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Patient-centred Intervention With Virtual Support for Obesity and Kidney Transplant Access (PIVOT)

28 de septiembre de 2026 actualizado por: Kristin Clemens

Obesity has a serious impact on people's health and quality of life. For those with advanced kidney disease (i.e. approaching the need for dialysis), obesity is especially problematic - obesity can not only lead to worsening kidney function and kidney failure, but it can also prevent patients from receiving a lifesaving kidney transplantation due to concerns about operation risks. Unfortunately, there is an urgent need but no rigorously proven treatments to help people with advanced kidney disease lose weight effectively and safely.

The investigative team is a large team of doctors, nurses, dieticians, exercise specialists, social scientists, and patients with a lived experience, have spent three years advancing research to help people with advanced kidney disease achieve a healthier body weight. They have created a special weight loss program that combines individualized coaching on diet and save activity with a medication proven to help people with healthier kidneys lose weight (i.e. Ozempic). This research program is called PIVOT: Patient-centred Intervention with Virtual support for Obesity and kidney Transplant access.

The investigators have started to test PIVOT in a small pilot study and early results show that there is potential to study the program on a much larger scale (i.e. across Canada). With funding from CIHR, the investigators aim to reach more Canadians with advanced kidney disease (including people of lower income, women, and people of different races) with an aim of helping them lose weight safely, feel better, obtain a kidney transplant, and staying healthier over the longer term.

Descripción general del estudio

Estado

Aún no reclutando

Condiciones

Intervención / Tratamiento

Tipo de estudio

Intervencionista

Inscripción (Estimado)

880

Fase

  • Fase 4

Contactos y Ubicaciones

Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.

Estudio Contacto

Ubicaciones de estudio

    • Ontario
      • London, Ontario, Canadá
      • London, Ontario, Canadá, N6A4V2

Criterios de participación

Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.

Criterio de elegibilidad

Edades elegibles para estudiar

18 años y mayores (Adulto, Adulto Mayor)

Acepta Voluntarios Saludables

No

Géneros elegibles para el estudio

Todos

Descripción

Inclusion Criteria:

  • 18 years or older
  • BMI >35 kg/m2
  • eGFR <15ml/min/1.73m2 at baseline OR 2-year KFRE2 of 10% or greater

Exclusion Criteria:

  • Known contraindication to a GLP-1RA (pancreatitis, personal or family history of medullary thyroid cancer, hypersensitivity, pregnancy, breastfeeding)
  • Type 1 diabetes

Plan de estudios

Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.

¿Cómo está diseñado el estudio?

Detalles de diseño

  • Propósito principal: Tratamiento
  • Asignación: Aleatorizado
  • Modelo Intervencionista: Asignación paralela
  • Enmascaramiento: Ninguno (etiqueta abierta)

Armas e Intervenciones

Grupo de participantes/brazo
Intervención / Tratamiento
Experimental: Virtual Weight Management Program

A maximum tolerated dose of semaglutide will be administered once weekly subcutaneously, up to a dose of 2.0 mg. Participants will also receive nutritional and movement advice, as well as virtual coaching once every 4 weeks for 6 months.

Maximum tolerated dose of semaglutide subcutaneously once weekly. Maximum dose of 2.0 mg.

Otros nombres:
  • Ozempic
  • Wegovy
  • Generic Semaglutide
  • Apo-Semaglutide
  • Semaglutide Injection

Virtual meeting with intervention coach once every 4 weeks for 6 months, where the coach will discuss the goals and progress with participant, nutritional advice, exercise advice, and motivational support.

Otros nombres:
  • Control de peso
  • Entrenamiento
Sin intervención: Usual Care

Usual care participants will continue to receive the typical standard of kidney and diabetes care. They will not receive any study medication or coaching.

¿Qué mide el estudio?

Medidas de resultado primarias

Medida de resultado
Medida Descripción
Periodo de tiempo
Change in Body Weight
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Continuous measure of weight in kilograms assessed on calibrated clinic scales (dry weight for those receiving dialysis given fluid shifts)

Baseline to 26 weeks +/- 14 days

Medidas de resultado secundarias

Medida de resultado
Medida Descripción
Periodo de tiempo
Quality of Life - Kidney Disease Quality of Life 36-Item Short Form
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Change in Kidney Disease Quality of Life (KDQOL-36) score across treatment arms. KDQOL-36 is scored on a 0-100 scale across five domains, with higher scores indicating better health-related quality of life.

Baseline to 26 weeks +/- 14 days
Health-Related Quality of Life - European Quality of Life 5 Dimensions, 5 Level (EQ-5D-5L) Questionnaire
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Change in health-related quality of life measured using the European Quality of Life 5-Dimension, 5-Level questionnaire across treatment arms. A score of 11111 = no problems in any dimension (best), and a score of 55555 = extreme problems in all dimensions (worst).

Baseline to 26 weeks +/- 14 days
Change in Functional Status - Kidney Disease Quality of Life 36-Item Short form (KDQOL-36)
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Change in functional status measured with KDQOL-36™ scores across treatment arms. KDQOL-36 is scored on a 0-100 scale across five domains, with higher scores indicating better health-related quality of life.

