Effect of RAS Blockers on CKD Progression in Elderly Patients With Non Proteinuric Nephropathies (PROERCAN01)

NCT ID: NCT03195023

Last Updated: 2019-02-22

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

106 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-06-30

Study Completion Date

2022-12-31

Brief Summary

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This study evaluates the effect of renin-angiotensin blockers on chronic kidney disease progression in elderly (\>65 years old) patients with non-proteinuric nephropathies. Half of the patients will receive angiotensin converting enzyme inhibitors, while the other half will not receive them. Renal function, proteinuria and cardiovascular events will be follow up during a three year period.

Detailed Description

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STUDY DESIGN: Open, multicentre, prospective, parallel-group, randomized controlled study comparing the effect of an angiotensin converting enzyme inhibitor (ACEI) vs standard antihypertensive treatment without ACEI, in the progression of renal disease in elderly patients with non-proteinuric 3-4 stage chronic renal disease.

Elderly patients (\> 65 years) with moderate-severe non-proteinuric chronic renal disease (estimated Glomerular Filtrate Rate between 19-59 ml per minute per 1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration Group equation) and urine-creatinine rate \< 30 mg/g, will be included. They will be randomly assigned in a 1:1 ratio to receive ACEI or standard antihypertensive treatment. Patients will be followed up for 3 years.

Conditions

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Renal Insufficiency, Chronic Proteinuria

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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RAS Blockers

Patients in this arm will receive Lisinopril 20mg/day

Group Type ACTIVE_COMPARATOR

Lisinopril

Intervention Type DRUG

Non RAS Blockers

Patients in this arm will receive Amlodipine 10mg/day or Lercanidipine 20mg/day +/- diuretics

Group Type ACTIVE_COMPARATOR

Amlodipine

Intervention Type DRUG

Patients in this arm will receive antihypertensive treatment different from RAS blockers. If they previously received RAS blockers, they will be substitute for either Amlodipine or Lercanidipine +/- diuretics

Interventions

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Lisinopril

Intervention Type DRUG

Amlodipine

Patients in this arm will receive antihypertensive treatment different from RAS blockers. If they previously received RAS blockers, they will be substitute for either Amlodipine or Lercanidipine +/- diuretics

Intervention Type DRUG

Other Intervention Names

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Angiotensin converting enzyme inhibitors Lercanidipine, Furosemide, Thiazides

Eligibility Criteria

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Inclusion Criteria

* Age \>65 years
* Chronic kidney disease stage 3 or 4 (GFR measured by CKD-EPI 15-59 ml/min/1,73 m2)
* Albumine/creatinine index \< 30 mg/g in simple urine sample or albuminuria \< 30 mg/day in 24-hour urine sample.
* Previous hypertensive treatment::

1. patients who have not received RAS blockers in the three months prior to inclusion can be included
2. patients who are receiving RAS blockers could be included after one month washout period

Exclusion Criteria

* Diabetes mellitus (type 1 or 2)
* Glomerulopathy
* Chronic heart failure or coronary heart disease
* Poorly controlled hypertension (\>160/100 mmHg)
* Monorrenal
* Active malignant neoplasia (except skin cancer different from melanoma). Patients who have been free of malignancy for the last 5 years could be included.
* Chronic symptomatic or not controlled inflammatory disease (eg rheumatoid arthritis, Chron disease, ulcerative colitis or systemic lupus erythematosus)
* Chronic liver disease
* Allergy or intolerance to renin angiotensin system blockers or calcium channel blockers
* Hepatitis B, C or HIV infection
* Immunosuppressive treatment in the 3 months prior to inclusion
* Hospitalization of any cause in the three months prior to inclusion
* Rapidly progressive kidney disease (decline in GFR \>5ml/min/1.73 m2/year)
* Inability to sign the informed consent
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital General Universitario Gregorio Marañon

OTHER

Sponsor Role lead

Responsible Party

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Maria Maria Angeles Goicoechea Diezhandino

