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Gelijk opstarten van the 4 richtlijn gerichte CKD-therapieën (RAPID-CKD) (RAPID-CKD)

7 mei 2026 bijgewerkt door: Baylor Research Institute

Een piloot-gerandomiseerde klinische studie om haalbaarheid, veiligheid en werkzaamheid te beoordelen van versnelde, gelijktijdige start van therapie bij chronische nierziekte en diabetes type 2: RAPID-CKD

Het doel van deze studie is om te bepalen of het starten van alle vier chronische nierziekte-therapieën tegelijkertijd veilig en effectief is bij patiënten met diabetes type 2 en chronische nierziekte. De studiehypothese stelt dat het tegelijk starten van alle vier aanbevolen niermedicijnen veilig en effectief is in het verminderen van albuminurie, een eiwit in de urine, zonder een afname van de nierfunctie of een stijging van de kaliumspiegels in vergelijking met het starten van één medicijn tegelijk.

Studie Overzicht

Gedetailleerde beschrijving

This study is a pilot, open-label, randomized clinical trial designed to evaluate the feasibility, safety, and effectiveness of rapidly starting multiple guideline-recommended therapies in people with type 2 diabetes and chronic kidney disease.

In current clinical practice, these medicines are usually started one at a time over many months. This step-by-step approach may delay potential benefits and leave people at continued risk of kidney disease progression and cardiovascular complications. This study will test a different approach, where these therapies are started in a structured and closely monitored way over a short period of time.

Participants will be randomly assigned to either a rapid initiation strategy or usual care. In the rapid group, up to four approved therapies will be started and adjusted over approximately 8 weeks using a structured treatment plan. In the usual care group, treatment will follow standard clinical practice, where medications are introduced gradually at the discretion of the treating clinician.

Participants in both groups will be followed for 6 months. During this time, they will have regular clinic visits and laboratory testing to monitor kidney function, potassium levels, and overall treatment tolerance.

This pilot study will provide important information on whether this rapid treatment approach can be safely implemented in real-world clinical settings and whether participants are able to start and continue multiple therapies within a short time frame.

Studietype

Ingrijpend

Inschrijving (Geschat)

64

Fase

  • Fase 4

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studiecontact

Studie Locaties

    • Texas
      • Temple, Texas, Verenigde Staten, 76508
        • Baylor Scott and White Medical Center- Temple
        • Contact:
        • Hoofdonderzoeker:
          • Shahzeb Khan, MD

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

  • Volwassen
  • Oudere volwassene

Accepteert gezonde vrijwilligers

Nee

Beschrijving

Inclusiecriteria:<\/p>

  • Patiënten van 18-84 jaar<\/li>
  • eGFR 45 tot ≤90 mL\/min\/1,73 m2<\/li>
  • UACR >200 mg\/g<\/li>
  • diagnose van T2D30<\/li>
  • ontvangen van ≤2 aanbevolen geneesmiddelenklassen volgens richtlijnen, ongeacht dosis, gedurende ≥4 weken voor screening<\/li>
  • geschikt voor alle 4 geneesmiddelen<\/li>
  • systolische bloeddruk >90 mmHg<\/li>
  • bereid om schriftelijke geïnformeerde toestemming te geven en zich te houden aan studiebezoeken.<\/li><\/ul>

