- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05171686
Diuretics and Volume Overload in Early CKD (DOCK)
Association of Diuretics With Change in Extracellular Volume, Natriuretic Peptides, Symptoms, and Cardiovascular Outcomes in CKD
Study Overview
Status
Conditions
Detailed Description
The investigators previously showed that brain natriuretic peptide (BNP) and N-terminal-pro-BNP (NT-pro-BNP), measures of ventricular stretch, are associated with death and cardiovascular (CV) outcomes in patients with chronic kidney disease (CKD) stages 1-3, and the investigators' preliminary pilot results suggest that these natriuretic peptides may correlate with objective measures of excess extracellular volume (ECV) and with symptoms common in CKD. The overarching objective is to determine if initiation of diuretic treatment or increase in dose is associated with changes in BNP and NT-pro-BNP, patient-reported symptom burden, and short-term hemodynamic parameters in patients with CKD stages 1-3 and elevated blood pressure, and whether these changes correlate with changes in ECV. The central hypothesis is that the change in ECV after starting or increasing diuretics in Veterans with stages 1-3 CKD is associated with changes in 1) natriuretic peptides, 2) patient-level factors, and 3) CV physiology.
The investigators will compare the changes in natriuretic peptides, symptoms, and CV parameters with the change in ECV after diuretic initiation or dose increase. The primary aim is to determine if initiation of diuretic treatment or increase in diuretic dose is associated with changes in natriuretic peptides. Secondary aims are to determine the effect of diuretic change on patient-reported symptom burden, and CV physiology.
This clinical trial will include 46 outpatients with CKD stages 1-3 and blood pressure >140/90 mmHg. At the first visit, the investigators will initiate or increase the dose of a thiazide or loop diuretic. Study measures other than echocardiogram will be repeated 4 weeks after the intervention to determine changes in these parameters. ECV will be measured by whole-body multifrequency bioimpedance spectroscopy (BIS), which is a validated, non-invasive, painless measure of ECV. Plasma BNP and NT-pro-BNP will be measured, and patient-reported fatigue, depression, and quality of life will be quantified using validated questionnaires. Hemodynamic parameters include blood pressure, pulse pressure, and total peripheral resistance index (TPRI) and cardiac index measured by Non-Invasive Hemodynamic Monitoring. A transthoracic echocardiogram will measure left ventricular mass index, valvular disease, and diastolic dysfunction.
Variables will be compared within participants between baseline and Visit 2 using paired Wilcoxon Signed Rank tests or paired Student's t tests, depending on variable distributions. Correlations between change in ECV/total body weight and all continuous outcome measures will be analyzed using Spearman or Pearson correlations, applying appropriate transformations. Linear regression analysis will control for clinically relevant variables. The relationship between ECV/total body weight and natriuretic peptides from both visits will be evaluated using a mixed effects model to account for the change in these measures between baseline and Visit 2.
Study Type
Enrollment (Estimated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Lucile P Gregg, MD
- Phone Number: (713) 440-4400
- Email: lucile.gregg@va.gov
Study Locations
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-
Texas
-
Houston, Texas, United States, 77030-4211
- Recruiting
- Michael E. DeBakey VA Medical Center, Houston, TX
-
Contact:
- Lucile P Gregg, MD
- Phone Number: 713-440-4400
- Email: lucile.gregg@va.gov
-
Principal Investigator:
- Lucile P Gregg, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Male or female Veterans age 18 years or older. There will be no upper age limit.
The presence of CKD stages 1, 2, or 3, as defined below by Kidney Disease Improving Global Outcomes guidelines, for a period of at least 3 months.
- Stage 1: eGFR 90 mL/min/1.73 m2 and spot urine albumin-to-creatinine ratio 30 mg/g.
- Stage 2: eGFR 60-89 mL/min/1.73 m2 and spot urine albumin-to-creatinine ratio 30 mg/g.
- Stage 3: eGFR 30-59 mL/min/1.73 m2.
- Measured blood pressure either >140 mmHg systolic or >90 mmHg diastolic at the two most recent clinic visits.
- Able to understand and sign informed consent after the nature of the study has been fully explained.
