GARNET™ Filter (GARNET Device) IDE Used in Chronic Hemodialysis Patients With a Bloodstream Infection

Feasibility of Hemodialysis With the GARNET Device in Chronic Hemodialysis Patients With a Bloodstream Infection

To evaluate the feasibility of performing combined hemodialysis with the GARNET device in chronic hemodialysis patients with a blood stream infection (BSI), and measure clinical performance and safety endpoints.

Study Overview

• Status: Recruiting
• Conditions: Bloodstream Infection
• Intervention / Treatment: Device: GARNET device

Detailed Description

This is a prospective, multi-center, single- arm study. Each subject will receive two (2) sessions of hemodialysis with the GARNET each of 3-4 hour duration at a blood flow rate of 250 to 400 mL/min. Any necessary dialysis treatment dosing prescription changes will be made by the treating physician, based on results of small molecule clearance (i.e., urea reduction ratio (URR)). After the second treatment session with the GARNET device, the subjects will resume their hemodialysis regimen using a standard hemodialyzer. Subjects will be followed for 30 days after the final treatment session to evaluate safety.

• Study Type: Interventional
• Enrollment (Anticipated): 15
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Nisha V Varma; Phone Number: 6260 617-963-8990; Email: nvarma@miraki.com

Study Locations

• United States
  • District of Columbia
    • Washington, District of Columbia, United States, 20037
      • Not yet recruiting
      • George Washington University
      • Contact: Dominic Raj, MD
      • Principal Investigator: Dominic Raj, MD
      • Sub-Investigator: Renu Regunathan-Shenk, MD
      • Principal Investigator: Danielle Davison, MD
  • Maryland
    • Baltimore, Maryland, United States, 21201
      • Recruiting
      • University of Maryland at Baltimore
      • Contact: Matthew R Weir, MD
      • Principal Investigator: Matthew R Weir, MD
      • Sub-Investigator: Neil Agarwal, MD
      • Sub-Investigator: Farhan Ali, MD
    • Bethesda, Maryland, United States, 20889
      • Active, not recruiting
      • Walter Reed National Military Medical Center
  • Massachusetts
    • Boston, Massachusetts, United States, 02215
      • Recruiting
      • Beth Israel Deaconess Medical Center
      • Contact: Alon Dagan, MD
      • Principal Investigator: Alon Dagan, MD
  • Oregon
    • Portland, Oregon, United States, 97239
      • Recruiting
      • Oregon Health and Science University
      • Contact: Akram Khan, MD
      • Principal Investigator: Akram Khan, MD
      • Sub-Investigator: Raghav Wusirika, MD
  • Texas
    • Houston, Texas, United States, 77030
      • Not yet recruiting
      • Houston Methodist
      • Contact: Horacio E Adrogue, MD, FASN
      • Principal Investigator: Horacio E Adrogue, MD, FASN

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 90 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Hospitalized adults (age ≥ 18 years and ≤ 90 years)
2. Patients on chronic hemodialysis for ≥ 3 hours per treatment and a minimum of 3 times per week schedule

3. Suspected or confirmed BSI as defined by:

   a. For a suspected central-line (temporary or tunneled central venous catheters) and non- central line (arterio-venous fistula and arterio-venous graft) vascular infection:

   i. presence of at least one of the following signs or symptoms:

1. fever (>38.0°C), 2. pain*, 3. erythema*, or 4. heat at involved vascular site* (*with no other recognized cause); or

ii. presence of purulent drainage/pus at the vascular site, in accordance with the CDC/NHSN Surveillance Definitions for Specific Types of Infections

b. For other suspected infections:

i. presence of at least 2 of the 4 SIRS criteria:

1. Body temperature > 101°F (38.3°C) or < 96.8°F (36°C);
2. Heart rate > 90 beats per minute;
3. Respiratory rate > 20 breaths per minute;

4. White blood cell count > 12,000/mm³, < 4,000/mm³, or > 10% bands

   c. For confirmed infections:

   i. laboratory-confirmed BSI based on the isolation of an organism from blood cultures; or

   ii. If a laboratory-confirmed BSI due to a commensal organism, the presence of at least one of the following signs or symptoms will be required: fever (>38.0˚C), chills, or hypotension.

