Paricalcitol Improves Anemia of Inflammation

NCT ID: NCT02876211

Last Updated: 2024-12-09

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

TERMINATED

Clinical Phase

PHASE4

Total Enrollment

19 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-12-31

Study Completion Date

2024-12-31

Brief Summary

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Anemia of inflammation (AI) is a common comorbidity in hemodialysis patients. Paricalcitol is a selective vitamin D receptor activator with potential benefits on anti-inflammatory cytokines expression. The paricalcitol for the secondary hyperparathyroidism control may improve AI decreasing erythropoietin stimulating agents (ESAs) dosage.

Detailed Description

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Anemia of inflammation and secondary hyperparathyroidism (SHPT) are two common clinical complications in patients with chronic kidney disease. Eryptosis (accelerated red blood cell death) is a novel mechanism associated with renal anemia and several factors such us iron, erythropoietin and klotho (anti-aging hormone) deficiency have been associated with this process.

The use of the paricalcitol may inhibit pro-inflammatory cytokines expression, especially interleukine-6, which is one of the most important cytokine associated with the pathogenesis of the AI. If the use of the paricalcitol for the SHPT control may exert direct influence on the erythropoiesis process is not known.

Conditions

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Anemia

Keywords

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Renal disease Erythropoiesis Erythropoietin stimulating agent Iron Klotho Selective vitamin D receptor activation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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paricalcitol plus epoetin beta

Paricalcitol 2 capsules /three times per week \& epoetin

Group Type EXPERIMENTAL

Paricalcitol

Intervention Type DRUG

Paricalcitol 2 capsules/three times per week

Epoetin beta

Intervention Type DRUG

epoetin 1-3 times per week

placebo plus epoetin beta

Placebo 2 capsules/three times per week \& epoetin

Group Type PLACEBO_COMPARATOR

Epoetin beta

Intervention Type DRUG

epoetin 1-3 times per week

Placebo

Intervention Type DRUG

Placebo 2 capsules/three times per week

Interventions

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Paricalcitol

Paricalcitol 2 capsules/three times per week

Intervention Type DRUG

Epoetin beta

epoetin 1-3 times per week

Intervention Type DRUG

Placebo

Placebo 2 capsules/three times per week

Intervention Type DRUG

Other Intervention Names

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Selective vitamin D receptor activation anti-anemic drug

Eligibility Criteria

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Inclusion Criteria

* Age \>= 18 years.
* Patients with CKD on hemodialysis of any etiology..
* Hemoglobin between 9 and 12g/dl at least 12 weeks before enrollment in the study.
* Hemoglobin plasma levels stabilized: Hb variation \<or = 1 g / dl for the two months prior to inclusion in the study.
* Patients with anemia of renal etiology.
* ESA treatment with stable doses for 2 months prior to baseline.Stable dose ESA Definition: Variation \<or = 3000UI/week.
* Iron status: Ferritin\> 200 ng / mL and/or transferrin saturation index (IST):\> = 20%).
* KT / V \>= 1.2 ( Daugirdas-2nd generation).
* Calcium concentrations between : 8.4 to 9.5 mg / dl and phosphorus: 3.5-5.5 mg / dl.
* Vitamin D 25OH normal \>= 15 ng / ml (patients with lower levels will be supplemented with calcifediol 16000 IU / bi-weekly for 6 weeks in selected patients).
* PTHi concentrations\> = 150 pg / mL and \<or = to 300 pg / ml.
* Patients who accept their inclusion in the study and sign informed consent.

Exclusion Criteria

* Epoetin beta dose \> 18,000 IU / weekly.
* Pregnant woman of childbearing age or gestational wishes or not to use adequate contraception ( the Ogino-Knaus contraceptive method is considered unsuitable).
* Active bleeding episode or history of transfusion the 2 months prior to baseline.
* Patients with non-renal causes of anemia: malignancies, folic acid or vitamin B12 deficiency, hemoglobinopathies, hemolysis, pure red cell aplasia secondary to erythropoietin.
* Patients treated with the selective vitamin D receptor activator in the 3 months prior to inclusion in the study.
* Acute or chronic symptomatic: heart failure (IV-NYHA), infection or inflammatory disease, uncontrolled hypertension that requires the suspension of epoetin beta, thrombocytopathies, aplastic anemia.
* Immunosuppressive treatment with uncontrolled Hemoglobin level
* Allergy to paricalcitol or any of its components.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital Son Espases

OTHER

Sponsor Role lead

Responsible Party

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Miguel Giovanni Uriol Rivera

Ph.D. MD.

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Miguel Uriol, Ph.D.M.D.

Role: PRINCIPAL_INVESTIGATOR

Son Espases University Hospital

Locations

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Son Espases University Hospital

Palma de Mallorca, Balearic Islands, Spain

Site Status

Countries

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Spain

References

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Sun CC, Vaja V, Babitt JL, Lin HY. Targeting the hepcidin-ferroportin axis to develop new treatment strategies for anemia of chronic disease and anemia of inflammation. Am J Hematol. 2012 Apr;87(4):392-400. doi: 10.1002/ajh.23110. Epub 2012 Jan 31.

Reference Type BACKGROUND
PMID: 22290531 (View on PubMed)

Perlstein TS, Pande R, Berliner N, Vanasse GJ. Prevalence of 25-hydroxyvitamin D deficiency in subgroups of elderly persons with anemia: association with anemia of inflammation. Blood. 2011 Mar 10;117(10):2800-6. doi: 10.1182/blood-2010-09-309708. Epub 2011 Jan 14.

Reference Type BACKGROUND
PMID: 21239700 (View on PubMed)

Kempe DS, Ackermann TF, Fischer SS, Koka S, Boini KM, Mahmud H, Foller M, Rosenblatt KP, Kuro-O M, Lang F. Accelerated suicidal erythrocyte death in Klotho-deficient mice. Pflugers Arch. 2009 Jul;458(3):503-12. doi: 10.1007/s00424-009-0636-4. Epub 2009 Jan 28.

Reference Type BACKGROUND
PMID: 19184092 (View on PubMed)

Other Identifiers

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PIERAID-2013

Identifier Type: -

Identifier Source: org_study_id