- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05870007
Atorvastatin and Alkali Therapy in Patients With Autosomal Dominant Polycystic Kidney Disease
Atorvastatin and Alkali Therapy in Patients With Autosomal Dominant Polycystic Kidney Disease, A Pilot Trial for Safety and Feasibility
Study Overview
Status
Intervention / Treatment
Study Type
Enrollment (Anticipated)
Phase
- Phase 2
Contacts and Locations
Study Locations
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-
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New Taipei City, Taiwan, 235
- Shuang Ho Hospital
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Taipei, Taiwan
- Taipei Medical University Hospital
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Taipei, Taiwan
- Wan Fang Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patient voluntarily gives informed consent to participate in the study and signed study's IC and HIPAA.
- Patient is age 18 or older at the time of consent.
If applicable, female of reproductive potential (Females who are successfully sterilized (surgical sterilization methods include hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or are postmenopausal (defined as amenorrhea for at least 12 consecutive months) are not considered to be of reproductive potential) must be non-pregnant (as confirmed by a urine pregnancy test at screening) and non-lactating, and agree:
- Either abstain from intercourse (when it is in line with their preferred and usual lifestyle), or
- Use 2 medically acceptable, highly-effective forms of contraception for the duration of study, and at least 30 days after discontinuing study drug (highly-effective forms of contraception can include approved hormonal contraceptives (oral, injectable, and implantable), and barrier methods (such as a condom or diaphragm) when used with a spermicide.))
Patients has ADPKD diagnosed by unified criteria using a combination of ultrasound results, genotyping and MRI as needed (1, 2). Kidney ultrasound is usually used for screening because it is safe, effective, and inexpensive. Diagnostic criteria are based upon whether the genotype is known. Disease severity varies between the different genotypes. The great majority of patients at risk for ADPKD are from families with an unknown genotype. This diagnosis will take place prior to recruitment / inclusion into the study.
The following ultrasonographic criteria for the diagnosis of ADPKD are for at-risk patients from families of where the genotype is not known:
- If the patient is between 18 and 39 years of age, at least three unilateral or bilateral kidney cysts. The specificity and positive predictive value at this age-range is 100 percent. (sensitivity of 82 and 96 percent for individuals between 15 and 29 years and between 30 to 39 years of age, respectively).
- If the patient is 40 to 59 years of age, at least two cysts in each kidney (sensitivity, specificity, and positive predictive value of 90, 100, and 100 percent, respectively).
- Among individuals 60 years or older, at least four cysts in each kidney. (100 percent sensitivity and specificity).
- The above patients with estimated GFR ≥30 ml/min i.e. with stage 1-3b CKD
- Plasma bicarbonate ≤ 25 mMol/L
- Metabolic acidosis
- The patient agrees to immediately inform Investigator and research coordinator of any changes or planned changes in concomitant medication
Exclusion Criteria:
- Patients with known allergy or sensitive to Atorvastatin or NaHCO3
- Acute coronary disease, liver disease, muscle disease, or a history of pulmonary edema
- Creatine Phospho Kinase (CPK) > 2ULN (2.5 ULN in African Americans). Elevated creatine phosphokinase could be a marker of rhabdomyolysis, which is a potential side effect of pravastatin. In general, patients with African American ancestry can have higher normal level of CPK
- Patients with systemic disease that impacting kidney per Investigator's decision
- Patients with known unstable cerebral aneurysm per Investigator's decision
- Pregnancy or lactation, or patients who refuse to use recommended contraception methods
- Proteinuria > 1000 mg/day
- History of non-compliance of medication per Investigator's decision
- Patients with uncontrolled hypertension, edema, or development of severe MA as per Investigator's decision
- History of cancer
- History of liver disease: hepatic failure/shock, cirrhosis
- Current or planned use of any of prohibited concomitant medication
- Patients with history of nephrolithiasis
Following medications prohibited at the time of enrollment and during the study and if the patient is started on these medications then the patient will be excluded from the study:
rapamycin or its analogues tolvaptan spironolactone cimetidine and ketoconazole erythromycin cyclosporine gemfibrozil colchicine niacin (>1 g/day) other lipid lowering medications in the class of statins
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Control group
Standard treatment alone
|
|
Active Comparator: Atorvastatin
Standard treatment + Atorvastatin 20mg QD
|
Atorvastatin 20mg
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Active Comparator: Atorvastatin AND Alkali
Standard treatment + Atorvastatin 20mg QD + Sodium Bicarbonate therapy up to 1800mg per day
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Atorvastatin 20mg
Sodium bicarbonate would be titrated up to 1800mg per day according to metabolic acidosis severity during clinical follow-up
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changes in kidney function in patients enrolled in different arms of the study
Time Frame: 12 months
|
The investigators will estimate the effect of Atorvastatin and NaHCO3 on kidney function in patients with ADPKD compared to Atorvastatin alone or Standard therapy: serum creatinine-derived estimated glomerular filtration rate (eGFR) calculated by CKD-EPI equation, to evaluate kidney function.
