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A Prompt REstart Study of Renin-Angiotensin System Inhibitors After Acute Kidney Injury (APRES-AKI)

2026年9月4日 更新者：University of California, San Francisco

The goal of this pilot clinical trial is to learn if early restart of renin-angiotensin system inhibitor (RASi) medications is feasible and well-tolerated in hospitalized patients with acute kidney injury (AKI). Researchers will compare early RASi restart to usual care.

Study participants will restart RASi per study protocol, obtain a lab test in 1-2 weeks if RASi restarted in the hospital and not collected as part of routine care, and answer questions at the 90-day follow-up.

研究概览

地位

招聘中

条件

干预/治疗

详细说明

Among at-risk patients with heart failure and chronic kidney disease, use of RASi medications decreases the subsequent risk of adverse events such as cardiovascular death and kidney disease progression. However, RASi treatment is often stopped when AKI is detected in the hospital based on the notion that restoring an intact renin-angiotensin system in the context of hypovolemia or hypotension may be helpful to maintain perfusion to the glomeruli and thus support the glomerular filtration rate.

In observational studies, restart of RASi medications among at-risk patients after AKI has been associated with decreased subsequent rates of mortality, cardiovascular events, and kidney disease progression. However, there is no rigorous evidence from randomized trials to guide optimal strategy of RASi restart after AKI.

This is a pilot trial among hospitalized patients with AKI whose RASi were held to investigate the feasibility and tolerability of a strategy of early RASi restart (n=30) compared to usual care (n=30). This pilot trial will provide valuable data critical to inform the design of a larger definitive trial.

The study hypothesis is that the strategy of early RASi restart after AKI is feasible and well-tolerated. This pilot trial will inform the design of a larger definitive trial to determine whether early RASi restart can increase rates of RASi use at 90 days compared to usual care.

研究类型

介入性

注册 (估计的)

60

阶段

  • 第四阶段

联系人和位置

本节提供了进行研究的人员的详细联系信息，以及有关进行该研究的地点的信息。

学习联系方式

学习地点

  • 美国
    • California
      • San Francisco、California、美国、94143
        • 招聘中
        • University of California, San Francisco
        • 接触：

参与标准

研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。

资格标准

适合学习的年龄

  • 成人
  • 年长者

接受健康志愿者

不

描述

Inclusion Criteria:

  • Age ≥ 18 years
  • Pre-admission RASi use for Class I indication (e.g., heart failure, kidney disease)
  • RASi stopped in the setting of AKI (defined by ≥1.5x baseline SCr)
  • AKI in recovery (defined by a decrease in SCr by ≥0.3mg/dL from peak)

Exclusion Criteria:

  • RASi allergy or contraindication (i.e., angioedema, bilateral renal artery stenosis)
  • Ongoing dialysis requirement
  • Pregnant or breastfeeding
  • Prisoner
  • Palliative or hospice care involvement
  • Unable to consent
  • No enteral route of medication administration
  • Clinician judgment

学习计划

本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。

研究是如何设计的？

设计细节

  • 主要用途：治疗
  • 分配：随机化
  • 介入模型：并行分配
  • 屏蔽：无（打开标签）

武器和干预

参与者组/臂
干预/治疗
有源比较器：Usual care
RASi restart will be deferred to the study participant's providers.
药品：Usual Care
RASi restart will be deferred to the study participant's providers.
实验性的：Early RASi restart strategy
The early restart strategy is to resume RASi as soon as the serum creatinine (SCr) downtrends by ≥0.3mg/dL from peak. In addition, the following criteria must be met: most recent potassium ≤5mEq/L, SCr-based eGFR reported as ≥15 mL/min/1.73m2, and average systolic blood pressure≥120mmHg 12 hours prior to restart. If the study participant is discharged from the hospital before the RASi restart criteria are met, management of RASi restart would be deferred to the discretion of longitudinal outpatient healthcare team.
药品：Early RASi restart strategy
The early restart strategy is to resume RASi as soon as the serum creatinine (SCr) downtrends by ≥0.3mg/dL from peak. In addition, the following criteria must be met: most recent potassium ≤5mEq/L, CKD-EPI SCr-based eGFR reported as ≥15 mL/min/1.73m2, and average SBP ≥120mmHg 12 hours prior to restart. If the study participant is discharged from the hospital before the RASi restart criteria are met, management of RASi restart would be deferred to the discretion of longitudinal outpatient healthcare team.
其他名称：
  • renin-angiotensin system inhibitors

研究衡量的是什么？

主要结果指标

结果测量
措施说明
大体时间
Feasibility- RASi use separation
大体时间：From date of enrollment until date of hospital discharge or up to 90 days if remains in the hospital
Proportion of patients in the early RASi restart arm and the usual care arm who restart RASi within 72 hours of SCr downtrending by ≥0.3mg/dL from peak SCr and at hospital discharge
From date of enrollment until date of hospital discharge or up to 90 days if remains in the hospital

次要结果测量

结果测量
措施说明
大体时间
Tolerability- 90 day follow up completion
大体时间：Up to 90 days
Proportion of participants who complete 90 day follow up
Up to 90 days
Tolerability- Lab evaluation post RASi
大体时间：Up to 2 weeks post hospital discharge or 90 days if patient remains in the hospital
Proportion with potassium and SCr evaluations within 1-2 weeks of RASi restart
Up to 2 weeks post hospital discharge or 90 days if patient remains in the hospital
Tolerability- SCr evaluation after hospital discharge
大体时间：Up to 90 days
Proportion with SCr evaluation after hospital discharge
Up to 90 days
Tolerability- Proteinuria evaluation
大体时间：Up to 90 days
Proportion with proteinuria evaluation after hospital discharge
Up to 90 days

其他结果措施

结果测量
措施说明
大体时间
Screening-to-recruitment ratio
大体时间：Total study duration, anticipated 2.5 years, up to 4 years total
Number of patients screened divided by the number of patients enrolled
Total study duration, anticipated 2.5 years, up to 4 years total
Adverse events
大体时间：Up to 90 days
Total number of adverse events and number of adverse events attributable to study intervention. Adverse events include: hyperkalemia (>5.5mEq/L and >6mEq/L), recurrent AKI (minor (30-<50% decline) versus major (>=50% decline) in eGFR), symptomatic hypotension or hypertension, emergency room visits, hospitalizations, increase index hospital length of stay
Up to 90 days
90 day RASi use
大体时间：Up to 90 days
Proportion with RASi use at 90 days
Up to 90 days
Cumulative RASi exposure
大体时间：Up to 90 days
Number of days with RASi use
Up to 90 days
Days to RASi restart
大体时间：Up to 90 days
Days to RASi restart from day of peak SCr
Up to 90 days

合作者和调查者

在这里您可以找到参与这项研究的人员和组织。

赞助

University of California, San Francisco

合作者

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

调查人员

  • 首席研究员：Yuenting D Kwong, MD MAS、University of California, San Francisco

研究记录日期

这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。

研究主要日期

学习开始 (实际的)

2026年9月1日

初级完成 (估计的)

2029年3月1日

研究完成 (估计的)

2029年3月1日

研究注册日期

首次提交

2026年7月16日

首先提交符合 QC 标准的

2026年7月23日

首次发布 (实际的)

2026年7月29日

研究记录更新

最后更新发布 (实际的)

2026年9月8日

上次提交的符合 QC 标准的更新

2026年9月4日

最后验证

2026年9月1日

更多信息

与本研究相关的术语

关键字

其他相关的 MeSH 术语

其他研究编号

  • 25-45052
  • K23DK139456 (美国 NIH 拨款/合同)

计划个人参与者数据 (IPD)

计划共享个人参与者数据 (IPD)？

是的

IPD 计划说明

Individual participant data collected after deidentification

IPD 共享支持信息类型

  • 研究方案

药物和器械信息、研究文件

研究美国 FDA 监管的药品

是的

研究美国 FDA 监管的设备产品

不

在美国制造并从美国出口的产品

不

此信息直接从 clinicaltrials.gov 网站检索，没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求，请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改，我们的网站上也会自动更新.

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