Coronary Microvascular Dysfunction in Chronic Kidney Disease

NCT ID: NCT04014127

Last Updated: 2019-07-10

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

Total Enrollment

100 participants

Study Classification

OBSERVATIONAL

Study Start Date

2019-05-07

Study Completion Date

2020-12-31

Brief Summary

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This is an observational study assessing coronary microvascular function in healthy controls with normal kidney function, living kidney donors, pre-dialysis patients with chronic kidney disease stage 5 and patients on peritoneal dialysis.

Detailed Description

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The clinical syndrome of uraemic cardiomyopathy is prevalent in end stage renal disease and is associated with pathological cardiovascular changes including left ventricular hypertrophy, diastolic dysfunction and diffuse interstitial fibrosis. These combine to confer an elevated cardiovascular risk, including an increased risk of sudden cardiac death.

The cause of this increased cardiovascular risk is not clear but it is thought that coronary microvascular dysfunction may play a role. Coronary microvascular dysfunction is prevalent in many myocardial disease states, such as hypertrophic cardiomyopathy and heart failure with preserved ejection fraction, that share pathological similarities with uraemic cardiomyopathy.

Coronary flow reserve, a marker of coronary microvascular function, can be assessed non-invasively using echocardiography techniques. Previous studies have shown a reduction in coronary flow reserve in patients with chronic kidney disease. However, it is not clear if kidney donors - individuals who have a reduced kidney function but do not have progressive kidney disease - also demonstrate microvascular dysfunction. Similarly, although there is some evidence that patients on dialysis have improved coronary flow reserve compared to patients with pre-dialysis chronic kidney disease stage 5, there has been limited investigation into the role of peritoneal dialysis on coronary flow reserve.

Conditions

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Kidney Disease, Chronic Myocardial Dysfunction

Study Design

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Observational Model Type

OTHER

Study Time Perspective

PROSPECTIVE

Study Groups

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Controls

25 controls with preserved renal function

Coronary flow reserve assessment

Intervention Type DIAGNOSTIC_TEST

Coronary flow reserve will be assessed using Doppler transthoracic echocardiograpy and myocardial contrast echocardiography.

Sphygmocor

Intervention Type DIAGNOSTIC_TEST

Pulse wave analysis and pulse wave velocity will be assessed using the Sphygmocor device

Electrocardiogram

Intervention Type DIAGNOSTIC_TEST

An electrocardiogram will be performed prior to administration of adenosine to ensure no resting conduction disease

Blood test

Intervention Type OTHER

Blood tests will be performed for markers of renal function, bone mineral metabolism and myocardial stretch and injury

Urinary albumin/creatinine ratio

Intervention Type OTHER

Urine will be analysed for albumin/creatinine ratio

Kidney Donors

25 living kidney donors who have donated a kidney at least 12 months prior to enrollment in the study.

Coronary flow reserve assessment

Intervention Type DIAGNOSTIC_TEST

Coronary flow reserve will be assessed using Doppler transthoracic echocardiograpy and myocardial contrast echocardiography.

Sphygmocor

Intervention Type DIAGNOSTIC_TEST

Pulse wave analysis and pulse wave velocity will be assessed using the Sphygmocor device

Electrocardiogram

Intervention Type DIAGNOSTIC_TEST

An electrocardiogram will be performed prior to administration of adenosine to ensure no resting conduction disease

Blood test

Intervention Type OTHER

Blood tests will be performed for markers of renal function, bone mineral metabolism and myocardial stretch and injury

Urinary albumin/creatinine ratio

Intervention Type OTHER

Urine will be analysed for albumin/creatinine ratio

Pre-dialysis

25 patients with pre-dialysis chronic kidney disease stage 5

Coronary flow reserve assessment

Intervention Type DIAGNOSTIC_TEST

Coronary flow reserve will be assessed using Doppler transthoracic echocardiograpy and myocardial contrast echocardiography.

Sphygmocor

Intervention Type DIAGNOSTIC_TEST

Pulse wave analysis and pulse wave velocity will be assessed using the Sphygmocor device

Electrocardiogram

Intervention Type DIAGNOSTIC_TEST

An electrocardiogram will be performed prior to administration of adenosine to ensure no resting conduction disease

Blood test

Intervention Type OTHER

Blood tests will be performed for markers of renal function, bone mineral metabolism and myocardial stretch and injury

Urinary albumin/creatinine ratio

Intervention Type OTHER

Urine will be analysed for albumin/creatinine ratio

Peritoneal dialysis

25 patients with chronic kidney disease stage 5 undergoing peritoneal dialysis

Coronary flow reserve assessment

Intervention Type DIAGNOSTIC_TEST

Coronary flow reserve will be assessed using Doppler transthoracic echocardiograpy and myocardial contrast echocardiography.

Sphygmocor

Intervention Type DIAGNOSTIC_TEST

Pulse wave analysis and pulse wave velocity will be assessed using the Sphygmocor device

Electrocardiogram

Intervention Type DIAGNOSTIC_TEST

An electrocardiogram will be performed prior to administration of adenosine to ensure no resting conduction disease

Blood test

Intervention Type OTHER

Blood tests will be performed for markers of renal function, bone mineral metabolism and myocardial stretch and injury

Urinary albumin/creatinine ratio

Intervention Type OTHER

Urine will be analysed for albumin/creatinine ratio

Interventions

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Coronary flow reserve assessment

Coronary flow reserve will be assessed using Doppler transthoracic echocardiograpy and myocardial contrast echocardiography.

Intervention Type DIAGNOSTIC_TEST

Sphygmocor

Pulse wave analysis and pulse wave velocity will be assessed using the Sphygmocor device

Intervention Type DIAGNOSTIC_TEST

Electrocardiogram

An electrocardiogram will be performed prior to administration of adenosine to ensure no resting conduction disease

Intervention Type DIAGNOSTIC_TEST

Blood test

Blood tests will be performed for markers of renal function, bone mineral metabolism and myocardial stretch and injury

Intervention Type OTHER

Urinary albumin/creatinine ratio

Urine will be analysed for albumin/creatinine ratio

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Healthy control with normal renal function
* Living kidney donor who has donated \>12 months prior to enrolment in study
* Chronic kidney disease stage 5 who are pre-dialysis or on peritoneal dialysis
* Able to provide written informed consent

Exclusion Criteria

* Pregnancy
* Known ischaemic heart disease
* Diabetes mellitus
* Uncontrolled hypertension
* Evidence of 2nd or 3rd degree AV block or sick sinus syndrome in absence of a pacemaker
* History of allergic/adverse reaction to adenosine or Sonovue
* History of long QT syndrome
* Severe hypotension
* Significant valvular heart disease
* Significant chronic obstructive pulmonary disease or asthma with bronchospasm
* Unstable angina not controlled with medication
* Concurrent use of dipyridamole
* Decompensated heart failure
* Poor echo acoustic windows
* Chronic kidney disease stage 5 on haemodialysis
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University Hospital Birmingham NHS Foundation Trust

OTHER

Sponsor Role lead

Responsible Party

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Anna Price

Co-Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jonathan N Townend, MD FRCP FESC

Role: PRINCIPAL_INVESTIGATOR

University Hospitals Birmingham

Locations

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Queen Elizabeth Hospital

Birmingham, , United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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Ashwin Radhakrishnan, BM MRCP

Role: CONTACT

+447756931470

Facility Contacts

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Ashwin Radhakrishnan, BM MRCP

Role: primary

+447756931470

Other Identifiers

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RRK6607

Identifier Type: -

Identifier Source: org_study_id

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