Trace Element Replenishment Study in Hemodialysis Patients

NCT ID: NCT01473914

Last Updated: 2016-12-16

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

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-11-30

Study Completion Date

2014-01-31

Brief Summary

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A pilot randomized trial that compares a new renal nutritional supplement with the standard renal vitamin.

The primary objective is to compare two doses (medium and high) of the new supplement with the renal vitamin currently being prescribed to people with End Stage Renal Disease (ESRD).

Secondary objective is to demonstrate the feasibility of recruitment for a definitive larger trial.

Detailed Description

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People with severe kidney disease follow a restricted diet aimed at reducing intake of sodium, potassium and phosphate. These dietary restrictions require reducing their intake of many fresh fruits and vegetables, which may lead to nutritional deficiency. Although the potential for malnutrition in people with kidney disease is well recognized, blood levels of most vitamins and trace elements are rarely measured. Instead, most North Americans with severe kidney disease are routinely prescribed a "renal vitamin" such as Replavite which contains a mixture of B and C vitamins.

Recent evidence (including our work; see http://www.biomedcentral.com/bmcmed/subjects/nephrology) indicates that people with severe kidney disease are often deficient in several other biologically essential substances (selenium, zinc) that are readily amenable to supplementation. Pilot data from the Northern Alberta Renal Program (NARP) indicate that approximately 90% of patients have zinc levels below the lower limit of normal; findings for selenium are similar.

Potential benefits of zinc supplementation include improvements in immune function, taste sensitivity (perhaps reducing dietary sodium intake), and improved appetite. Potential benefits of selenium supplementation include reductions in the risk of vascular disease and infection. Supplementation with vitamin E was shown in a randomized trial to reduce serious cardiovascular morbidity in people with kidney failure, but is not routinely used in dialysis patients. This suggests that supplementation of zinc, selenium, and vitamin E has theoretical benefits in kidney failure. Since patients with kidney failure already take many medications, it is logical to combine any new nutritional supplements with the ingredients of the standard renal vitamin to reduce pill burden.

This protocol concerns a novel nutritional supplement consisting of zinc, selenium and vitamin E in addition to the contents of the standard renal supplement of B and C vitamins.

This pilot randomized, double blind trial will compare 2 doses of the new supplement with the standard renal vitamin.

2.0 Objectives: Primary objective: compare two formulations of the new supplement (low and medium doses of zinc and selenium) with standard treatment (Replavite or equivalent renal vitamin).

Secondary objective: demonstrate the feasibility of recruitment for a definitive larger trial

Conditions

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End Stage Renal Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Low dose

Standard renal vitamin plus low dose zinc and selenium plus vitamin E

1 capsule p.o, daily

Group Type EXPERIMENTAL

Low dose: supplemental zinc, selenium and vitamin E

Intervention Type DIETARY_SUPPLEMENT

1. ZINC 25mg (AS ZINC SULFATE)
2. SELENIUM 50 mcg (AS SODIUM SELENITE)
3. VITAMIN E (D-ALPHA-TOCOPHEROL) (AS SUCCINATE) 250 IU

Standard renal vitamin: B and C renal vitamin

Intervention Type DIETARY_SUPPLEMENT

1. BIOTIN 300 MCG
2. D-PANTOTHENIC ACID (CALCIUM D-PANTOTHENATE) 10 MG
3. FOLIC ACID 1 MG
4. NIACINAMIDE 20 MG
5. VITAMIN B1 (THIAMINE MONONITRATE) 1.5 MG
6. VITAMIN B12(CYANOCOBALAMIN) 6 MCG
7. VITAMIN B2 (RIBOFLAVIN) 1.7 MG
8. VITAMIN B6 (PYRIDOXINE HYDROCHLORIDE) 10 MG
9. VITAMIN C (ASCORBIC ACID) 100 MG
10. INERT FILLER (CORNSTARCH)

Medium dose

Standard renal vitamin plus medium doses of zinc and selenium plus vitamin E

1 capsule p.o, daily

Group Type EXPERIMENTAL

Standard renal vitamin: B and C renal vitamin

Intervention Type DIETARY_SUPPLEMENT

1. BIOTIN 300 MCG
2. D-PANTOTHENIC ACID (CALCIUM D-PANTOTHENATE) 10 MG
3. FOLIC ACID 1 MG
4. NIACINAMIDE 20 MG
5. VITAMIN B1 (THIAMINE MONONITRATE) 1.5 MG
6. VITAMIN B12(CYANOCOBALAMIN) 6 MCG
7. VITAMIN B2 (RIBOFLAVIN) 1.7 MG
8. VITAMIN B6 (PYRIDOXINE HYDROCHLORIDE) 10 MG
9. VITAMIN C (ASCORBIC ACID) 100 MG
10. INERT FILLER (CORNSTARCH)

Medium dose: supplemental zinc, selenium and vitamin E

Intervention Type DIETARY_SUPPLEMENT

1. ZINC 50 mg (AS ZINC SULFATE)
2. SELENIUM 75 mcg (AS SODIUM SELENITE)
3. VITAMIN E (D-ALPHA-TOCOPHEROL) (AS SUCCINATE) 250 IU