Exclusion Criteria:
- Unable to understand or provide informed consent.
- Unwilling or unable to participate in the protocol or comply with any of its components.
- CKD stages 4-5, defined as eGFR <30 mL/min/1.73 m2.
- Receiving chronic hemodialysis or peritoneal dialysis.
- Recipient of a kidney transplant.
- Serum potassium <3.5 mEq/L at baseline.
- Known left ventricular ejection fraction <40% on visual estimate based on chart review of available echocardiogram data.
- Known hepatic cirrhosis.
- Major limb amputation.
- Known pregnancy.
- Presence of a pacemaker or defibrillator.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Diuretic augmentation
The participant's blood pressure medication regimen will be altered to initiate a thiazide-type or loop diuretic in those not already prescribed a diuretic, or to increase the dose if one is already prescribed.
|
The participant's blood pressure medication regimen will then be altered to initiate a thiazide-type (hydrochlorothiazide or chlorthalidone) or loop diuretic (furosemide, bumetanide, or torsemide) in those not already prescribed a diuretic, or to increase the dose if one is already prescribed
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in NT-pro-BNP
Time Frame: 4 weeks
|
Change in NT-pro-BNP from baseline to 4 weeks after intervention
|
4 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in BNP
Time Frame: 4 weeks
|
Change in BNP from baseline to 4 weeks after intervention
|
4 weeks
|
Change in FACIT-F score
Time Frame: 4 weeks
|
Change in fatigue as measured by FACIT-F score from baseline to 4 weeks after intervention
|
4 weeks
|
Change in QIDS-SR16
Time Frame: 4 weeks
|
Change in depression as measured by the QIDS-SR16 from baseline to 4 weeks after intervention
|
4 weeks
|
Change in KDQOL
Time Frame: 4 weeks
|
Change in quality of life as measured by the KDQOL from baseline to 4 weeks after intervention
|
4 weeks
|
Change in total peripheral resistance index
Time Frame: 4 weeks
|
Change in total peripheral resistance index from baseline to 4 weeks after intervention
|
4 weeks
|
Change in systolic blood pressure
Time Frame: 4 weeks
|
Change in systolic blood pressure from baseline to 4 weeks after intervention
|
4 weeks
|
Change in diastolic blood pressure
Time Frame: 4 weeks
|
Change in diastolic blood pressure from baseline to 4 weeks after intervention
|
4 weeks
|
Change in mean arterial pressure
Time Frame: 4 weeks
|
Change in mean arterial pressure from baseline to 4 weeks after intervention
|
4 weeks
|
Change in pulse pressure
Time Frame: 4 weeks
|
Change in pulse pressure from baseline to 4 weeks after intervention
|
4 weeks
|
Change in cardiac index
Time Frame: 4 weeks
|
Change in cardiac index from baseline to 4 weeks after intervention
|
4 weeks
|
Change in extracellular volume normalized/total body weight
Time Frame: 4 weeks
|
Change in extracellular volume normalized to total body weight from baseline to 4 weeks after intervention
|
4 weeks
|
Collaborators and Investigators
Investigators
- Principal Investigator: Lucile P Gregg, MD, Michael E. DeBakey VA Medical Center, Houston, TX
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
- Pathologic Processes
- Cardiovascular Diseases
- Vascular Diseases
- Urologic Diseases
- Disease Attributes
- Renal Insufficiency
- Chronic Disease
- Female Urogenital Diseases
- Female Urogenital Diseases and Pregnancy Complications
- Urogenital Diseases
- Male Urogenital Diseases
- Hypertension
- Kidney Diseases
- Renal Insufficiency, Chronic
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Antihypertensive Agents
- Natriuretic Agents
- Membrane Transport Modulators
- Sodium Chloride Symporter Inhibitors
- Sodium Potassium Chloride Symporter Inhibitors
- Hydrochlorothiazide
- Furosemide
- Chlorthalidone
- Diuretics
- Bumetanide
- Torsemide
Other Study ID Numbers
- NEPH-001-21S
- 1IK2CX002368-01A1 (U.S. NIH Grant/Contract)
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
product manufactured in and exported from the U.S.
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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