Transcutaneous Auricular Vagal Neuromodulation Therapy (AVNT™) in Chronic Kidney Disease Autonomic Dysfunction
Feasibility and Preliminary Efficacy of Transcutaneous Auricular Vagal Neuromodulation Therapy (AVNT™) in Chronic Kidney Disease Autonomic Dysfunction: A Randomized, Sham-Controlled Pilot Trial (Parasym-CKD)
The purpose of this pilot study is to establish the feasibility of home-based Auricular Vagal Neuromodulation Therapy (AVNT™) in Chronic Kidney Disease (CKD) patients, generate preliminary efficacy data on autonomic function outcomes, and explore whether timing variation influences treatment response.
Studie Overzicht
Toestand
Toestand
Conditie
Conditie
Interventie / Behandeling
Interventie / Behandeling
Studietype
Studietype
Inschrijving (Geschat)
Inschrijving
Fase
Fase
- Niet toepasbaar
Contacten en locaties
Studiecontact
Studiecontact
- Naam: Qandeel Soomro, MD, MS
- Telefoonnummer: 929-573-1168
- E-mail: Qandeel.Soomro@nyulangone.org
Studie Contact Back-up
- Naam: David Moran
- Telefoonnummer: 212-263-4072
- E-mail: David.Moran@nyulangone.org
Studie Locaties
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New York
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New York, New York, Verenigde Staten, 10016
- NYU Langone Health
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Deelname Criteria
Geschiktheidscriteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
Inclusion Criteria:
- Age ≥18 years at time of informed consent
- Documented Chronic Kidney Disease (CKD) stage G3-G5 (estimated Glomerular Filtration Rate (eGFR) 15-59 mL/min/1.73 m²), not on maintenance dialysis, based on eGFR or clinical documentation
- Patients at New York University (NYU) clinics who meet criteria
- Non NYU patients reaching out study team via iConnect
- Clinically stable: No hospitalization, acute kidney injury, or acute illness requiring medical intervention within prior 4 weeks
- Stable dosing of autonomically active medications: participants taking beta-blockers, other rate-controlling agents, anticholinergics, or sympathomimetics must be on a stable dose for ≥4 weeks before baseline with no anticipated changes during the study. Use of these agents is recorded and included as a covariate in analyses of heart-rate-based endpoints. Autonomically active medications: agents that materially affect heart rate, blood pressure, or autonomic tone - beta-blockers, non-dihydropyridine calcium-channel blockers, alpha-blockers, central sympatholytics (e.g., clonidine), midodrine, fludrocortisone, anticholinergics, sympathomimetics/stimulants, serotonin-norepinephrine reuptake inhibitors (SNRIs)/selective serotonin reuptake inhibitors (SSRIs), and diuretics are recorded with agent, dose, and timing, must be stable for ≥4 weeks before baseline with no anticipated change during the study, and are included as covariates. Home measurements are taken at a consistent time relative to the participant's usual dosing.
Exclusion Criteria:
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Implantable cardioverter-defibrillator (ICD) or other implanted cardiac device
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Known severe coronary disease (≥70% stenosis in major vessel) or myocardial infarction within past 5 years
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Hospitalized within 4 weeks
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Syncope or unexplained loss of consciousness within past 12 months
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Uncontrolled arrhythmia (atrial fibrillation with resting heart rate >110 bpm, recent runs of sustained ventricular tachycardia or supraventricular tachycardia) within 3 months.
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Severe bradycardia (<40 bpm at rest, symptomatic) , or second- or third-degree atrioventricular (AV) block without a functioning pacemaker
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Neurological/Anatomical Exclusions:
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History of vagotomy (surgical cutting of vagus nerve)
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Trigeminal neuralgia within 1 year
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Epilepsy or seizure disorder (unless well-controlled defined as seizure free with stable dose of medication for ≥2 years)
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Dementia or cognitive impairment preventing informed consent or study compliance
Renal/General Medical Exclusions:
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End-stage kidney disease (ESKD) on maintenance hemodialysis or peritoneal dialysis
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Pregnancy or breastfeeding
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Active malignancy (except non-melanoma skin cancer)
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Severe hepatic disease (Child-Pugh Class C cirrhosis)
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Immunosuppression (within 8 weeks of enrollment) or active immunosuppressive therapy
Skin/Electrode-Related Exclusions:
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Active infection or severe lesions at tragus preventing electrode placement
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Known allergy to gold or electrode materials
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Implanted device at <2 cm proximity to ear tragus (e.g., cochlear implant, cerebral shunt, invasive Vagus Nerve Stimulation (VNS))
Substance Use/Other:
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Active substance uses disorder (within 1 year) or alcohol use >14 drinks/week
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Participation in another clinical trial within 30 days
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Any condition that, in the investigator's judgment, would make participation unsafe or preclude compliance
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Prisoners
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Faculteitstoewijzing
- Masker: Dubbele
Aantal wapens
Wapens en interventies
Deelnemersgroep / ArmDeelnemersgroep / Arm |
Interventie / BehandelingInterventie / Behandeling |
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Sham-vergelijker: Sham-AM
Participants will use the sham-device for 1 hr/day at 7:00 AM. |
The device is equipped with a "ramp-down sham mode". In this mode, no electrical stimulation will occur for the remainder of the session and participant intensity adjustments are disabled. Participants will use the sham-device at home once daily for 60 minutes either in the morning at 7am or in the evening at 7pm. |
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Sham-vergelijker: Sham-PM
Participants will use the sham-device for 1 hr/day at 7:00 PM. |
The device is equipped with a "ramp-down sham mode". In this mode, no electrical stimulation will occur for the remainder of the session and participant intensity adjustments are disabled. Participants will use the sham-device at home once daily for 60 minutes either in the morning at 7am or in the evening at 7pm. |
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Experimenteel: Active-AM
Participants will use the active AVNT device for 1 hr/day at 7:00 AM. |
The device consists of a handheld stimulation unit (~2 inches) connected to a tragus earpiece electrode (worn like an in-ear headphone, removed after each session). Participants will undergo AVNT™ at home once daily for 60 minutes either in the morning at 7am or in the evening at 7pm at a pulse width of 250 μs, frequency of 20 Hz, and comfortable, patient-titrated intensity based on personalized perceptual thresholds.