4. Subject agrees to comply with all follow-up evaluations

5. Subject has provided written informed consent; or if unable to perform informed consent, written informed consent on behalf of the subject has been provided by a legally-authorized representative.

Exclusion Criteria:

1. Pregnancy confirmed by positive urine or serum test, or lactating mothers
2. Subject with severe concomitant disease expected to prolong hospitalization or cause death in ≤ 30 days, or terminal illness, or "do not resuscitate" code status
3. Known sensitivity/allergy to heparin
4. Known sensitivity/allergy to polyethersulfone dialyzers
5. Active bleeding (e.g. active GI bleeding, hematuria or epistaxis, untreated coagulopathy or bleeding from a non-compressible site)
6. Severe thrombocytopenia (platelet count < 50,000/μL)
7. Active enrollment in another study (patients enrolled in an observational study without any interventions or in post-market surveillance do not need to be excluded)
8. Inability to achieve vascular access blood flow rates of ≥250mL/min during the previous dialysis treatment
9. Requirement for Continuous Renal Replacement Therapy/Sustained Low Efficiency Dialysis (CRRT/SLED) due to hemodynamic instability
10. Hemodynamic instability
11. Medical conditions requiring regular blood transfusion
12. Hypocalcemia or clinical symptoms of hypocalcemia at time of enrollment
13. History of or known hypercoagulable state (e.g. Systemic Lupus Erythematosus (SLE), antiphospholipid syndrome/lupus anticoagulant, protein C or S deficiency, antithrombin deficiency, factor V Leiden deficiency, active cancer, sickle cell disease, and history of deep vein thrombosis (DVT))

14. History of a condition documented in the medical record within 6 months prior to enrollment that may result in an increased risk for thrombosis, including any of the following:

    1. Multiple incidents (≥ 2) of unresolvable thrombosis-induced catheter malfunctions which required catheter exchange, occurring within the 6 months prior to enrollment
    2. Prior history of renal transplant thrombosis
    3. Elevated Factor VIII with or without familial hypercholesterolemia
    4. Hyperhomocysteinemia with a homocysteine level of >4 mg/L (17.2 μmol/L)
15. Currently taking oral contraception

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: GARNET device; All enrolled subjects will receive treatment with the GARNET device.	Device: GARNET device; Use of new filter in conjunction with standard of care dialysis.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety - Rate of adjudicated device- or GARNET device procedure-related Serious Adverse Events (SAEs)	Rate of adjudicated device or GARNET device procedure-related Serious Adverse Events (SAEs) All primary safety endpoints will be reported as adjudicated by the designated Clinical Events Committee (CEC) during treatment and through the 30-day follow-up period.	30-day follow-up post-2nd GARNET device treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Resolution of Blood Stream Infection at 30-days post 2nd GARNET device treatment	• Resolution of Blood Stream Infection	30-day follow-up post-2nd GARNET device treatment
Clearance for small (blood urea nitrogen) and middle (beta-2-microglobulin) molecule solutes by the GARNET device, as measured by the intra-dialytic urea and beta-2-microglobulin reduction ratio.	• Extent of clearance of solutes (small and middle molecules)	During Week 1 participation - Day 0: pre and post first GARNET device treatment and pre and post second GARNET device treatment which must occur by Day 7.

Collaborators and Investigators

• Sponsor: Boa Biomedical, Inc.
• Collaborators: Avania

Study record dates

Study Major Dates

• Study Start (Actual): March 15, 2021
• Primary Completion (Anticipated): October 15, 2021
• Study Completion (Anticipated): December 31, 2021

Study Registration Dates

• First Submitted: November 19, 2020
• First Submitted That Met QC Criteria: December 6, 2020
• First Posted (Actual): December 8, 2020

Study Record Updates

• Last Update Posted (Actual): September 5, 2021
• Last Update Submitted That Met QC Criteria: September 1, 2021
• Last Verified: September 1, 2021

More Information

Terms related to this study

• Keywords: Infection; Sepsis; Dialysis; Hemodialysis; Blood Stream Infection; Bloodstream; PAMPs
• Additional Relevant MeSH Terms: Pathologic Processes; Systemic Inflammatory Response Syndrome; Inflammation; Disease Attributes; Sepsis; Infections; Communicable Diseases
• Other Study ID Numbers: 700-00002

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No
• IPD Plan Description: Individual participant data will not be made available to other researchers.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes