Metabolic Acidosis in Renal Transplant Patients

NCT ID: NCT00913796

Last Updated: 2010-10-22

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2007-12-31
• Study Completion Date: 2010-03-31

Brief Summary

Acidosis (accumulation of acid in the body) may be an underrecognized problem in patients after renal transplantation. It may have consequences on physical performance due to negative effects on bone and muscle metabolism.

Therefore, the purpose of this study is

1. to determine the status of physical capacity and bone structure in renal transplant patients with metabolic acidosis

2. to study the effect of substituting base equivalents (citrate) on acid/base status of renal transplant patients with acidosis

3. to compare the status of physical capacity and bone structure in renal transplant patients with metabolic acidosis before and after substitution with citrate

Detailed Description

Chronic kidney disease is developing to become one of the major health problems in the Western world with more than one million patients on renal replacement therapy, and many more expected in the years ahead [1]. Survival of patients with end stage renal disease has become possible with the introduction of dialysis therapy. Renal transplantation has resulted both in further reduction of mortality and improvement in quality of life for patients with end stage renal disease. Nevertheless, successful transplantation with regard to graft and patient survival is still associated with significant morbidity. Apart from infectious complications and cardiovascular disease, limitations in physical capacity from musculoskeletal disorders have become a relevant problem, resulting in reduced quality of life, poor physical functioning and inability to work.

Muscle and bone metabolism in chronic kidney disease are typically disturbed resulting in significant pathology and dysfunction of the affected tissues. They are associated with metabolic disorders related to renal insufficiency, among which metabolic acidosis is a major contributor. Metabolic acidosis is a well recognized problem in renal transplant patients. However, its prevalence, pathogenesis, course and sequelae are not well established. In particular, its relation to post-transplant bone and muscle disorders, and the impact on physical capabilities in renal transplant patients have not been comprehensively investigated so far.

The purpose of the proposed project is to examine the characteristics and pathogenesis of post-transplant metabolic acidosis, and its relation to bone and muscle pathologies and impact on physical capabilities in renal transplant patients. In particular, the following aims are proposed to investigate in de novo and long-term renal transplantation:

Aim # 1: To examine the type, degree and course of metabolic acidosis in renal transplant patients, early and long-term after transplantation

Aim # 2: To examine alterations in mineral and bone metabolism, and bone structure, and their relationship to the acid/base disorder

Aim # 3: To examine overall physical performance, exercise capacity and muscle energy content, and their relationship to the acid/base disorder

In order to analyze secondary effects of subclinical and overt acidosis on bone (Aim # 2) and muscle (Aim # 3), patients will be studied at baseline, and then be supplemented with base equivalents in order to achieve a stable plasma serum bicarbonate concentration of 24-26 mmol/l, and be reexamined thereafter. Completion of the three aims will allow to comprehensively analyze the pathogenesis of and interrelations between acid/base status, mineral metabolism, bone disorders and muscle function in renal transplant patients. This will be the first study to link metabolic alterations to structural and functional measures of the musculoskeletal system, and to the impact of the resulting pathologies on physical disabilities in patients with a kidney graft. We are in dire need to know the magnitude of the problem, whether to treat, and how aggressive to treat these patients. The results of this project will be indispensable regarding justification to rigorously evaluate and treat metabolic acidosis in patients with chronic renal insufficiency and after transplantation.

Conditions

Renal Transplant Patients; Metabolic Acidosis; Physical Capacity; Bone Disease; Mineral Metabolism

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Postassium citrate

Aim: correction of metabolic acidosis

Group Type: EXPERIMENTAL

Potassium citrate

Intervention Type: DRUG

2.41 gram of citrate b.i.d. for 12 months. Dosage to be adjusted according to serum potassium concentration.

Potassium chloride

Potassium chloride is given to compensate for any possible effects of potassium in potassium citrate (primary treatment).

Group Type: ACTIVE_COMPARATOR

Potassium chloride

Intervention Type: DRUG

370 mg potassium t.i.d. for 12 months. Dosage to be adjusted according to serum postassium concentration.

Interventions

Potassium citrate

2.41 gram of citrate b.i.d. for 12 months. Dosage to be adjusted according to serum potassium concentration.

Intervention Type: DRUG

Potassium chloride

370 mg potassium t.i.d. for 12 months. Dosage to be adjusted according to serum postassium concentration.

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• Patients with a renal graft having been transplanted within the previous 8 years and being at least 3 months post transplantation, or, patients scheduled to undergo transplantation from a living organ donor within the upcoming 3 months
• Venous serum bicarbonate concentration < 24 mmol/L at time of baseline determination
• Renal transplant function with a calculated glomerular filtration rate (GFR) greater or equal 30 ml/min according to the Cockcroft-Gault formula
• Immunosuppressive therapy including a calcineurin inhibitor (cyclosporine A or tacrolimus)
• Age 20 through 65 years of either sex
• Written informed consent for study participation

Exclusion Criteria

• Acute rejection episode requiring specific therapy within 4 weeks before study inclusion
• Severe impairment in general health and/or physical handicaps (malignant neoplasia, catabolic state, acute systemic infection requiring therapy)
• Mental illness, psychiatric disorder
• Tetracycline intolerance
• Planned or "overt" pregnancy

• Minimum Eligible Age: 20 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Texas Southwestern Medical Center

OTHER

Sponsor Role: collaborator

Swiss Federal Institute of Technology

OTHER

Sponsor Role: collaborator

University of Zurich

OTHER

Sponsor Role: lead

Responsible Party

University Hospital Zurich

Principal Investigators

Patrice M. Ambühl, M.D.

Role: PRINCIPAL_INVESTIGATOR

University of Zurich

Locations

University Hospital of Zurich

Zurich, Canton of Zurich, Switzerland

Countries

Switzerland

References

Starke A, Corsenca A, Kohler T, Knubben J, Kraenzlin M, Uebelhart D, Wuthrich RP, von Rechenberg B, Muller R, Ambuhl PM. Correction of metabolic acidosis with potassium citrate in renal transplant patients and its effect on bone quality. Clin J Am Soc Nephrol. 2012 Sep;7(9):1461-72. doi: 10.2215/CJN.01100112. Epub 2012 Jul 5.

Reference Type: DERIVED

PMID: 22773591 (View on PubMed)

Other Identifiers

3200B0-112299

Identifier Type: -

Identifier Source: org_study_id