Revascularization of Renal Artery Stenosis Versus Medical Therapy for the Treatment of Ischemic Nephropathy

NCT ID: NCT01023373

Last Updated: 2009-12-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2003-10-31

Study Completion Date

2009-05-31

Brief Summary

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The aim of the study is to value, in patients with chronic kidney disease and hypertension, whether medical therapy plus interventional renal artery revascularization is superior to medical therapy alone for the treatment of hemodynamically significant (\>70%) atherosclerotic renal artery stenosis, diagnosed by duplex doppler ultrasonography and confirmed by magnetic resonance angiography, in terms of avoidance of the progression of renal damage, control of hypertension and in reducing the cerebro and cardiovascular complications.

Detailed Description

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Atherosclerotic renovascular disease (ARVD), due to renal hypoperfusion caused by mono or bilateral renal artery stenosis (RAS), is a increasing cause of chronic kidney disease and many elderly patients start dialysis due to ARDVD. Moreover ARVD is frequently progressive and reduces life-expectancy more than other causes of end stage renal disease, with a mortality rate higher than in patients with stable angina, similar to that of patients operated for colon cancer.

Unfortunately, there is not a definite therapy to cure this disease, despite important advancements in both medical therapy and in interventional radiology. Aim of the study is to see whether percutaneous transluminal interventional radiology plus stenting (PTRS) of the renal artery offers more, in terms of both preventing the progression of renal failure and controlling the hypertension, compared with the medical therapy addressed to control hypertension, improve the dyslipidemic profile and optimise the platelet anti-aggregant therapy, following the most recent guidelines. The eligible patients will be centrally randomized to:

1. medical treatment with hypotensive drugs (all class of hypotensive agents will be used according to single-center experience including drugs agent on renin-angiotensin-aldosterone-system, when permitted), lipid lowering therapy (namely all class of statins-or hydroxymethylglutaryl-coA reductase inhibitors)and anti-platelet (acetylsalicylate and/or ticlopidine or clopidrogel according to single-center experience) or to
2. the same medical therapy, as previously described in group a, associated with PTRS, according to a standardized protocol, with a follow up at 2 years extended to other 2 years

Conditions

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Atherosclerosis Chronic Kidney Disease Hypertension, Renovascular Ischemic Nephropathy Renal Artery Stenosis

Keywords

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Angioplasty Atherosclerotic reno vascular disease (ARVD) Cardio- and cerebro- vascular comorbidity End stage renal disease (ERSD) kidney diseases High blood pressure Hypertension Ischemic nephropathy Percutaneous transluminal renal artery stenting (PTRS) Randomized controlled trials Renal artery stenosis (RAS) Renal insufficiency Vascular diseases

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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B:PTRS

B: the same medical therapy, as previously described in group A, associated with PTRS

Group Type EXPERIMENTAL

PTRS

Intervention Type PROCEDURE

Percutaneous transluminal renal artery stenting. The same medical therapy, as in group A, plus PTRS

renal artery stent

Intervention Type DEVICE

Non-drug intervention, percutaneous transluminal renal artery stent angioplasty

renal artery stent

Intervention Type DEVICE

Adding the renal artery stenting (in group B) to the optimal medical therapy (as in group A) that includes hypotensive drugs, statins and antiplatelet therapy

A:medical therapy

hypotensive drugs, statins and antiplatelet therapy

Group Type ACTIVE_COMPARATOR

Medical treatment

Intervention Type DRUG

hypotensive drugs, statins and anti-platelets

renal artery stent

Intervention Type DEVICE

Adding the renal artery stenting (in group B) to the optimal medical therapy (as in group A) that includes hypotensive drugs, statins and antiplatelet therapy

Interventions

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Medical treatment

hypotensive drugs, statins and anti-platelets

Intervention Type DRUG

PTRS

Percutaneous transluminal renal artery stenting. The same medical therapy, as in group A, plus PTRS

Intervention Type PROCEDURE

renal artery stent

Non-drug intervention, percutaneous transluminal renal artery stent angioplasty

Intervention Type DEVICE

renal artery stent

Adding the renal artery stenting (in group B) to the optimal medical therapy (as in group A) that includes hypotensive drugs, statins and antiplatelet therapy

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Age ≤ 80 years
* Presence of ostial renal artery stenosis ≥ 70% (determined by Duplex Doppler ultrasonography and confirmed by Magnetic Resonance valuated by at least two experienced operators)
* Serum creatinine ≤ 3 mg/dl and/or creatinine clearance (Modification of Diet in Renal Disease, MDRD formula)≥ 30 ml/min, defined as stage 3 or greater CKD based on National Kidney Foundation classification
* Longitudinal ultrasonographic diameter of the stenotic kidney ≥ 8 cm
* Blood pressure values ≤ 150/90 mmHg with the use of less than four hypotensives drugs

Exclusion Criteria

* Age \> 80 years
* Other well-known nephropathy cause of renal failure
* Duplex doppler ultrasonography Resistive Index values \>0.8
* Total occlusion of renal artery lumen
* Occurrence of cerebral or cardiac vascular diseases in the 6 months before the enrolment in the study
* Malignancy with a life expectation less than one year
* Previous documented cholesterol thrombo embolization episodes (clinically, bioptically or instrumentally)
* Liver failure
* Cardiac failure (NYHA IV class) or instable angina
* Well-known intolerance or contraindications to the use of iodinated contrast media, to statins or to anti platelets drugs
* Previous renal angioplasty
* Pregnancy
Minimum Eligible Age

45 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Azienda Unita Sanitaria Locale di Piacenza

OTHER

Sponsor Role lead

Responsible Party

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Divisione Nefrologia e Dialisi, da Saliceto Hospital, AUSL Piacenza, Italy

Principal Investigators

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Roberto Scarpioni

Role: PRINCIPAL_INVESTIGATOR

Divisione Nefrologia e Dialisi, "Guglielmo da Saliceto" Hospital, Azienda USL Piacenza, Italy

Emanuele Michieletti

Role: PRINCIPAL_INVESTIGATOR

U.O. Radiologia II "Guglielmo da Saliceto" Hospital, Piacenza

Locations

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Divisione di Nefrologia e Dialisi, "Guglielmo da Saliceto" Hospital, Azienda USL Piacenza

Piacenza, Piacenza, Italy

Site Status

Countries

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Italy

References

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Scarpioni R, Michieletti E, Cristinelli L, Ugolotti U, Scolari F, Venturelli C, Cancarini G, Pecchini P, Malberti F, Maroldi R, Rozzi G, Olivetti L. Atherosclerotic renovascular disease: medical therapy versus medical therapy plus renal artery stenting in preventing renal failure progression: the rationale and study design of a prospective, multicenter and randomized trial (NITER). J Nephrol. 2005 Jul-Aug;18(4):423-8.

Reference Type RESULT
PMID: 16245247 (View on PubMed)

Other Identifiers

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388-2002

Identifier Type: -

Identifier Source: org_study_id