Prophylactic Antibiotic Treatment in Hemodialysis

NCT ID: NCT05248620

Last Updated: 2024-01-30

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

800 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-02-14

Study Completion Date

2029-05-31

Brief Summary

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The purpose of this study is to assess the efficacy of prophylactic antibiotic treatment on blood stream infections and severe culture negative infections, in patients on newly started hemodialysis(HD), with a central venous catheter as vascular access.

Detailed Description

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After being informed about the study and potential risks all eligible patients, giving written informed consent will be included in the study. At week 0 patients will be randomized in a single blinded manner (participants and care providers) in a 1:1 manner to receive 500/125mg amoxicillin/clavulanic acid 30-120 minutes before each hemodialysis with a central venous catheter (CVC) as vascular access, or corresponding placebo. The timing of antibiotic administration has been established in a pilot-study in order to secure a sufficient concentration of antibiotics during the dialysis session. In case of side effects to amoxicillin/clavulanic acid, the prophylactic antibiotic will be shifted to 600mg clindamycin. Total treatment period with prophylactic antibiotics is 6 months, with a 1 year follow-up.

Conditions

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Hemodialysis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Multicenter, randomized, single-blinded, placebo controlled study, with blinded endpoint evaluation
Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors
Amoxicillin/placebo is provided in identical containers. Amoxicillin and placebo tablets are looking similar, but by decision of the Danish Medicines Agency amoxicillin tablets must not be removed from the original folio packing prior to use. Clindamycin active and placebo tablets look similar (incapsulated), and are provided in identical containers. Study medicine will be provided by 1-2 nurses at each site, who are unblinded. The patients and care providers are blinded

Study Groups

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Active

Amoxicillin/clavulanic acid 500/125mg, tablets, will be administered before each hemodialysis for 6 months

Group Type ACTIVE_COMPARATOR

Amoxicillin Clavulanic 500/125mg or placebo

Intervention Type DRUG

Prophylactic antibiotic treatment

Placebo

Placebo tablets, similar to the active drug, will be administered before each hemodialysis for 6 months

Group Type PLACEBO_COMPARATOR

Amoxicillin Clavulanic 500/125mg or placebo

Intervention Type DRUG

Prophylactic antibiotic treatment

Interventions

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Amoxicillin Clavulanic 500/125mg or placebo

Prophylactic antibiotic treatment

Intervention Type DRUG

Other Intervention Names

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Aurobindo

Eligibility Criteria

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Inclusion Criteria

* End Stage Kidney Disease (ESKD) patients who receive an uncuffed or cuffed CVC for expected chronic HD, regardless of previous ESKD treatment modality (PD or KTX) and hemodialysis access (AV-fistula or AV-graft))
* ≥18 years
* Ability to understand the study background, risk and benefit of treatment and to give written informed consent

Exclusion Criteria

* Unable to give informed consent
* Known intolerance to beta-lactam antibiotics and clindamycin
* Active infection treated with antibiotics
* Breastfeeding
* Pregnancy. In women of childbearing age, an approved birth control must be ensured at least 1 month before and during all the 6 months of antibiotic/placebo treatment.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Zealand University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Niels E Bruun, Professor

Role: PRINCIPAL_INVESTIGATOR

Dept. cardiology, Zealand University Hospital, Roskilde, Denmark

Locations

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Rigshospitalet

Copenhagen, Capital Region, Denmark

Site Status NOT_YET_RECRUITING

Herlev-Gentofte Hospital

Copenhagen, Capital Region, Denmark

Site Status RECRUITING

North Zealand Hospital Hillerød

Hillerød, Capital Region, Denmark

Site Status NOT_YET_RECRUITING

Aarhus University Hospital

Aarhus, Middle Region, Denmark

Site Status NOT_YET_RECRUITING

Aalborg University Hospital

Aalborg, North Region, Denmark

Site Status RECRUITING

ZUH Roskilde

Roskilde, Region Sjælland, Denmark

Site Status RECRUITING

Odense University Hospital

Odense, Region South, Denmark

Site Status RECRUITING

Countries

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Denmark

Central Contacts

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Niels E Bruun, Professor

Role: CONTACT

+4525159309

Kasper K Iversen, Professor

Role: CONTACT

Facility Contacts

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Marianne Rix, Consultant

Role: primary

Anne-Lise Kamper, Consultant

Role: backup

Henrik P Hansen, Consultant

Role: primary

Kasper K Iversen, Professor

Role: backup

Marianne Bertelsen, Consultant

Role: primary

Jens D Jensen, Consultant

Role: primary

Bo Madsen, Consultant

Role: primary

Niels E Bruun, Professor

Role: primary

+4525159309

Rikke Borg, Consultant

Role: backup

Per B Jensen, Consultant

Role: primary

References

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Gupta V, Yassin MH. Infection and hemodialysis access: an updated review. Infect Disord Drug Targets. 2013 Jun;13(3):196-205. doi: 10.2174/1871526511313030008.