Baseline to 26 weeks +/- 14 days
Change in Functional Status - European Quality of Life five-dimensional, five-level generic measure (EQ-5D-5L) scores across treatment arms.
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Measured via EQ-5D-5L (European Quality of Life five-dimensional, five-level generic measure) scores across treatment arms. A score of 11111 = no problems in any dimension (best), and a score of 55555 = extreme problems in all dimensions (worst).

Baseline to 26 weeks +/- 14 days
Weight Loss ≥5%
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Percentage of participants achieving at least 5% reduction in body weight from baseline.

Baseline to 26 weeks +/- 14 days
Weight Loss ≥10%
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Percentage of participant achieving at least 10% reduction in body weight from baseline.

Baseline to 26 weeks +/- 14 days
Weight Loss ≥15%
Periodo de tiempo: 26 weeks +/- 14 days

Percentage of participants achieving at least 15% reduction in body weight from baseline.

26 weeks +/- 14 days
Weight Loss ≥20%
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Percentage of participants achieving at least 20% reduction in body weight from baseline.

Baseline to 26 weeks +/- 14 days
Body Mass Index (BMI)
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Change in BMI across treatment arms. Measured in kg/m²

Baseline to 26 weeks +/- 14 days
Body Surface Area (BSA)
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Change in BSA across treatment arms. Measured in m².

Baseline to 26 weeks +/- 14 days
Body Mass Index <35 kg/m²
Periodo de tiempo: Week 26 +/- 14 days

Percentage of participants achieving a BMI below <35 kg/m², corresponding to the specified weight-based threshold for transplant listing.

Week 26 +/- 14 days
Dalhousie Clinical Frailty Scale Rating
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Change in Dalhousie Clinical Frailty Scale rating across treatment arms. The scale ranges from 1 (very fit) to 9 (terminally ill).

Baseline to 26 weeks +/- 14 days
SARC-F Score
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Change in sarcopenia measured by SARC-F score across treatment arms. This questionnaire is scored out of 10, with a score of 4 or higher indicating probable sarcopenia.

Baseline to 26 weeks +/- 14 days
FRAIL Scale
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Change in frailty measured by the FRAIL Scale across treatment arms. The scale scores five components - fatigue, resistance, ambulation, illnesses, and loss of weight - on a 0-5 scale, with 0 indicating robust, 1-2 pre-frail, and 3 or more indicating frailty.

Baseline to 26 weeks +/- 14 days
Acute Kidney Injury (AKI)
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Incidence of AKI. AKI defined by KDIGO as creatinine ≥ 1.5x baseline within 7 days in non-dialysis participants

Baseline to 26 weeks +/- 14 days
Hypoglycemia
Periodo de tiempo: Baseline to week 26 +/- 14 days

Incidence of hypoglycemia (blood glucose <4 mmol/L or time below target using continuous glucose monitoring)

Baseline to week 26 +/- 14 days
Gastrointestinal Symptoms
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Incidence of gastrointestinal symptoms, including nausea, vomiting, constipation

Baseline to 26 weeks +/- 14 days
Acute Biliary Disease
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Incidence of acute biliary disease.

Baseline to 26 weeks +/- 14 days
Acute Pancreatitis
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Incidence of acute pancreatitis.

Baseline to 26 weeks +/- 14 days
Diabetic Retinopathy Interventions
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Incidence of interventions for diabetic retinopathy

Baseline to 26 weeks +/- 14 days
Injection-site reactions
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Incidence of injection-site reactions in the intervention arm.

Baseline to 26 weeks +/- 14 days
Malignant Neoplasms
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Incidence of malignant neoplasms.

Baseline to 26 weeks +/- 14 days
Coaching Visit Adherence
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Percentage of participants completing ≥4 of 6 coaching visits.

Baseline to 26 weeks +/- 14 days
Semaglutide Discontinuation
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Percentage of participants discontinuing semaglutide in the intervention arm.

Baseline to 26 weeks +/- 14 days
Achievement of semaglutide dose ≥1.0 mg/week
Periodo de tiempo: Week 26 +/- 14 days

Percentage of participants in the intervention group achieving a semaglutide dose of ≥1.0 mg/week.

Week 26 +/- 14 days
Achievement of Semaglutide Dose ≥2.0 mg/week
Periodo de tiempo: 26 weeks +/- 14 days

Percentage of participants achieving a semaglutide dose of ≥2.0 mg/week

26 weeks +/- 14 days
Semaglutide Initiation in Usual Care
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Percentage of usual care arm participants initiating semaglutide during the study period.

Baseline to 26 weeks +/- 14 days
Use of Semaglutide in Usual Care Participants
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Percentage of participants using semaglutide in the usual care arm.