    Exclusiecriteria:<\/p>

    • Type 1 diabetes<\/li>
    • elke bekende primaire niet-diabetische nierziekte (bijv. polycysteuze nierziekte, glomerulonefritis, interstitiële nefritis, enz.)<\/li>
    • geschiedenis van niertransplantatie<\/li>
    • leverziekte (bijv. aspartaattransaminase of alaninetransaminase >5 keer, of bilirubine >3 keer de bovengrens van normaal)<\/li>
    • serumkalium >5,5 mEq\/L bij baseline<\/li>
    • bekende overgevoeligheid voor enig onderzoeksgeneesmiddel<\/li>
    • levensverwachting <6 maanden<\/li>
    • actieve maligniteit of infectie<\/li>
    • broze diabetes (gedefinieerd als ernstige glycemische instabiliteit met ziekenhuisopname of spoedeisende zorg voor hypoglykemie of hyperglykemie in de afgelopen 6 maanden)<\/li>
    • hoog risico op hypoglykemie (Clarke- of Gold-score ≥4)31<\/li>
    • voorspeld 12-maandsrisico op aan hypoglykemie gerelateerde spoedeisende hulpbezoeken of ziekenhuisopnames >5% met behulp van de Kaiser Permanente hypoglykemie-voorspellingsscore32,33<\/li>
    • gebruik van hoge doses insuline (>1 eenheid\/kg\/dag).<\/li><\/ul>

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: Gerandomiseerd
  • Interventioneel model: Parallelle opdracht
  • Masker: Geen (open label)

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Actieve vergelijker: Interventionele Groep
Proefpersonen ontvangen alle vier de therapieën (medicijnen) voor chronische nierziekte tegelijkertijd.
10-40 mg per dag
".25-1.0 mg 1 keer per week"
10-40 mg per dag
Andere namen:
  • Benazepril
12.5-50 mg 3 keer per dag
Andere namen:
  • Capotopril
2,5-10 mg per dag
10-40 mg per dag
Andere namen:
  • Fosinopril
dagelijks 5-20 mg
3,75-15 mg per dag
Andere namen:
  • Moexipril
4-16 mg per dag
Andere namen:
  • Perindopril
10-40 mg per dag
Andere namen:
  • Quinapril
1,25-5 mg per dag
Andere namen:
  • Ramipril
1-4 mg per dag
Andere namen:
  • Trandolapril
40-80mg per dag
Andere namen:
  • Azilsartan
8-32 mg per dag
Andere namen:
  • Candesartancilexetil
150-300 mg per dag
Andere namen:
  • Irbesartan
25-100 mg per dag
Andere namen:
  • Losartan
20-40 mg per dag
Andere namen:
  • Olmesartan
20-80 mg per dag
Andere namen:
  • Telmisartan
80-320mg daily
Andere namen:
  • Valsartan
100 mg per dag
Andere namen:
  • Canagliflozine
10 mg per dag
Andere namen:
  • Dapagliflozine Propaandiol
10 mg per dag
Andere namen:
  • Empagliflozine
5 mg per dag
20 mg per dag
Andere namen:
  • Bexagliflozine
200-400 mg per dag
Andere namen:
  • SAR439954
Actieve vergelijker: Controlegroep
Deelnemers kregen standaardbehandeling
10-40 mg per dag
".25-1.0 mg 1 keer per week"
10-40 mg per dag
Andere namen:
  • Benazepril
12.5-50 mg 3 keer per dag
Andere namen:
  • Capotopril
2,5-10 mg per dag
10-40 mg per dag
Andere namen:
  • Fosinopril
dagelijks 5-20 mg
3,75-15 mg per dag
Andere namen:
  • Moexipril
4-16 mg per dag
Andere namen:
  • Perindopril
10-40 mg per dag
Andere namen:
  • Quinapril
1,25-5 mg per dag
Andere namen:
  • Ramipril
1-4 mg per dag
Andere namen:
  • Trandolapril
40-80mg per dag
Andere namen:
  • Azilsartan
8-32 mg per dag
Andere namen:
  • Candesartancilexetil
150-300 mg per dag
Andere namen:
  • Irbesartan
25-100 mg per dag
Andere namen:
  • Losartan
20-40 mg per dag
Andere namen:
  • Olmesartan
20-80 mg per dag
Andere namen:
  • Telmisartan
80-320mg daily
Andere namen:
  • Valsartan
100 mg per dag
Andere namen:
  • Canagliflozine
10 mg per dag
Andere namen:
  • Dapagliflozine Propaandiol
10 mg per dag
Andere namen:
  • Empagliflozine
5 mg per dag
20 mg per dag
Andere namen:
  • Bexagliflozine
200-400 mg per dag
Andere namen:
  • SAR439954

