Prevention of Intradialytic Hypotension by Inhibiting Bradykinin B2 Receptor

Prevention of Intradialytic Hypotension by Inhibiting Bradykinin B2 Receptor A Randomized, Double-blind, Placebo-controlled, Cross Over Explorative Study

Currently, there is no medication available to adequately treat patients undergoing hemodialysis who are suffering from intradialytic hypotension (IDH). Medical interventions such as Trendelenburg positioning, saline bolus administration, reduction of ultrafiltration rate, interruption of the hemodialysis, and other medical treatments are the methods of choice to treat the hypotensive condition of these patients and thus to maintain the systolic blood pressure. Patients suffering from IDH have a higher reported mortality rate due to the given stress on their cardiovascular system. New treatments, therefore, would give clinicians an additional alternative to current existing approaches and might help patients to maintain their blood pressure during hemodialysis.

The main objective of the study is to evaluate the efficacy of icatibant in the prevention of systolic blood pressure (SBP) drop in patients on hemodialysis suffering from recurrent IDH episodes during hemodialysis.

Study Overview

• Status: Recruiting
• Conditions: Intradialytic Hypotension
• Intervention / Treatment: Drug: Icatibant; Drug: Placebo

Detailed Description

Aim 1 is to test the hypothesis that in patients prone to IDH, blockade of bradykinin B2 receptor with icatibant prevents the drop of blood pressure and maintains hemodynamic stability. For this purpose, heart rate and blood pressure during hemodialysis are monitored. Importantly, the study will be conducted in an outpatient clinic, using the patients' usual hemodialysis dose and settings as for a regular hemodialysis session.

Aim 2 is to test the hypothesis that in patients prone to IDH, inhibition of the plasma kallikrein system with icatibant prevents symptoms associated with IDH such as cramps, dizziness, and nausea, and improves the quality of life (QoL) and recovery time after hemodialysis. Hemodialysis is associated with many complications, including IDH, that negatively affect the QoL of patients and their families. Any intervention that prevents the occurrence of IDH will result in a faster recovery from hemodialysis. The present study will evaluate the impact of icatibant on preventing symptoms associated with IDH and reducing recovery time after hemodialysis.

• Study Type: Interventional
• Enrollment (Estimated): 26
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: Delia M Woods, BSN/MSL; Phone Number: 615-327-7181; Email: delia.woods@vumc.org

Study Locations

• United States
  • Tennessee
    • Nashville, Tennessee, United States, 37212
      • Recruiting
      • Vanderbilt Fresenius

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients ≥ 18 to ≤ 80 years of age
• Patients with end-stage renal disease on hemodialysis (including hemodiafiltration) for at least 6 months, receiving 3 dialysis sessions per week and who are in a stable clinical condition per investigator's judgement
• Patients on hemodialysis with at least 6 IDH episodes during the last 8 weeks based on medical record assessment
• Pre-dialysis systolic blood pressure ≥ 110 and ≤ 170 mmHg assessed by two consecutive and averaged pre-HD blood pressure measurments
• Patients adequately hemodialyzed with a Kt/V ≥ 1.2
• Patients whose treatment regimen remained unchanged within 14 days prior to dosing (diet, medication, dry weight, treatment time, dialysate composition and temperature, dialysis shift, blood flow, and dialysate flow, vascular access)
• Female subjects < 55 years of age to agree on effective contraception methods throughout the study period and who have a negative pregnancy test before initiating study activities
• Body weight ≤ 150 kg

Exclusion Criteria:

• Patients who have been hospitalized during the last 4 weeks before enrolment, except vascular access related hospitalization
• Patients with known clinically evident inflammatory or infectious disease per investigator's evaluation
• Severe anemia with a hemoglobin (Hb) < 8.0 g/dL at screening
• Platelet count < 50 x 109/L
• Hepatic disease associated with ALT > 3x ULN, or total bilirubin >2x ULN with direct bilirubin > 20% of the total bilirubin level
• Known bleeding disorders e.g., von-Willebrand disease or Hemophilia A, B, C, etc.
• Recent (<3 months before screening) thromboembolic event, e.g., acute coronary syndrome, stroke, or venous thrombosis embolism (except dialysis access thrombosis)
• Recent (<3 months before screening) major surgery or scheduled major surgery during study participation
• Scheduled living donor renal transplant during study participation
• Persistent heart failure as classified by the New York Heart Association (NYHA) classification of 3 or higher
• Receiving antiplatelet therapy except daily ASA ≤ 150 mg/day
• Receiving anticoagulation in therapeutic doses, other than standard anticoagulation during the hemodialysis procedure
• Patients with significant pre-dialysis overload as defined by > 5kg above dry weight estimated by bioimpedance spectroscopy
• Patient's life expectancy < 6 months per investigator's judgement

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Icatibant; 153 mL 0.9% saline bag containing 30 mg icatibant acetate (10 mg/ml) IV at each dialysis treatment for four weeks (12 hemodialysis sessions)	Drug: Icatibant; Icatibant will be administered with an infusion rate of 100µg/kg/h for 15 minutes before their hemodialysis session (pre-infusion) and 50µg/kg/h during their routine hemodialysis session (maintenance infusion).
Placebo Comparator: Placebo; 153 mL 0.9% saline bag IV at each dialysis treatment at each dialysis treatment for four weeks (12 hemodialysis sessions)	Drug: Placebo; 0.9% sodium chloride will be administered as the same rate as icatibant

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Blood pressure during hemodialysis	Average systolic blood pressure	0-8 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hypotension events	We will record the number of hypotensive events during hemodialysis. We expect a decrease of event in the treatment arm compared to placebo	0-8 week
Symptomatology associated with hypotension	At the end of each hemodialysis session in the cross-over main study, the presence of any symptoms associated with hypotension using a standardized questionnaire will be assessed. This questionnaire will include symptoms such as cramps, dizziness, nausea and fatigue rating, and will be scored according to the severity from 0 to 4 (none to severe) for the first listed symptoms, and according to the SONG-HD Fatigue scoring for the last listed symptom, respectively.	0-8 weeks

Collaborators and Investigators

• Sponsor: Vanderbilt University Medical Center
• Collaborators: Renal Research Institute; Pharvaris Netherlands B.V.
• Investigators: Principal Investigator: Talat A Ikizler, MD, Vanderbilt University Medical Center; Principal Investigator: Jorge L Gamboa, MD/PhD, Vanderbilt University Medical Center; Principal Investigator: Peter Kotanko, MD, FASN, Renal Research Institute

Study record dates

Study Major Dates

• Study Start (Actual): December 11, 2023
• Primary Completion (Estimated): July 1, 2026
• Study Completion (Estimated): November 1, 2026

Study Registration Dates

• First Submitted: February 27, 2023
• First Submitted That Met QC Criteria: April 17, 2023
• First Posted (Actual): April 28, 2023

Study Record Updates

• Last Update Posted (Actual): April 15, 2026
• Last Update Submitted That Met QC Criteria: April 10, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Bradykinin; Hemodialysis; Intradialytic hypotension; Icatibant; Kallikrein-Kinin System
• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Hypotension; Immunosuppressive Agents; Immunologic Factors; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Anti-Inflammatory Agents; Peripheral Nervous System Agents; Antirheumatic Agents; Sensory System Agents; Analgesics, Non-Narcotic; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Complement Inactivating Agents; Bradykinin B2 Receptor Antagonists; Bradykinin Receptor Antagonists; icatibant
• Other Study ID Numbers: 222301

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No