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12 months
|
Changes in kidney function in patients enrolled in different arms of the study
Time Frame: 12 months
|
The investigators will estimate the effect of Atorvastatin and NaHCO3 on kidney function in patients with ADPKD compared to Atorvastatin alone or Standard therapy: serum blood urea nitrogen (BUN), to evaluate kidney function.
|
12 months
|
Changes in kidney function in patients enrolled in different arms of the study
Time Frame: 12 months
|
The investigators will estimate the effect of Atorvastatin and NaHCO3 on kidney function in patients with ADPKD compared to Atorvastatin alone or Standard therapy: serum sodium level (Na), to evaluate kidney function.
|
12 months
|
Changes in kidney function in patients enrolled in different arms of the study
Time Frame: 12 months
|
The investigators will estimate the effect of Atorvastatin and NaHCO3 on kidney function in patients with ADPKD compared to Atorvastatin alone or Standard therapy: serum potassium level (K), to evaluate kidney function.
|
12 months
|
Changes in liver function in patients enrolled in different arms of the study
Time Frame: 12 months
|
The investigators will test liver function test panels in patients with ADPKD compared to Atorvastatin alone or Standard therapy.
The liver function panel should be within normal limits for enrollment and continuation in the study.
Liver function test with ALT will be evaluated at the end of the trial.
|
12 months
|
Changes in liver function in patients enrolled in different arms of the study
Time Frame: 12 months
|
The investigators will test liver function test panels in patients with ADPKD compared to Atorvastatin alone or Standard therapy.
The liver function panel should be within normal limits for enrollment and continuation in the study.
Liver function test with AST will be evaluated at the end of the trial.
|
12 months
|
Changes in liver function in patients enrolled in different arms of the study
Time Frame: 12 months
|
The investigators will test liver function test panels in patients with ADPKD compared to Atorvastatin alone or Standard therapy.
The liver function panel should be within normal limits for enrollment and continuation in the study.
Liver function test with total bilirubin will be evaluated at the end of the trial.
|
12 months
|
Changes in liver function in patients enrolled in different arms of the study
Time Frame: 12 months
|
The investigators will test liver function test panels in patients with ADPKD compared to Atorvastatin alone or Standard therapy.
The liver function panel should be within normal limits for enrollment and continuation in the study.
Liver function test with increase in prothrombin time will be evaluated at the end of the trial.
|
12 months
|
Changes in muscle injury marker function in patients enrolled in different arms of the study
Time Frame: 12 months
|
The investigators will estimate the effect of Atorvastatin and NaHCO3 on creatine phospho kinase (CPK) in patients with ADPKD compared to Atorvastatin alone or Standard therapy.
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12 months
|
Changes in muscle tenderness in patients enrolled in the study
Time Frame: 12 months
|
The investigators will estimate the effect of Atorvastatin and NaHCO3 on muscle tenderness in patients with ADPKD compared to Atorvastatin alone or Standard therapy.
The physical exam will evaluate tenderness to palpation in major muscle groups such as leg, arm and back muscles.
It will be graded as presence or absence.
The patients will only be enrolled if there is absence of tenderness in muscles upon palpation on physical exam.
If there is tenderness on exam or the patient reports tenderness that is then confirmed by exam the patient will be removed from the study.
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12 months
|
Changes in blood pressure in patients enrolled in different arms of the study
Time Frame: 12 months
|
The investigators will estimate the effect of Atorvastatin and NaHCO3 on blood pressure (systolic and diastolic) in patients with ADPKD compared to Atorvastatin alone or Standard therapy
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Urinary alkalinization changes
Time Frame: 12 months
|
These parameters will be ascertained by measurements of urinary pH.
|
12 months
|
Inflammatory markers in blood and urine
Time Frame: 12 months
|
The investigators will assess inflammatory markers (interleukins, prostaglandins and other cytokines) in leukocytes, plasma, and urine in the different study groups. The biomarkers that will be measured are HETE / HODE species phospho-AMPK Inflammatory and metabolic biomarkers: NGAL, KIM1 in blood and urine. |
12 months
|
AMPK pathway activation
Time Frame: 12 months
|
The investigators will determine whether and to what extent the AMPK pathway is activated in leukocytes and urine derived from patients in the study groups at the different study visits.
Concentration of AMPK pathway-related metabolites in serum and urine would be measured (Creatinine, Osmolality, Lactate, Pyruvate, Succinate, Total Protein, PKM2, LDHA, PDK1).
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12 months
|
Collaborators and Investigators
Collaborators
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
- Pathologic Processes
- Urologic Diseases
- Disease Attributes
- Congenital Abnormalities
- Renal Insufficiency
- Genetic Diseases, Inborn
- Joint Diseases
- Musculoskeletal Diseases
- Muscular Diseases
- Musculoskeletal Abnormalities
- Abnormalities, Multiple
- Kidney Diseases, Cystic
- Ciliopathies
- Chronic Disease
- Female Urogenital Diseases
- Female Urogenital Diseases and Pregnancy Complications
- Urogenital Diseases
- Male Urogenital Diseases
- Kidney Diseases
- Renal Insufficiency, Chronic
- Polycystic Kidney Diseases
- Polycystic Kidney, Autosomal Dominant
- Arthrogryposis
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Antimetabolites
- Anticholesteremic Agents
- Hypolipidemic Agents
- Lipid Regulating Agents
- Hydroxymethylglutaryl-CoA Reductase Inhibitors
- Atorvastatin
Other Study ID Numbers
- TMU-JIRB N202208049
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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