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
On-study retention rate at 6 months
Tijdsspanne: 6 months
Proportion of participants who remain on all four guideline-directed CKD therapies at maximally tolerated doses without permanent discontinuation
6 months
Sustained decline in eGFR ≥30%
Tijdsspanne: 6 months
Proportion of participants with sustained decline in estimated glomerular filtration rate (eGFR; two consecutive readings ≥2 weeks apart)
6 months
Change in UACR
Tijdsspanne: 6 months
Relative change in log-transformed urine albumin-to-creatinine ratio (UACR) from baseline to 6 months
6 months

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Enrollment rate
Tijdsspanne: 6 months
Number of participants enrolled per month
6 months
Protocol adherence
Tijdsspanne: 6 months
Proportion of participants initiating all four therapies within 8 weeks
6 months
Treatment discontinuation
Tijdsspanne: 6 months
Proportion of participants who permanently discontinue one or more therapies
6 months
Moderate Hyperkalemia
Tijdsspanne: 6 months
Incidence of potassium levels greater than 5.5 to less than or equal to 6.0 mmol/L
6 months
Severe Hyperkalemia
Tijdsspanne: 6 months
Incidence of potassium levels greater than 6.0 mmol/L
6 months
Acute Kidney Injury
Tijdsspanne: 6 months
Incidence of acute kidney injury (AKI) events (persistent estimated glomerular filtration rate decline ≥30% without return to <30% with drug discontinuation; or hospitalization with diagnosis of AKI related to medications) during the study period
6 months
End-stage kidney disease
Tijdsspanne: 6 months
Incidence of progression to end-stage kidney disease (initiation of chronic dialysis [hemo- or peritoneal dialysis] for ≥90 days or kidney transplantation, or persistent [≥2 values, including the last value if not on dialysis or transplant] estimated glomerular filtration rate <15 mL/min/1.73m^2)
6 months
Number of participants with permanent drug discontinuation
Tijdsspanne: 6 months
Number of participants with permanent discontinuation of one or more study drugs not due to study completion or death.
6 months
Rate of change in estimated glomerular filtration rate (slope)
Tijdsspanne: 6 months
Rate of change in estimated glomerular filtration rate over the 6-month study period
6 months
Change in glycated hemoglobin (HbA1c)
Tijdsspanne: 6 months
Change in glycated hemoglobin (HbA1c) levels from baseline
6 months
Number of participants who achieve >30% reduction in urine albumin-to-creatinine ratio
Tijdsspanne: 6 months
Number of participants achieving >30% reduction in urine albumin-to-creatinine ratio
6 months
Change in Kidney Disease Quality of Life-36 score
Tijdsspanne: 6 months
Change from baseline in Kidney Disease Quality of Life-36 (KDQOL-36) score. Scores range from 0 to 100, with higher scores indicating better quality of life.
6 months
Change in Patient-Reported Outcomes Measurement Information System score
Tijdsspanne: 6 months
Change from baseline in Patient-Reported Outcomes Measurement Information System (PROMIS) score. PROMIS includes seven domains: Physical Function, Anxiety, Depression, Fatigue, Sleep Disturbance, Ability to Participate in Social Roles and Activities, and Pain Interference. Each domain includes 4 items scored from 1 to 5, with raw domain scores ranging from 4 to 20, and domain scores are converted to standardized T-scores with a mean of 50 and standard deviation of 10. A separate Pain Intensity item is rated on a 0 to 10 scale, where 0 indicates no pain and 10 indicates worst imaginable pain. For Physical Function and Ability to Participate in Social Roles and Activities, higher scores indicate better health. For Anxiety, Depression, Fatigue, Sleep Disturbance, Pain Interference, and Pain Intensity, higher scores indicate greater symptom burden or worse health status.
6 months
Change in Treatment Burden Questionnaire (TBQ) score
Tijdsspanne: 6 months
Change from baseline in Treatment Burden Questionnaire (TBQ) score. TBQ is composed of 13 items rated on a Likert scale ranging from 0 (not a problem) to 10 (big problem) and assesses the burden associated with taking medicine, self-monitoring, laboratory tests, doctor visits, need for organization, administrative tasks, following advice on diet and physical activity, and social impact of the treatment. TBQ item scores can be summed into a global score, ranging from 0 to 130. Higher scores indicating greater treatment burden.
6 months
Change in Living with Medicines Questionnaire version 3 score
Tijdsspanne: 6 months
Change from baseline in Living with Medicines Questionnaire version 3 (LMQ-3) score. LMQ-3 consists of 41 items scored on a 5-point Likert scale. Total scores range from 41 to 205, with higher scores indicating greater treatment burden.
6 months