Standard treatment

Standard renal vitamin

1 capsule p.o, daily

Group Type ACTIVE_COMPARATOR

Standard renal vitamin: B and C renal vitamin

Intervention Type DIETARY_SUPPLEMENT

1. BIOTIN 300 MCG
2. D-PANTOTHENIC ACID (CALCIUM D-PANTOTHENATE) 10 MG
3. FOLIC ACID 1 MG
4. NIACINAMIDE 20 MG
5. VITAMIN B1 (THIAMINE MONONITRATE) 1.5 MG
6. VITAMIN B12(CYANOCOBALAMIN) 6 MCG
7. VITAMIN B2 (RIBOFLAVIN) 1.7 MG
8. VITAMIN B6 (PYRIDOXINE HYDROCHLORIDE) 10 MG
9. VITAMIN C (ASCORBIC ACID) 100 MG
10. INERT FILLER (CORNSTARCH)

Interventions

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Low dose: supplemental zinc, selenium and vitamin E

1. ZINC 25mg (AS ZINC SULFATE)
2. SELENIUM 50 mcg (AS SODIUM SELENITE)
3. VITAMIN E (D-ALPHA-TOCOPHEROL) (AS SUCCINATE) 250 IU

Intervention Type DIETARY_SUPPLEMENT

Standard renal vitamin: B and C renal vitamin

1. BIOTIN 300 MCG
2. D-PANTOTHENIC ACID (CALCIUM D-PANTOTHENATE) 10 MG
3. FOLIC ACID 1 MG
4. NIACINAMIDE 20 MG
5. VITAMIN B1 (THIAMINE MONONITRATE) 1.5 MG
6. VITAMIN B12(CYANOCOBALAMIN) 6 MCG
7. VITAMIN B2 (RIBOFLAVIN) 1.7 MG
8. VITAMIN B6 (PYRIDOXINE HYDROCHLORIDE) 10 MG
9. VITAMIN C (ASCORBIC ACID) 100 MG
10. INERT FILLER (CORNSTARCH)

Intervention Type DIETARY_SUPPLEMENT

Medium dose: supplemental zinc, selenium and vitamin E

1. ZINC 50 mg (AS ZINC SULFATE)
2. SELENIUM 75 mcg (AS SODIUM SELENITE)
3. VITAMIN E (D-ALPHA-TOCOPHEROL) (AS SUCCINATE) 250 IU

Intervention Type DIETARY_SUPPLEMENT

Other Intervention Names

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Replavite

Eligibility Criteria

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Inclusion Criteria

1. Stable on hemodialysis for 3 to 36 months
2. Age greater or equal to 18 years
3. Receiving Replavite or equivalent renal vitamin at baseline
4. Receiving 3 dialysis treatments per week

Exclusion Criteria

1. Pregnant (sexually active pre-menopausal females must have negative serum pregnancy test at baseline)
2. Pregnancy, kidney transplantation, a dialysis modality switch, or gastrointestinal surgery planned within 6 months
3. Known allergy to corn starch
4. Known allergy to zinc, selenium, vitamin E or renal vitamin.
5. Projected life expectancy of \<6 months
6. Any other conditions or procedures that, in the opinion of the investigator, would impede absorption of the study product.
7. Participants already taking a vitamin E, zinc or selenium supplement (alone or included in another multi-vitamin).
8. Individuals with a history of head or neck cancer in the past 5 years.
9. Ostomy or short gut syndrome.
10. Enroll in another (interventional) trial.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Alberta Health services

OTHER

Sponsor Role collaborator

Marcello Tonelli

OTHER

Sponsor Role lead

Responsible Party

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Marcello Tonelli

MD, Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Marcello A Tonelli, MD

Role: PRINCIPAL_INVESTIGATOR

University of Alberta

Locations

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University of Calgary

Calgary, Alberta, Canada

Site Status

University of Alberta

Edmonton, Alberta, Canada

Site Status

Countries

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Canada

References

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Tonelli M, Wiebe N, Thompson S, Kinniburgh D, Klarenbach SW, Walsh M, Bello AK, Faruque L, Field C, Manns BJ, Hemmelgarn BR; Alberta Kidney Disease Network. Trace element supplementation in hemodialysis patients: a randomized controlled trial. BMC Nephrol. 2015 Apr 11;16:52. doi: 10.1186/s12882-015-0042-4.

Reference Type RESULT
PMID: 25884981 (View on PubMed)

Colombijn JM, Hooft L, Jun M, Webster AC, Bots ML, Verhaar MC, Vernooij RW. Antioxidants for adults with chronic kidney disease. Cochrane Database Syst Rev. 2023 Nov 2;11(11):CD008176. doi: 10.1002/14651858.CD008176.pub3.

Reference Type DERIVED
PMID: 37916745 (View on PubMed)

Related Links

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http://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-015-0042-4

Published open access article with final results

Other Identifiers

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TRSV1

Identifier Type: -

Identifier Source: org_study_id