Nefrologist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Maria Angeles Goicoechea, PhD, MD

Role: PRINCIPAL_INVESTIGATOR

Hospital General Universitario Gregorio Marañon

Locations

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Gregorio Maranon Hospital

Madrid, , Spain

Site Status RECRUITING

Countries

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Spain

Central Contacts

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Maria Angeles Goicoechea, PhD, MD

Role: CONTACT

0034609838684

Ana Maria Garcia Prieto, MD

Role: CONTACT

0034676611045

Facility Contacts

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Maria Angeles Goicoechea, PhD, MD

Role: primary

0034609838684

Ana María García, MD

Role: backup

0034676611045

References

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Jafar TH, Stark PC, Schmid CH, Landa M, Maschio G, de Jong PE, de Zeeuw D, Shahinfar S, Toto R, Levey AS; AIPRD Study Group. Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis. Ann Intern Med. 2003 Aug 19;139(4):244-52. doi: 10.7326/0003-4819-139-4-200308190-00006.

Reference Type BACKGROUND
PMID: 12965979 (View on PubMed)

Wright JT Jr, Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J, Cheek D, Douglas-Baltimore JG, Gassman J, Glassock R, Hebert L, Jamerson K, Lewis J, Phillips RA, Toto RD, Middleton JP, Rostand SG; African American Study of Kidney Disease and Hypertension Study Group. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. 2002 Nov 20;288(19):2421-31. doi: 10.1001/jama.288.19.2421.

Reference Type BACKGROUND
PMID: 12435255 (View on PubMed)

O'Hare AM, Kaufman JS, Covinsky KE, Landefeld CS, McFarland LV, Larson EB. Current guidelines for using angiotensin-converting enzyme inhibitors and angiotensin II-receptor antagonists in chronic kidney disease: is the evidence base relevant to older adults? Ann Intern Med. 2009 May 19;150(10):717-24. doi: 10.7326/0003-4819-150-10-200905190-00010.

Reference Type BACKGROUND
PMID: 19451579 (View on PubMed)

Ahmed AK, Kamath NS, El Kossi M, El Nahas AM. The impact of stopping inhibitors of the renin-angiotensin system in patients with advanced chronic kidney disease. Nephrol Dial Transplant. 2010 Dec;25(12):3977-82. doi: 10.1093/ndt/gfp511. Epub 2009 Oct 10.

Reference Type BACKGROUND
PMID: 19820248 (View on PubMed)

Weiss JW, Thorp ML, O'Hare AM. Renin-angiotensin system blockade in older adults with chronic kidney disease: a review of the literature. Curr Opin Nephrol Hypertens. 2010 Sep;19(5):413-9. doi: 10.1097/MNH.0b013e32833b8d6b.

Reference Type BACKGROUND
PMID: 20539228 (View on PubMed)

Turgut F, Balogun RA, Abdel-Rahman EM. Renin-angiotensin-aldosterone system blockade effects on the kidney in the elderly: benefits and limitations. Clin J Am Soc Nephrol. 2010 Jul;5(7):1330-9. doi: 10.2215/CJN.08611209. Epub 2010 May 24.

Reference Type BACKGROUND
PMID: 20498247 (View on PubMed)

Garcia-Prieto AM, Verdalles U, de Jose AP, Arroyo D, Aragoncillo I, Barbieri D, Camacho RE, Goicoechea M. Renin-angiotensin-aldosterone system blockers effect in chronic kidney disease progression in hypertensive elderly patients without proteinuria: PROERCAN trial. Hipertens Riesgo Vasc. 2024 Apr-Jun;41(2):95-103. doi: 10.1016/j.hipert.2023.11.005. Epub 2024 Mar 19.

Reference Type DERIVED
PMID: 38508877 (View on PubMed)

Other Identifiers

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PROERCAN01

Identifier Type: -

Identifier Source: org_study_id

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