Andere namen:
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Experimenteel: Active-PM
Participants will use the active AVNT device for 1 hr/day at 7:00 PM. |
The device consists of a handheld stimulation unit (~2 inches) connected to a tragus earpiece electrode (worn like an in-ear headphone, removed after each session). Participants will undergo AVNT™ at home once daily for 60 minutes either in the morning at 7am or in the evening at 7pm at a pulse width of 250 μs, frequency of 20 Hz, and comfortable, patient-titrated intensity based on personalized perceptual thresholds.
Andere namen:
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Wat meet het onderzoek?
Primaire uitkomstmaten
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Change in Orthostatic Heart Rate Response
Tijdsspanne: Week 0, Week 2
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Difference in standing heart rate at 1 minute minus baseline seated heart rate, averaged across daily home measurements in Week 0 (baseline) and last 3-5 days of Week 2 (post-intervention). |
Week 0, Week 2
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Secundaire uitkomstmaten
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Change in high-sensitivity C-reactive protein (hs-CRP) (pg/mL)
Tijdsspanne: Week 0, Week 2
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Week 0, Week 2
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Change in Interleukin-6 (IL-6) (pg/mL)
Tijdsspanne: Week 0, Week 2
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Week 0, Week 2
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Change in Urine Albumin-Creatinine Ratio (UACR) (mg/g creatinine)
Tijdsspanne: Week 0, Week 2
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Week 0, Week 2
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Change in Composite Autonomic Symptom Score-31 (COMPASS-31)
Tijdsspanne: Week 0, Week 2
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The COMPASS-31 is a 31-item, self-administered clinical questionnaire used to measure the severity and distribution of autonomic nervous system symptoms (dysautonomia). Scores range from 0 to 100, where higher scores indicate worse autonomic dysfunction. |
Week 0, Week 2
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Percentage of participants who achieved ≥85% prescribed minutes (714 of 840 min)
Tijdsspanne: Week 2
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Week 2
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Percentage of patients that completed ≥70% of scheduled autonomic measurements
Tijdsspanne: Week 2
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Week 2
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Medewerkers en onderzoekers
Sponsor
Sponsor
Onderzoekers
Onderzoekers
- Hoofdonderzoeker: Qandeel Soomro, MD, MS, NYU Langone Health
Studie record data
Bestudeer belangrijke data
Studie start (Geschat)
Studie start
Primaire voltooiing (Geschat)
Primaire voltooiing
Studie voltooiing (Geschat)
Studie voltooiing
Studieregistratiedata
Eerst ingediend
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Werkelijk)
Eerst geplaatst
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update geplaatst
Laatste update ingediend die voldeed aan QC-criteria
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Aanvullende relevante MeSH-voorwaarden
- Urogenitale ziekten
- Pathologische processen
- Mannelijke urogenitale ziekten
- Urologische ziekten
- Vrouwelijke urogenitale ziekten
- Vrouwelijke urogenitale ziekten en zwangerschapscomplicaties
- Chronische ziekte
- Ziekte attributen
- Nierinsufficiëntie
- Pathologische aandoeningen, tekenen en symptomen
- Nier Ziekten
- Nierinsufficiëntie, chronisch
Andere studie-ID-nummers
Andere studie-ID-nummers
- 26-00938
Plan Individuele Deelnemersgegevens (IPD)
Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?
Beschrijving IPD-plan
The de-identified participant data from the final research dataset will be shared upon reasonable request beginning 9 to 36 months after publication or as required by a condition of awards or supporting agreements, provided the requesting investigator executes a data use agreement with NYU Langone Health. This instance of data sharing will also require separate IRB review as well as review from NYU Langone's Data Sharing Strategy Board (DSSB). Requests should be directed to: Qandeel.Soomro@nyulangone.org. The protocol and statistical analysis plan will be posted on Clinicaltrials.gov only as required by federal regulation or supporting awards and agreements.
IPD-tijdsbestek voor delen
Beginning 9 months and ending 36 months following article publication or as required by a condition of awards and agreements supporting the research.
IPD-toegangscriteria voor delen
The investigator who proposed to use the data will be granted access upon reasonable request. Requests should be directed to Qandeel.Soomro@nyulangone.org. To gain access, data requestors will need to sign a data access agreement. This instance of data sharing will also require separate IRB review as well as review from NYU Langone's DSSB.
IPD delen Ondersteunend informatietype
- LEERPROTOCOOL
- SAP
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