Intravascular Ultrasound in Patients With End-stage Renal Disease on Dialysis

NCT ID: NCT04399941

Last Updated: 2024-12-27

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

RECRUITING

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-08-03

Study Completion Date

2026-09-30

Brief Summary

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Hemodialysis represents a life line of patients with end stage renal disease, who are commonly maintained on hemodialysis through catheters. Prolonged exposure to these catheters eventually damages the walls of veins, which results in stenosis at the local site. This condition is called central venous stenosis (CVS) and affects number of patients on hemodialysis in the United States and can compromise the dialysis efficacy. The current diagnostic modality for CVS is venography, which has several limitations. This study proposes to examine intravenous ultrasound (IVUS) as a potentially superior modality, which will provide additional information.

Detailed Description

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Conditions

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End Stage Renal Disease

Keywords

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intravenous ultrasound (IVUS) central venous stenosis (CVS) hemodialysis dialysis access malfunction fistulogram stenosis virtual histology (VH-IVUS) software

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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IVUS and venography group

Participants in the this group will receive venography/fistulogram, intravascular ultrasound (IVUS), and image processing.

Group Type EXPERIMENTAL

Venography

Intervention Type DIAGNOSTIC_TEST

The venography will be performed as part of the patient's standard of care. The dialysis access will be punctured upstream of the arteriovenous anastomosis in AVF or AVG using a 4-F coaxial access set (Micro- puncture; Cook, Inc, Bloomington, Indiana). The contrast will be injected intravenously by a pump with 200 psi and a bolus of 2m/sec for total of 5 ml during upper extremity vein filming and 10 ml of contrast bolus by 3 ml/s during central vein filming while holding the breath in inspiration in anterioposterior plane.

Intravascular ultrasound (IVUS)

Intervention Type DIAGNOSTIC_TEST

IVUS will be performed through the same sheath of the coaxial access set using an Eagle Eye Platinum RX digital catheter 7F over a compatible guidewire under fluoroscopic guidance. The lesion will be estimated fluoroscopically from the marker IVUS catheter in the vein and the cranial and caudal margins of stenotic lesion will be directly visualized during pullback of the IVUS catheter.

Image processing

Intervention Type OTHER

Image processing will be performed by two radiologists in a blinded manner on the images devoid of personal identifier. An adjudication committee will oversee the process and confirm their findings in case of a discrepancy.

Interventions

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Venography

The venography will be performed as part of the patient's standard of care. The dialysis access will be punctured upstream of the arteriovenous anastomosis in AVF or AVG using a 4-F coaxial access set (Micro- puncture; Cook, Inc, Bloomington, Indiana). The contrast will be injected intravenously by a pump with 200 psi and a bolus of 2m/sec for total of 5 ml during upper extremity vein filming and 10 ml of contrast bolus by 3 ml/s during central vein filming while holding the breath in inspiration in anterioposterior plane.

Intervention Type DIAGNOSTIC_TEST

Intravascular ultrasound (IVUS)

IVUS will be performed through the same sheath of the coaxial access set using an Eagle Eye Platinum RX digital catheter 7F over a compatible guidewire under fluoroscopic guidance. The lesion will be estimated fluoroscopically from the marker IVUS catheter in the vein and the cranial and caudal margins of stenotic lesion will be directly visualized during pullback of the IVUS catheter.

Intervention Type DIAGNOSTIC_TEST

Image processing

Image processing will be performed by two radiologists in a blinded manner on the images devoid of personal identifier. An adjudication committee will oversee the process and confirm their findings in case of a discrepancy.

Intervention Type OTHER

Other Intervention Names

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Fistulogram

Eligibility Criteria

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Inclusion Criteria

* ESRD (end stage renal disease) patients at BMC (Boston Medical Center)
* Receiving hemodialysis
* Has a dialysis access malfunction
* Undergoing a diagnostic fistulogram for the dialysis access malfunction

Exclusion Criteria

* None
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

NIH

Sponsor Role collaborator

Boston Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Vipul Chitalia, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Boston Medical Center

Locations

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Boston Medical Center

Boston, Massachusetts, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Vipul Chitalia, MD PhD

Role: CONTACT

Phone: 617 638 7330

Email: [email protected]

Facility Contacts

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Vipul Chitalia, MD PhD

Role: primary

Other Identifiers

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1R21DK119740-01A1

Identifier Type: NIH

Identifier Source: secondary_id

View Link

H-37396

Identifier Type: -

Identifier Source: org_study_id