- ICH GCP
- Registro de ensayos clínicos de EE. UU.
- Ensayo clínico NCT01036490
Exercise in Obese Diabetic Patients With Chronic Kidney Disease (EX-ODCKD)
Structured Exercise in Obese Diabetic Patients With Chronic Kidney Disease
Descripción general del estudio
Descripción detallada
Patients with type 2 diabetes, obesity, and chronic kidney disease (CKD) are generally physically inactive, have a high mortality rate, and may benefit from an exercise program. However, there have been no randomized controlled trials to determine the benefits of exercise training in this population. This study seeks to substantiate the hypothesis that increasing energy expenditure by exercise training in the obese diabetic patient with CKD will result in the following benefits:
- Renal benefits, including reduction in proteinuria and stabilization of glomerular filtration rate (GFR)
- Cardiovascular benefits, including decreased blood pressure, decreased heart rate, and increased exercise tolerance.
- Improved glucose control (lower glycated hemoglobin), lipid control (decreased cholesterol with improved atherogenic profile)
- Improved body composition (weight loss, increased lean body mass and decreased fat mass).
- Decreased inflammation (assessed by high-sensitivity C-reactive protein), endothelial dysfunction (assessed by flow-mediated dilatation), and oxidative stress (assessed by reduced glutathione).
- Increased health-related quality of life.
In preparation for this proposal, the investigators performed a 24-week randomized controlled feasibility study comparing aerobic exercise plus optimal medical management to medical management alone in patients with type 2 diabetes, obesity (BMI > 30 kg/m2), and stage 2-4 CKD (eGFR 15-90 mL/min/1.73m2) with persistent proteinuria of > 200 mg/g. Subjects randomized to exercise underwent thrice weekly aerobic training for 6 followed by 18 weeks of supervised home exercise. The primary outcome variable was change in proteinuria. Exercise training resulted in a significant improvement in exercise duration during stress testing which persisted until 24 weeks. This was accompanied by significant decreases in resting systolic blood pressure and 24-hour proteinuria at 24 weeks. No changes were seen in the control group. The investigators concluded that exercise training in obese diabetic patients with CKD is feasible and results in a demonstrable training effect (increased exercise duration and decreased resting blood pressure). Moreover, it may decrease proteinuria and thus have a renoprotective effect.
The investigators now propose a larger-scale randomized controlled trial to determine the effects of exercise on renal functions, cardiovascular fitness, inflammation, and oxidative stress in diabetic patients with CKD. This will be a 52-week randomized study based on the investigators' pilot study design with some modifications. As opposed to the 6-week training period and 18-week home exercise period utilized in the pilot study, subjects randomized to exercise will undergo 12 weeks of intensive exercise training in the exercise laboratory followed by 40 weeks of supervised home exercise training (total duration of study 1 year). Moreover, due to recent recommendations that resistance training be incorporated into exercise training regimens in type 2 diabetic patients, the investigators will incorporate resistance (strength) training in this proposal. The primary outcome variable will be change in proteinuria at 12 and 52 weeks. Secondary outcome variables will be change in albuminuria and estimated glomerular filtration rate (eGFR) at 12 and 52 weeks. In addition, the investigators will measure blood pressure (BP), glycated hemoglobin, lipid profile, C-reactive protein (CRP) levels, body weight and composition, endothelial dysfunction (by flow-mediated dilatation), and Quality of Life (QoL) evaluations. The Index of Coexistent Diseases (ICED) to measure comorbidities to determine if comorbid conditions had any influence on the outcomes of the study. The Center for Epidemiologic Studies Depression Scale (CES-D) will also be used to determine the influence of depression (covariate) on study outcomes and adherence with the study objectives.
This study will directly address the effects of a structured exercise program in a patient population at high risk for cardiovascular complications. The investigators will specifically address the novel idea that exercise will not only improve cardiovascular fitness but will also ameliorate the renal complications resulting from diabetes.
Tipo de estudio
Inscripción (Actual)
Fase
- No aplica
Contactos y Ubicaciones
Ubicaciones de estudio
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Illinois
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Hines, Illinois, Estados Unidos, 60141-5000
- Edward Hines Jr. VA Hospital, Hines, IL
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Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Descripción
Inclusion Criteria:
- Diabetes mellitus
- CKD Stages 2-4
- BMI > 30
- Persistent proteinuria (urine protein/creatinine > 200 mg/g for > 3 mo)
- On treatment with ACE inhibitor or ARB
- On treatment with aspirin
- On treatment with statin (if LDL > 100)
Exclusion Criteria:
- Symptomatic neuropathy/retinopathy
- Positive stress test due to coronary arterial disease
- Symptomatic cardiovascular disease
- Congestive heart failure (New York Heart Association Class III or IV)
- Chronic obstructive pulmonary disease (FEV1 < 50% predicted and/or requires supplemental oxygen support during exercise)
- Complaints of angina during the stress test
- Cerebrovascular disease/cognitive impairment
- Renal transplant
- Inability to walk on the treadmill
- Any unforeseen illness or disability that would preclude exercise testing or training
- Participation in a formal exercise program within the previous 12 weeks
Plan de estudios
¿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 |
---|---|
Sin intervención: Control
Grupo de control
|
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Experimental: Exercise
Exercise Group
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Exercise training for 12 weeks followed by home exercise for 40 weeks
|
¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Periodo de tiempo |
---|---|
Change in Proteinuria
Periodo de tiempo: 12 weeks minus baseline
|
12 weeks minus baseline
|
Change in Proteinuria
Periodo de tiempo: 52 weeks minus baseline
|
52 weeks minus baseline
|
Medidas de resultado secundarias
Medida de resultado |
Periodo de tiempo |
---|---|
Change in Albuminuria
Periodo de tiempo: 12 weeks minus baseline
|
12 weeks minus baseline
|
Change in Albuminuria
Periodo de tiempo: 52 weeks minus baseline
|
52 weeks minus baseline
|
Change in Estimated Glomerular Filtration Rate (eGFR)
Periodo de tiempo: 12 weeks minus baseline
|
12 weeks minus baseline
|
Change in Estimated Glomerular Filtration Rate (eGFR)
Periodo de tiempo: 52 weeks minus baseline
|
52 weeks minus baseline
|
Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Eileen G. Collins, PhD RN, Edward Hines Jr. VA Hospital, Hines, IL
- Investigador principal: David J Leehey, Edward Hines Jr. VA Hospital, Hines, IL
Publicaciones y enlaces útiles
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Actual)
Finalización primaria (Actual)
Finalización del estudio (Actual)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Estimar)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- F7264-R
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
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