reducing Incidence of Paracentesis Induced Circulatory Dysfunctions in ACLF Patients-A Randomized Controlled Trial.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
OBJECTIVE:
Primary objective: Incidence of Paracentesis induced circulatory dysfunction in patients undergoing modest volume paracentesis (MVP) (>3 and <5 litres) with midodrine plus 25% albumin v/s 25% albumin infusion alone at day 7
Secondary objective:
- Change in systolic, diastolic and mean BP at day 3 and 6
- Increase in plasma renin activity at day 6
- Incidence of Hyponatremia, HE and AKI at day 3 and 6
- Predictors of Paracentesis induced circulatory dysfunction
- Predictors of 28 day survival.
Methodology :
Patients with Acute on chronic liver failure having grade III ascites will be given either albumin or albumin plus midodrine. Midodrine will be started 4 hrs before tap to achieve target MAP. Ascitic tapping will be followed by vital monitoring and monitoring of vital parameters along with measurement of changes in s. rennin at day 3 and 6.
- All patient will be undergo complete physical examination and complete clinical history will be recorded.
- Baseline cbc,LFT,KFT and INR level will be sent on day 1 along with baseline s. renin levels
- Those eligible will be randomised in to two groups
- GROUP A will be given albumin 8g/l of ascitic tap during tap along with placebo for 7 days.
- GROUP B will be given midodrine 7.5 mg to 12.5 mg tds (keeping the target MAP above 70 mmhg)for 7 days plus albumin same as in other group.
Study Population: Patients of acute on chronic liver failure who are admitted to and attending the OPD at ILBS.
Study Design: Randomized controlled trial Study Period:NOV 2019 to march 2019
Sample Size:
Considering incidence of PICD in albumin group is 30% and reduction to 10% by adding midodrine with alpha =5%, and power of study being 80%. No. of cases in each group- 66 Total-132 Furthur with 10% dropout we need to enroll 150 cases (75 in each group) randomly allocated in two groups by block randomization method with block size of 5.
- Intervention: This RCT will be conducted at ILBS New Delhi between Dec 2019 and March 2021
- Monitoring and assessment:
- All patient will be undergo complete physical examination and complete clinical history will be recorded.
- Baseline cbc,LFT,KFT and INR level will be sent on day 1 along with baseline s. renin levels
- Those eligible will be randomised in to two groups
- GROUP A will be given albumin 8g/l of ascitic tap along with placebo for 7 days. Standard albumin therapy will continue (40gm/week)
- GROUP B will be given midodrine 7.5 mg to 10 mg tds (keeping the target MAP above 70 mmhg)for 7 days plus albumin same as in other group.
Expected outcome of the project:
Primary:
- Incidence of PICD at day 3 and day6
Secondary:
- Changes in hemodynamic parameters at 1, 3 and 6 hour, Day 3, Day 6 post paracentesis
- Increase in plasma renin activity at Day 3, Day 6
- Incidence of Hyponatremia, HE and AKI at day 3 and 6
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Delhi
-
New Delhi, Delhi, India, 110070
- Institute of Liver & Biliary Sciences
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- ACLF patients (as per APASL definition) with grade II/III ascites
Exclusion Criteria:
- Age < 18 or >75 years
- Hepatocellular carcinoma
- Extrahepatic portal vein obstruction
- Non cirrhotic ascites
- Serum creatinine >1.5mg/dl
- Refractory septic shock
- Beta blockersPortal vein thrombosis
- Grade 3-4 HE
- Pregnancy or Lactation
- Active variceal bleed
- Respiratory, cardiac, renal failure
- Uncontrolled hypertension
- Severe coagulopathy
- Refusal to participate
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: SINGLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: Albumin with placebo
Group A will be given albumin 8g/l of ascitic tap along with placebo for 7 days.
Standard albumin therapy will continue (40gm/week)
|
Placebo
Albumin will be 8g/l of ascitic tap.
Standard albumin therapy will continue (40gm/week)
|
EXPERIMENTAL: Albumin with Midodrine
GROUP B will be given midodrine 7.5 mg to 10 mg tds (keeping the target MAP above 70 mmhg)for 7 days plus albumin same as in other group.
|
Albumin will be 8g/l of ascitic tap.
Standard albumin therapy will continue (40gm/week)
Midodrine 7.5 mg to 10 mg TDS (keeping the target MAP above 70 mmHg).
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Incidence of PICD (Paracentesis Induced Circulatory Dysfunction)
Time Frame: Day 3
|
Day 3
|
Incidence of PICD (Paracentesis Induced Circulatory Dysfunction)
Time Frame: Day 6
|
Day 6
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Changes in Mean Arterial Pressure (MAP) post paracentesis.
Time Frame: 1 hour
|
1 hour
|
Changes in Heart Rate post paracentesis.
Time Frame: 1 hour
|
1 hour
|
Changes in Mean Arterial Pressure (MAP) post paracentesis.
Time Frame: 3 hours
|
3 hours
|
Changes in Heart Rate post paracentesis.
Time Frame: 3 hours
|
3 hours
|
Changes in Mean Arterial Pressure (MAP) post paracentesis.
Time Frame: 6 hours
|
6 hours
|
Changes in Heart Rate post paracentesis.
Time Frame: 6 hours
|
6 hours
|
Changes in Mean Arterial Pressure (MAP) post paracentesis.
Time Frame: Day 3
|
Day 3
|
Changes in Heart Rate post paracentesis.
Time Frame: Day 3
|
Day 3
|
Changes in Mean Arterial Pressure (MAP) post paracentesis.
Time Frame: Day 6
|
Day 6
|
Changes in Heart Rate post paracentesis.
Time Frame: Day 6
|
Day 6
|
Change in plasma renin activity in both groups
Time Frame: Day 3
|
Day 3
|
Change in plasma renin activity in both groups
Time Frame: Day 6
|
Day 6
|
Incidence of Hyponatremia in both groups
Time Frame: Day 3
|
Day 3
|
Incidence of Hyponatremia in both groups
Time Frame: Day 6
|
Day 6
|
Incidence of Hepatic Encephalopathy in both groups
Time Frame: Day 3
|
Day 3
|
Incidence of Hepatic Encephalopathy in both groups
Time Frame: Day 6
|
Day 6
|
Incidence of Acute Kidney Injury in both groups
Time Frame: Day 3
|
Day 3
|
Incidence of Acute Kidney Injury in both groups
Time Frame: Day 6
|
Day 6
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (ANTICIPATED)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
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
- Digestive System Diseases
- Hepatic Insufficiency
- Liver Diseases
- Liver Failure, Acute
- End Stage Liver Disease
- Liver Failure
- Acute-On-Chronic Liver Failure
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Autonomic Agents
- Peripheral Nervous System Agents
- Adrenergic alpha-Agonists
- Adrenergic Agonists
- Sympathomimetics
- Vasoconstrictor Agents
- Adrenergic alpha-1 Receptor Agonists
- Midodrine
Other Study ID Numbers
- ILBS-ACLF-06
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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