Collaborative Research on HFR High Flux

NCT ID: NCT01492491

Last Updated: 2016-06-14

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

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-09-30

Study Completion Date

2013-03-31

Brief Summary

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The purpose of this study is to evaluate the serum concentrations of antoxidant vitamines A, C, E, inflammatory cytokines and middle-large toxins in patients treated with online hemodiafiltration, standard HFR and SUPRA-HFR.

Detailed Description

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Today, as the research work of EUTOX group highlights, large cytokines and protein-bound solutes are gaining a relevant attention because of their emerging role as mortality predictors.

Online hemodiafiltration (online HDF) has demonstrated to offer a significant depuration for small and middle toxins, but removal of protein-bound solutes is scarce. Synthetic high-flux membranes do not allow infact significant removal of molecules heavier than 15-20 KDa. Super-flux membranes may enhance online HDF convective transport but it would surely expose the patient to unacceptable losses of albumin, vitamines and aminoacids because of the non selectivity of the convective transport.

HFR is a renal replacement therapy that utilizes convection, diffusion and adsorption. It uses a double-stage filter that consists of a high-flux polyethersulfone hemofilter in the first convective stage and a low-flux polyethersulfone filter in the second diffusive stage. The stages of the filter allow complete separation of convection from diffusion. The convective part of the first stage allows pure ultrafiltrate (UF) to pass through a sorbent resin cartridge. The first convective/adsorption stage has no net fluid removal. The blood and reinfused clean UF then undergo traditional dialysis. The second stage works by classicaHD and in this final stage the weight loss occurs. HFR has demonstrated in various clinical trials to reduce the microinflammatory state with no albumin loss and minimal aminoacids losses, thanks to the high selectivity of the resin sorbent.

SUPRA-HFR is a newly developed HDF therapy based on the HFR concept scheme, which includes a super-flux membrane in the first section, coupled with an empowered resin sorbent. This should significantly enhance large solutes depuration, overcoming online HDF flaws.

Therefore we proposed a prospective, multicenter, randomized study comparing online HDF, standard HFR and SUPRA-HFR. After a wash-out stabilization period of 4 months in post-dilution online HDF, an expected number of 50 patients will be randomized either in standard HFR (25) or in SUPRA-HFR (25) and followed for 6 months. Primary end points focus on the the removal of protein-bound solutes, inflammation and nutritional state. In addition, ESAs doses and hemoglobin levels will be assessed and compared between treatment groups.

This study will provide strong evidence on the safe and clinically effective use of super-flux membranes, introduced with SUPRA-HFR therapy. It is highly likely that the outcomes of this study will affect the daily clinical practice of Italian and European dialysis centers because of the potential innovation brought to the market.

The following hypotheses will be tested:

* SUPRA-HFR selectivity will reduce consistently the albumin, aminoacids and vitamines A, C, E losses compared to online HDF.
* SUPRA-HFR better preservation of the nutritional parameters, coupled with the possibility to remove protein-bound toxins and cytokines should lead to a higher reduction of the microinflammatory status, compared to online HDF and to standard HFR.
* SUPRA-HFR impact on inflammation status should ameliorate the anemia management by reducing the administered ESAs doses.

Conditions

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Inflammation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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standard HFR therapy

standard HFR hemodiafiltration therapy

Group Type NO_INTERVENTION

No interventions assigned to this group

SUPRA-HFR therapy

SUPRA-HFR hemodiafiltration therapy

Group Type ACTIVE_COMPARATOR

SUPRA-HFR

Intervention Type DEVICE

usual dialytic prescription for duration, frequency, acid buffer and anticoagulation regimen.

Interventions

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SUPRA-HFR

usual dialytic prescription for duration, frequency, acid buffer and anticoagulation regimen.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* dialysis vintage \> 6 months
* well functioning vascular access (QB \> 300 mL/min)
* informed consent given

Exclusion Criteria

* polycystic kidney disease (PKD)
* significant acute or chronic inflammatory comorbidities
* non-renal related anemia
* blood transfusions in the last 2 months before enrollment
* alcohol or drugs abuse
* malignant neoplasm
* hemoglobinopathy or myelopathy
* pregnancy
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Bellco s.r.l.

UNKNOWN

Sponsor Role collaborator

Istituto Superiore di Sanità

OTHER

Sponsor Role collaborator

Azienda Sanitaria Locale di Cagliari

OTHER

Sponsor Role lead

Responsible Party

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Piergiorgio Bolasco

Head Physician

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Piergiorgio Bolasco, MD

Role: PRINCIPAL_INVESTIGATOR

Azienda Sanitaria Locale di Cagliari

Locations

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Territorial dialysis service, Regional Health system nephrology and dialysis department

Cagliari, , Italy

Site Status

Nephrology and dialysis, SS. Trinità Hospital

Cagliari, , Italy

Site Status

Nephrology and dialysis, Civil Hospital

La Maddalena, , Italy

Site Status

Nephrology and dialysis, Civil Hospital

Lanusei, , Italy

Site Status

Nephrology and dialysis department, Versilia Hospital

Lido di Camaiore, , Italy

Site Status

Nephrology and dialysis department, Civil Hospital

Macomer, , Italy

Site Status

Nephrology and dialysis, San Francesco Hospital

Nuoro, , Italy

Site Status

Nephrology and dialysis, San Martino Hospital

Oristano, , Italy

Site Status

Nephrology and dialysis department, Bonaria Hospital

San Gavino Monreale, , Italy

Site Status

Nephrology and dialysis, San Camillo Hospital

Sorgono, , Italy

Site Status

Nephrology and dialysis, Dettori Hospital

Tempio, , Italy

Site Status

Countries

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Italy

References

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Wratten ML, Ghezzi PM. Hemodiafiltration with endogenous reinfusion. Contrib Nephrol. 2007;158:94-102. doi: 10.1159/000107239.

Reference Type BACKGROUND
PMID: 17684347 (View on PubMed)

Bolasco PG, Ghezzi PM, Serra A, Corazza L, Murtas S, Mascia M, Cossu M, Ferrara R, Cogoni G, Cadinu F, Casu D, Contu B, Passaghe M, Ghisu T, Ganadu M, Logias F. Hemodiafiltration with endogenous reinfusion with and without acetate-free dialysis solutions: effect on ESA requirement. Blood Purif. 2011;31(4):235-42. doi: 10.1159/000322400. Epub 2011 Jan 14.

Reference Type BACKGROUND
PMID: 21242676 (View on PubMed)

Panichi V, Manca-Rizza G, Paoletti S, Taccola D, Consani C, Filippi C, Mantuano E, Sidoti A, Grazi G, Antonelli A, Angelini D, Petrone I, Mura C, Tolaini P, Saloi F, Ghezzi PM, Barsotti G, Palla R. Effects on inflammatory and nutritional markers of haemodiafiltration with online regeneration of ultrafiltrate (HFR) vs online haemodiafiltration: a cross-over randomized multicentre trial. Nephrol Dial Transplant. 2006 Mar;21(3):756-62. doi: 10.1093/ndt/gfi189. Epub 2005 Nov 22.

Reference Type BACKGROUND
PMID: 16303780 (View on PubMed)

Palleschi S, Ghezzi PM, Palladino G, Rossi B, Ganadu M, Casu D, Cossu M, Mattana G, Pinna AM, Contu B, Ghisu T, Monni A, Gazzanelli L, Mereu MC, Logias F, Passaghe M, Amore A, Bolasco P; Sardinian Study Group. Vitamins (A, C and E) and oxidative status of hemodialysis patients treated with HFR and HFR-Supra. BMC Nephrol. 2016 Aug 26;17(1):120. doi: 10.1186/s12882-016-0315-6.

Reference Type DERIVED
PMID: 27566671 (View on PubMed)

Other Identifiers

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ASLCagliariPBolascosolismo52

Identifier Type: REGISTRY

Identifier Source: secondary_id

CRC-01

Identifier Type: -

Identifier Source: org_study_id

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