Wishing to Decrease Aquaresis in ADPKD Patients Treated With a V2Ra; the Effect of Regulating Protein and Salt

NCT ID: NCT04310319

Last Updated: 2020-11-05

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

NA

Total Enrollment

12 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-09-07

Study Completion Date

2021-10-31

Brief Summary

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This study evaluates the effect of regulating salt and protein intake on urinevolume in patients with ADPKD treated with a vasopressine V2 receptor antagonist (V2RA). The investigators hypothesize that changing sodium and protein intake will reduce V2RA-induced polyuria.

Detailed Description

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Autosomal Dominant Polycystic Kidney Disease (ADPKD) is characterized by the formation of numerous cysts in both kidneys and progressive renal function decline leading to renal replacement therapy (RRT) at a median age of 58 years. The first (and at the moment only) drug to slow down renal function decline, is a vasopressin V2 receptor antagonist (V2RA). This medicament slows renal function decline by 26 to 34%. V2RA also causes aquaresis associated side-effects such as polyuria of \>6 liter per day in the majority of patients. These side-effects limit wide spread use among ADPKD-patients. Therefore, there is a need to improve its tolerability. While using a V2RA, urine concentrating ability is strongly diminished. Therefore, urine volume is largely determined by total osmolar excretion. This is a well-known fact in nephrogenic diabetes insipidus, a disease with clear pathophysiological similarities to treatment with a vasopressin V2 receptor antagonist (a defect receptor versus pharmacological blockade). A recent study found osmolar excretion to be associated with urinary volume during V2RA treatment. Whether a change in osmolar load changes polyuria during V2RA has not yet been investigated. The investigators hypothesize that changing sodium and protein intake will reduce polyuria.

Conditions

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Polycystic Kidney, Autosomal Dominant ADPKD Autosomal Dominant Polycystic Kidney

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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Normal salt, low protein treatment period

6 grams of sodium chloride daily / Placebo

Group Type OTHER

Sodiumchloride

Intervention Type DIETARY_SUPPLEMENT

Subjects will receive 4 capsules containting 750 NaCl each 2dd, making a total of 6 grams NaCl per day.

Placebo comparator (protein)

Intervention Type DIETARY_SUPPLEMENT

Subjects will receive 2dd 40 ml of placebo beverage (identical to protein beverage).

Normal salt, normal protein treatment period

6 grams of sodium chloride daily / 40 grams of protein daily

Group Type OTHER

Sodiumchloride

Intervention Type DIETARY_SUPPLEMENT

Subjects will receive 4 capsules containting 750 NaCl each 2dd, making a total of 6 grams NaCl per day.

Protein

Intervention Type DIETARY_SUPPLEMENT

Subjects will receive 2dd 40 ml of a protein beverage containing 0.5 grams of protein per ml, making a total of 40 grams of protein per day.

Low salt, low protein treatment period

Double placebo

Group Type OTHER

Placebo comparator (salt)

Intervention Type DIETARY_SUPPLEMENT

Subjects will receive 4 placebo capsules (identical to salt capsules) 2dd.

Placebo comparator (protein)

Intervention Type DIETARY_SUPPLEMENT

Subjects will receive 2dd 40 ml of placebo beverage (identical to protein beverage).

Low salt, normal protein treatment period

Placebo / 40 grams of protein daily

Group Type OTHER

Protein

Intervention Type DIETARY_SUPPLEMENT

Subjects will receive 2dd 40 ml of a protein beverage containing 0.5 grams of protein per ml, making a total of 40 grams of protein per day.

Placebo comparator (salt)

Intervention Type DIETARY_SUPPLEMENT

Subjects will receive 4 placebo capsules (identical to salt capsules) 2dd.

Interventions

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Sodiumchloride

Subjects will receive 4 capsules containting 750 NaCl each 2dd, making a total of 6 grams NaCl per day.

Intervention Type DIETARY_SUPPLEMENT

Protein

Subjects will receive 2dd 40 ml of a protein beverage containing 0.5 grams of protein per ml, making a total of 40 grams of protein per day.

Intervention Type DIETARY_SUPPLEMENT

Placebo comparator (salt)

Subjects will receive 4 placebo capsules (identical to salt capsules) 2dd.

Intervention Type DIETARY_SUPPLEMENT

Placebo comparator (protein)

Subjects will receive 2dd 40 ml of placebo beverage (identical to protein beverage).

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

1. Diagnosis of ADPKD (ravine criteria/documented by nephrologist)
2. Stable treatment regimen of tolvaptan as part of routine clinical care in the highest dose tolerable (preferably 120 mg daily), with a urine osmolality lower than 250 mosmol/L.
3. Age \>= 18 years.
4. eGFR \>30 ml/min/1.73m2.
5. Providing informed consent.
6. Compliance to the recommended diet at two consecutive times.

Exclusion Criteria

1. Patients who, in the opinion of the investigator may present a safety risk.
2. Patients who are unlikely to adequately comply to the trial's procedures (due for instance to medical conditions likely to require interruption or discontinuation, history of substance abuse or non-compliance).
3. a. Patients taking medication likely to confound endpoint assessments:

* lithium in any dosing regimen;
* chronic use of systemic corticosteroids in any dosage;
* chronic use of any diuretics in any dosing regimen;
* daily use of any NSAIDs in any dosing regimen;

3\. b. Patients having concomitant illnesses likely to confound endpoint assessments (e.g. diabetes mellitus for which medication is needed or diabetes insipidus).

4\. Women who are pregnant or breastfeeding. 5. Patients with a blood pressure over 160/100 mm Hg at baseline.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Esther Meijer

OTHER

Sponsor Role lead

Responsible Party

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Esther Meijer

Principal Investigator, nephrologist

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Esther Meijer, Dr.

Role: PRINCIPAL_INVESTIGATOR

Universitar Medical Centre Groningen

Locations

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UMC Groningen

Groningen, , Netherlands

Site Status RECRUITING

Countries

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Netherlands

Central Contacts

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Meijer, Dr.

Role: CONTACT

003150 361 6161

Iris Koorevaar, drs.

Role: CONTACT

0031503614198

References

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St Pierre K, Cashmore BA, Bolignano D, Zoccali C, Ruospo M, Craig JC, Strippoli GF, Mallett AJ, Green SC, Tunnicliffe DJ. Interventions for preventing the progression of autosomal dominant polycystic kidney disease. Cochrane Database Syst Rev. 2024 Oct 2;10(10):CD010294. doi: 10.1002/14651858.CD010294.pub3.

Reference Type DERIVED
PMID: 39356039 (View on PubMed)

Other Identifiers

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NL2019WATER

Identifier Type: -

Identifier Source: org_study_id