Patient-centred Intervention With Virtual Support for Obesity and Kidney Transplant Access (PIVOT)
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
Estado
Condiciones
Condiciones
Intervención / Tratamiento
Intervención / Tratamiento
Tipo de estudio
Tipo de estudio
Inscripción (Estimado)
Inscripción
Fase
Fase
- Fase 4
Contactos y Ubicaciones
Estudio Contacto
Estudio Contacto
- Nombre: Heather LaPier
- Número de teléfono: 65373 519-646-6100
- Correo electrónico: heather.lapier@sjhc.london.on.ca
Ubicaciones de estudio
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Ontario
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London, Ontario, Canadá
- London Health Sciences Centre
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Contacto:
- Heather LaPier, MD
- Número de teléfono: 65373 519-646-6100
- Correo electrónico: heather.lapier@sjhc.london.on.ca
-
London, Ontario, Canadá, N6A4V2
- St. Joseph's Health Care
-
Contacto:
- Heather LaPier
- Número de teléfono: 65373 519-646-6100
- Correo electrónico: heather.lapier@sjhc.london.on.ca
-
-
Criterios de participación
Criterio de elegibilidad
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
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
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Ninguno (etiqueta abierta)
Número de brazos
Armas e Intervenciones
Grupo de participantes/brazoGrupo de participantes/brazo |
Intervención / TratamientoIntervención / 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:
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:
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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
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
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
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
Patrocinador
Patrocinador
Investigadores
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
Fechas importantes del estudio
Inicio del estudio (Estimado)
Inicio del estudio
Finalización primaria (Estimado)
Finalización primaria
Finalización del estudio (Estimado)
Finalización del estudio
Fechas de registro del estudio
Enviado por primera vez
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Publicado por primera vez
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización publicada
Última actualización enviada que cumplió con los criterios de control de calidad
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Última verificación
Más información
Términos relacionados con este estudio
Términos MeSH relevantes adicionales
- Enfermedades urogenitales
- Procesos Patológicos
- Trastornos Nutricionales
- Enfermedades urogenitales masculinas
- Enfermedades Renales
- Enfermedades urológicas
- Enfermedades urogenitales femeninas
- Enfermedades urogenitales femeninas y complicaciones del embarazo
- Enfermedad crónica
- Atributos de la enfermedad
- Sobrenutrición
- Peso corporal
- Insuficiencia renal
- Exceso de peso
- Condiciones Patológicas, Signos y Síntomas
- Enfermedades Nutricionales y Metabólicas
- Signos y síntomas
- Obesidad
- Insuficiencia Renal Crónica
- semaglutida
Otros números de identificación del estudio
Otros números de identificación del estudio
- PIVOT
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
Información sobre medicamentos y dispositivos, documentos del estudio
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