Reference Type BACKGROUND
PMID: 24001331 (View on PubMed)

Vogelzang JL, van Stralen KJ, Noordzij M, Diez JA, Carrero JJ, Couchoud C, Dekker FW, Finne P, Fouque D, Heaf JG, Hoitsma A, Leivestad T, de Meester J, Metcalfe W, Palsson R, Postorino M, Ravani P, Vanholder R, Wallner M, Wanner C, Groothoff JW, Jager KJ. Mortality from infections and malignancies in patients treated with renal replacement therapy: data from the ERA-EDTA registry. Nephrol Dial Transplant. 2015 Jun;30(6):1028-37. doi: 10.1093/ndt/gfv007. Epub 2015 Jan 29.

Reference Type BACKGROUND
PMID: 25637641 (View on PubMed)

Aslam S, Vaida F, Ritter M, Mehta RL. Systematic review and meta-analysis on management of hemodialysis catheter-related bacteremia. J Am Soc Nephrol. 2014 Dec;25(12):2927-41. doi: 10.1681/ASN.2013091009. Epub 2014 May 22.

Reference Type BACKGROUND
PMID: 24854263 (View on PubMed)

Sarnak MJ, Jaber BL. Mortality caused by sepsis in patients with end-stage renal disease compared with the general population. Kidney Int. 2000 Oct;58(4):1758-64. doi: 10.1111/j.1523-1755.2000.00337.x.

Reference Type BACKGROUND
PMID: 11012910 (View on PubMed)

Jaber BL. Bacterial infections in hemodialysis patients: pathogenesis and prevention. Kidney Int. 2005 Jun;67(6):2508-19. doi: 10.1111/j.1523-1755.2005.00364.x. No abstract available.

Reference Type BACKGROUND
PMID: 15882306 (View on PubMed)

de Jager DJ, Grootendorst DC, Jager KJ, van Dijk PC, Tomas LM, Ansell D, Collart F, Finne P, Heaf JG, De Meester J, Wetzels JF, Rosendaal FR, Dekker FW. Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA. 2009 Oct 28;302(16):1782-9. doi: 10.1001/jama.2009.1488.

Reference Type BACKGROUND
PMID: 19861670 (View on PubMed)

Chaudry MS, Gislason GH, Kamper AL, Rix M, Dahl A, Ostergaard L, Fosbol EL, Lauridsen TK, Oestergaard LB, Hassager C, Torp-Pedersen C, Bruun NE. The impact of hemodialysis on mortality risk and cause of death in Staphylococcus aureus endocarditis. BMC Nephrol. 2018 Sep 3;19(1):216. doi: 10.1186/s12882-018-1016-0.

Reference Type BACKGROUND
PMID: 30176809 (View on PubMed)

Chaudry MS, Carlson N, Gislason GH, Kamper AL, Rix M, Fowler VG Jr, Torp-Pedersen C, Bruun NE. Risk of Infective Endocarditis in Patients with End Stage Renal Disease. Clin J Am Soc Nephrol. 2017 Nov 7;12(11):1814-1822. doi: 10.2215/CJN.02320317. Epub 2017 Oct 3.

Reference Type BACKGROUND
PMID: 28974524 (View on PubMed)

Nelveg-Kristensen KE, Laier GH, Heaf JG. Risk of death after first-time blood stream infection in incident dialysis patients with specific consideration on vascular access and comorbidity. BMC Infect Dis. 2018 Dec 20;18(1):688. doi: 10.1186/s12879-018-3594-7.

Reference Type BACKGROUND
PMID: 30572826 (View on PubMed)

Sakhuja A, Nanchal RS, Gupta S, Amer H, Kumar G, Albright RC, Kashani KB. Trends and Outcomes of Severe Sepsis in Patients on Maintenance Dialysis. Am J Nephrol. 2016;43(2):97-103. doi: 10.1159/000444684. Epub 2016 Mar 10.

Reference Type BACKGROUND
PMID: 26959243 (View on PubMed)

Other Identifiers

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H-20026735

Identifier Type: -

Identifier Source: org_study_id

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