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Publicaties en nuttige links

De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.

Algemene publicaties

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  • Perkovic V, Tuttle KR, Rossing P, et al. Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. N Engl J Med. 2024;391(2):109-121. doi:10.1056/NEJMoa2403347. PubMed PMID: 38785209
  • Mayer GJ, Wanner C, Weir MR, et al. Analysis from the EMPA-REG OUTCOME® trial indicates empagliflozin may assist in preventing the progression of chronic kidney disease in patients with type 2 diabetes irrespective of medications that alter intrarenal hemodynamics. Kidney Int. 2019;96(2):489-504. doi:10.1016/j.kint.2019.02.033. PubMed PMID: 31142441
  • Neuen BL, Oshima M, Perkovic V, et al. Effects of canagliflozin on serum potassium in people with diabetes and chronic kidney disease: the CREDENCE trial. Eur Heart J. 2021;42(48):4891-4901. doi:10.1093/eurheartj/ehab497. PubMed PMID: 34423370
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  • Čelutkienė J, Čerlinskaitė-Bajorė K, Cotter G, et al. Impact of Rapid Up-Titration of Guideline-Directed Medical Therapies on Quality of Life: Insights From the STRONG-HF Trial. Circ Heart Fail. 2024;17(4):e011221. doi:10.1161/CIRCHEARTFAILURE.123.011221. PubMed PMID: 38445950
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Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start (Geschat)

30 april 2026

Primaire voltooiing (Geschat)

31 maart 2029

Studie voltooiing (Geschat)

31 maart 2029

Studieregistratiedata

Eerst ingediend

17 april 2026

Eerst ingediend dat voldeed aan de QC-criteria

17 april 2026

Eerst geplaatst (Werkelijk)

23 april 2026

Updates van studierecords

Laatste update geplaatst (Werkelijk)

8 mei 2026

Laatste update ingediend die voldeed aan QC-criteria

7 mei 2026

Laatst geverifieerd

1 april 2026

Meer informatie

Termen gerelateerd aan deze studie

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • 026-271

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

JA

Beschrijving IPD-plan

Individual participant data (IPD) that underlie the results reported in this study, after deidentification, will be shared. Shared data will include patient-level clinical and laboratory data, along with a data dictionary (README file) to facilitate interpretation.

Data will be made available through the Vivli data sharing platform. Prior to external sharing, all data will undergo internal review to ensure removal of identifiable information and compliance with institutional legal and ethical requirements.

Data will be available for a minimum of 10 years and access will be provided in accordance with participant informed consent and applicable regulatory and institutional policies.

IPD-tijdsbestek voor delen

Data will become available after publication of the primary results and will remain available on Vivli for a minimum of 10 years.

IPD-toegangscriteria voor delen

Access will be provided to qualified researchers through the Vivli data sharing platform. Prior to sharing, all data will undergo internal review to ensure removal of identifiable information and compliance with institutional legal and ethical requirements. Data sharing will be conducted in accordance with participant informed consent and applicable regulatory and institutional policies.

IPD delen Ondersteunend informatietype

  • LEERPROTOCOOL

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Ja

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

product vervaardigd in en geëxporteerd uit de V.S.

Nee

Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .

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