Baseline to 26 weeks +/- 14 days
Semaglutide Dose ≥1.0 mg/Week in Usual care Arm
Periodo de tiempo: 26 weeks +/- 14 days

Percentage of usual care participants achieving semaglutide dose ≥1.0 mg/week

26 weeks +/- 14 days
Semaglutide Dose ≥2.0 mg/Week in Usual Care Arm
Periodo de tiempo: 26 Weeks +/- 14 days

Percentage of usual care participants achieving semaglutide dose ≥2.0 mg/week

26 Weeks +/- 14 days
Body Fat Percentage Measured with Smart Scale
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Change in body fat percentage among the subsample of intervention participants using the study smart scale.

Baseline to 26 weeks +/- 14 days
Muscle Mass Measured with Smart Scale
Periodo de tiempo: Baseline to 26 weeks +/- 14 days

Measured in kilograms. Change in muscle mass among the subsample of intervention participants using the study smart scale.

Baseline to 26 weeks +/- 14 days
Intervention Costs
Periodo de tiempo: Baseline to 26 weeks

The total cost of the intervention incurred by participants during the 26-week follow-up period, in Canadian dollars (CAD)

Baseline to 26 weeks
Out-of-pocket costs
Periodo de tiempo: Baseline to 26 weeks

Total out-of-pocket costs incurred by participants during the 26-week study period-including costs directly related to the intervention. Measured in Canadian dollars (CAD)

Baseline to 26 weeks
Lost Productivity Costs
Periodo de tiempo: Baseline to 26 weeks

Costs associated with productivity losses during the 26-week follow-up period, including costs directly related to the participant's health care and intervention. Measured in Canadian dollars (CAD)

Baseline to 26 weeks
Health care utilization costs
Periodo de tiempo: Baseline to 26 weeks

Total costs associated with health care utilization during the study period, including physician visits, hospitalizations, emergency department visits, medications, allied health services. Measured in Canadian dollars (CAD) using provincial administrative health data.

Baseline to 26 weeks

Otras medidas de resultado

Medida de resultado
Medida Descripción
Periodo de tiempo
Change in HbA1c
Periodo de tiempo: Baseline to 24 Months

Change in glycated hemoglobin among participants with diabetes across treatment arms.

Baseline to 24 Months
Hospitalization for Hyperglycemia
Periodo de tiempo: Baseline to 24 Months

Incidence of hospitalization for hyperglycemia in participants with diabetes across treatment arms

Baseline to 24 Months
Hospitalization for hypoglycemia
Periodo de tiempo: Baseline to 24 Months

Incidence of hospitalization for hypoglycemia in participants with diabetes across treatment arms.

Baseline to 24 Months
Initiation of Dialysis
Periodo de tiempo: Baseline to 24 Months

Percentage of non-dialysis participants initiating dialysis across treatment arms

Baseline to 24 Months
Cardiovascular Composite
Periodo de tiempo: Baseline to 24 Months

Composite of hospitalization for acute myocardial infarction, stroke, amputation, or heart failure across treatment arms.

Baseline to 24 Months
Kidney Transplantation
Periodo de tiempo: Baseline to 24 months

Percentage of participants receiving kidney transplantation across treatment arms.

Baseline to 24 months
Healthcare utilization
Periodo de tiempo: 24 months

Health care utilization over 24 months including number of hospital admissions, emergency department, outpatient and primary care visits, specialist visits, rehabilitation, allied health care visits. Measured using provincial administrative health data.

24 months
Health care costs
Periodo de tiempo: 24 months

Health care costs over 24 months, including total health care costs, hospitalization-related costs, emergency department costs, outpatient and physician costs, medication costs. Measured in Canadian dollars (CAD) using provincial administrative health data.

24 months

Colaboradores e Investigadores

Aquí es donde encontrará personas y organizaciones involucradas en este estudio.

Patrocinador

Investigadores

  • Investigador principal: Kristin Clemens, MD, St. Joseph's Health Care London, Western University
  • Investigador principal: Louise Moist, MD, London Health Sciences Centre

Fechas de registro del estudio

Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados ​​por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.

Fechas importantes del estudio

Inicio del estudio (Estimado)

1 de enero de 2027

Finalización primaria (Estimado)

1 de enero de 2029

Finalización del estudio (Estimado)

1 de enero de 2029

Fechas de registro del estudio

Enviado por primera vez

10 de septiembre de 2026

Primero enviado que cumplió con los criterios de control de calidad

28 de septiembre de 2026

Publicado por primera vez (Actual)

5 de octubre de 2026

Actualizaciones de registros de estudio

Última actualización publicada (Actual)

5 de octubre de 2026

Última actualización enviada que cumplió con los criterios de control de calidad

28 de septiembre de 2026

Última verificación

1 de septiembre de 2026

Más información

Términos relacionados con este estudio

Otros números de identificación del estudio

  • PIVOT

Plan de datos de participantes individuales (IPD)

¿Planea compartir datos de participantes individuales (IPD)?

NO

Información sobre medicamentos y dispositivos, documentos del estudio

Estudia un producto farmacéutico regulado por la FDA de EE. UU.

No

Estudia un producto de dispositivo regulado por la FDA de EE. UU.

No

Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .