Left Ventricular Fibrosis in Chronic Kidney Disease

NCT ID: NCT03176862

Last Updated: 2017-06-06

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

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

UNKNOWN

Total Enrollment

260 participants

Study Classification

OBSERVATIONAL

Study Start Date

2015-09-30

Study Completion Date

2018-08-31

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

This study aims to understand the onset an functional consequences of left ventricular interstitial fibrosis in patients with chronic kidney disease (stage 2 to 5), as well as assess whether transplantation results in a regression of cardiac fibrosis.Thus all patients will undergo: 1) a cardiac magnetic resonance imaging (MRI) scan to assess cardiac function and measure left ventricular interstitial fibrosis; 2) a cardiopulmonary stress echocardiogram to understand the functional consequences of fibrosis and rule out any underlying ischaemic heart disease; 3) a 24 hour holter monitor and electrocardiogram (ECG) to assess whether these patients are at higher risk of arrhythmia.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Aim and objectives:

The primary objective of this study is to test the following hypotheses:

i) Patients with early stage chronic kidney disease (CKD) exhibit diffuse LV fibrosis manifest by prolonged native myocardial T1 times and expansion of the extracellular volume (ECV) measured on MRI with a graded relationship to eGFR (stage of CKD), independent of blood pressure and arterial stiffness.

The secondary research objectives are to test the following hypotheses:

i) Prolonged native myocardial T1 times are associated with impaired diastolic function, altered arterial-ventricular interaction and impaired effort tolerance.

ii) Prolonged T1 times correlate with increases in serum biomarkers of collagen turnover associated with myocardial fibrosis that could be used to risk stratify individuals and enable targeted, personalized clinical care.

iii) Renal transplantation results in a regression of myocardial fibrosis as measured by T1 mapping.

DESIGN:

A cross-sectional analysis of 40 patients in each stage 2-5 CKD will be undertaken. These individuals will only be studied once (at baseline). In addition to this, at least 20 patients will be studied who are about to undergo a kidney transplant. These individuals will be studied at baseline (around the time of surgery), at 6 weeks post-operatively, and then 1 year post-operatively to assess the effect on renal transplantation on myocardial fibrosis.

SUBJECTS:

Patients will be recruited from the clinics run by University Hospitals Birmingham NHS Foundation Trust (UHB) with stages 2, 3, 4 and 5 CKD defined using eGFR calculated with the 4-variable 'Modification of Diet in Renal Disease' (MDRD) equation, with a minimum of two consecutive tests at least 90 days apart. Forty patients will be recruited per group of CKD. All study subjects will undergo a cardiac MRI scan, a cardiopulmonary exercise tests with stress echocardiogram, a 24-hour ECG holter monitor, and blood tests.

CONTROLS:

Forty healthy control subjects and forty hypertensive control subjects will be studied. All patients will undergo the identical research protocol to the CKD subjects, except they will not have a stress echocardiogram or an ECG holter monitor.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Chronic Kidney Diseases Cardio-Renal Syndrome Myocardial Fibrosis Uraemic Cardiomyopathy

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Observational Model Type

COHORT

Study Time Perspective

CROSS_SECTIONAL

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

CKD

40 patients per group of CKD from stage 2 to stage 5.

cardiac magnetic resonance scan

Intervention Type DIAGNOSTIC_TEST

An MRI scan of the heart

Cardiopulmonary exercise test with stress echocardiogram

Intervention Type DIAGNOSTIC_TEST

An exercise bicycle test with echocardiogram done during the exercise.

24-hour ECG holter monitor

Intervention Type DIAGNOSTIC_TEST

3 stickers attached to a small monitor are worn for 24 hours.

12-lead ECG

Intervention Type DIAGNOSTIC_TEST

Can be done immediately by the bedside.

Blood test

Intervention Type BIOLOGICAL

20 mls of blood will be taken to measure routine laboratory tests and biomarkers of fibrosis.

Kidney transplant recipients

20 live-donor recipients will be studied pre-operatively and then followed up at 6 weeks and 1 years post-operatively.

cardiac magnetic resonance scan

Intervention Type DIAGNOSTIC_TEST

An MRI scan of the heart

24-hour ECG holter monitor

Intervention Type DIAGNOSTIC_TEST

3 stickers attached to a small monitor are worn for 24 hours.

12-lead ECG

Intervention Type DIAGNOSTIC_TEST

Can be done immediately by the bedside.

Cardiopulmonary exercise test

Intervention Type DIAGNOSTIC_TEST

An exercise bicycle test. No stress echocardiogram.

Blood test

Intervention Type BIOLOGICAL

20 mls of blood will be taken to measure routine laboratory tests and biomarkers of fibrosis.

Controls

40 healthy controls and 40 hypertensive controls.

cardiac magnetic resonance scan

Intervention Type DIAGNOSTIC_TEST

An MRI scan of the heart

Cardiopulmonary exercise test with stress echocardiogram

Intervention Type DIAGNOSTIC_TEST

An exercise bicycle test with echocardiogram done during the exercise.

12-lead ECG

Intervention Type DIAGNOSTIC_TEST

Can be done immediately by the bedside.

Cardiopulmonary exercise test

Intervention Type DIAGNOSTIC_TEST

An exercise bicycle test. No stress echocardiogram.

Blood test

Intervention Type BIOLOGICAL

20 mls of blood will be taken to measure routine laboratory tests and biomarkers of fibrosis.

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

cardiac magnetic resonance scan

An MRI scan of the heart

Intervention Type DIAGNOSTIC_TEST

Cardiopulmonary exercise test with stress echocardiogram

An exercise bicycle test with echocardiogram done during the exercise.

Intervention Type DIAGNOSTIC_TEST

24-hour ECG holter monitor

3 stickers attached to a small monitor are worn for 24 hours.

Intervention Type DIAGNOSTIC_TEST

12-lead ECG

Can be done immediately by the bedside.

Intervention Type DIAGNOSTIC_TEST

Cardiopulmonary exercise test

An exercise bicycle test. No stress echocardiogram.

Intervention Type DIAGNOSTIC_TEST

Blood test

20 mls of blood will be taken to measure routine laboratory tests and biomarkers of fibrosis.

Intervention Type BIOLOGICAL

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* \>18 years old
* CKD stage 2, 3, 4 and 5

Exclusion Criteria

* Pregnancy
* Ischaemic heart disease (angina, ACS)
* Cerebral vascular disease
* Peripheral vascular disease
* Renovascular disease
* Diabetes mellitus
* Valvular heart disease (more than mild)
* Established diagnosis of heart failure
* Cannot have an MRI scan
Minimum Eligible Age

18 Years

Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

British Heart Foundation

OTHER

Sponsor Role collaborator

Dr Manvir Kaur Hayer

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Dr Manvir Kaur Hayer

Clinical Research Fellow

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Nicola C Edwards, PhD

Role: PRINCIPAL_INVESTIGATOR

University Hospital Birmingham NHS Foundation Trust

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

University Hospital Birmingham

Birmingham, West Midlands, United Kingdom

Site Status RECRUITING

Countries

Review the countries where the study has at least one active or historical site.

United Kingdom

Central Contacts

Reach out to these primary contacts for questions about participation or study logistics.

Manvir K Hayer, MBChB

Role: CONTACT

07812732857

Jonathan N Townend, MD

Role: CONTACT

01213712000

Facility Contacts

Find local site contact details for specific facilities participating in the trial.

Manvir K Hayer, MBChB

Role: primary

01213712000

Jonathan N Townend, MD

Role: backup

01213712000

References

Explore related publications, articles, or registry entries linked to this study.

Hayer MK, Radhakrishnan A, Price AM, Liu B, Baig S, Weston CJ, Biasiolli L, Ferro CJ, Townend JN, Steeds RP, Edwards NC; Birmingham Cardio-Renal Group. Defining Myocardial Abnormalities Across the Stages of Chronic Kidney Disease: A Cardiac Magnetic Resonance Imaging Study. JACC Cardiovasc Imaging. 2020 Nov;13(11):2357-2367. doi: 10.1016/j.jcmg.2020.04.021. Epub 2020 Jul 15.

Reference Type DERIVED
PMID: 32682713 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

UHB

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.