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Pharmacologic Treatment of Congenital Nephrogenic Diabetes Insipidus

Primary Purpose

Nephrogenic Diabetes Insipidus

Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
sildenafil
calcitonin
hydrochlorothiazide/amiloride
indomethacin
Placebo for sildenafil
placebo for calcitonin
Sponsored by
University of Colorado, Denver
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Nephrogenic Diabetes Insipidus focused on measuring congenital nephrogenic diabetes insipidus, polyuria, urine osmolality, aquaporin-2, vasopressin V2 receptor

Eligibility Criteria

5 Years - 25 Years (Child, Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Known diagnosis of Congenital Nephrogenic Diabetes Insipidus (CNDI)
  • Age 5 to 25 years
  • Normal kidney function
  • Post-void residual urine < 200 ml (determined by bladder ultrasound)

Exclusion Criteria:

  • Impaired kidney function
  • Known urinary retention or bladder dysfunction
  • High blood pressure
  • Other significant chronic medical disease (e.g., heart failure, liver disease, etc.)
  • Allergy to study drugs

Sites / Locations

  • University of Colorado at Denver and Health Sciences Center
  • University of Aarhus

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Active Therapy

Placebo Control

Arm Description

4-day treatment with hydrochlorothiazide/amiloride, indomethacin, calcitonin, sildenafil

4-day treatment with hydrochlorothiazide/amiloride, indomethacin, placebo for calcitonin, placebo for sildenafil

Outcomes

Primary Outcome Measures

24h Urine Volume
urine volume in mL/d

Secondary Outcome Measures

Full Information

First Posted
May 23, 2007
Last Updated
February 8, 2018
Sponsor
University of Colorado, Denver
Collaborators
University of Aarhus
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1. Study Identification

Unique Protocol Identification Number
NCT00478335
Brief Title
Pharmacologic Treatment of Congenital Nephrogenic Diabetes Insipidus
Official Title
Pharmacologic Treatment of Congenital Nephrogenic Diabetes Insipidus
Study Type
Interventional

2. Study Status

Record Verification Date
February 2018
Overall Recruitment Status
Completed
Study Start Date
May 2007 (undefined)
Primary Completion Date
October 2012 (Actual)
Study Completion Date
October 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Colorado, Denver
Collaborators
University of Aarhus

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this research study is to determine if two investigational medications will be more effective in decreasing urine output than the currently available and routinely used medications in patients with congenital nephrogenic diabetes insipidus (NDI).
Detailed Description
The study involves the use of the investigational medications sildenafil and calcitonin. These medications have shown promise as treatment for NDI in laboratory (non-human) studies but have not been used for treatment of NDI in humans. At this time, there is no guarantee that these investigational medications will provide additional benefit to people with NDI. The study is open to males, between the ages of 5 and 25 years who have been diagnosed with Nephrogenic diabetes insipidus (NDI) and who have normal kidney and bladder function. A total of 40 patients with NDI will be enrolled in the study. The study will involve two outpatient clinic visits, followed by a 9-night hospital stay, followed by a final follow-up outpatient clinic visit. All visits will take place within a 20-day time period. At the first clinic visit, blood and urine testing for kidney and liver function and blood count will be performed. If the genetic alteration which causes your NDI has not been previously identified, blood for DNA testing will also be obtained. If a kidney and bladder ultrasound has not been performed in the past 6 months, it will be obtained. The ultrasound is to make sure that there is no problem with drainage of urine from the kidneys and bladder. Subjects will be asked to fill out food preference questionnaires to use for planning of meals for the hospital stay. Subjects will be given containers to collect two consecutive 24-hour urine samples at home. These urine collections will help determine how well the subjects routine medicines are working to control their NDI. At the second clinic visit, subjects will bring in the two 24-hour urine samples. Blood will again be collected for further testing of kidney function. Subjects will be given containers to collect another 24-hour urine just prior to the hospital visit. The third visit requires hospital admission and will be scheduled at the study site closest to the subjects home (The Children's Hospital, Denver, Colorado; University of Aarhus, Denmark). For the hospital visit, subjects will need to stop their usual NDI medications for 48 hours prior to the visit. Subjects will perform another 24-hour urine collection on the day prior to your hospital admission. This urine sample will be turned in to the laboratory when you are admitted to the hospital for the research study. The length of the hospital stay is 10 days/9 nights. During the stay, subjects can expect to have their weight, heart rate, and blood pressure checked three times a day. All urine will be collected. Blood testing will be performed every other day. Subjects will need to eat the meals provided at the hospital; all meals will be provided according to a low-salt diet restriction. Subjects may drink fluids as desired but they will need to avoid caffeine-containing beverages and alcohol. On the first day of the hospital stay, testing will be performed to confirm the diagnosis of NDI. This test involves administration of the medicine dDAVP (Desmopressin) through an IV catheter (into a vein) with collection of urine every 30 minutes for 4 hours. subjects will be randomized (like the toss of a coin) to receive either the investigational medication treatment for 4 days followed by the routine medication treatment for 4 days or vice versa. When subjects receive the routine medication treatment, they will receive placebos (inactive substances like a sugar pill) in place of the investigational medicines. In this way, neither the subject nor the investigator will know whether the subjects are receiving the investigational or the routine medication treatment first. Medicines will be given twice a day during the hospital stay. On the last day of the hospital stay, subjects will be instructed to resume their normal diet and medications. At a final outpatient clinic visit, blood testing and urinalysis will be performed. Potential benefits of participation include a no-cost health examination, laboratory studies, and an evaluation of current management of NDI. There is no cost for participation in this research study. No pay will be given to participants in this research study. This research study has been approved by the ethical review boards of the following institutions: Colorado Multiple Institutional Review Board (#06-0588), Emory University Institutional Review Board (#729-2005), and the University of Aarhus (#20050183). Individuals who decide to take part in this research study will need to sign a specific consent form at a participating institution as well as a release for use of personal health information (HIPAA form).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Nephrogenic Diabetes Insipidus
Keywords
congenital nephrogenic diabetes insipidus, polyuria, urine osmolality, aquaporin-2, vasopressin V2 receptor

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
4 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Active Therapy
Arm Type
Experimental
Arm Description
4-day treatment with hydrochlorothiazide/amiloride, indomethacin, calcitonin, sildenafil
Arm Title
Placebo Control
Arm Type
Placebo Comparator
Arm Description
4-day treatment with hydrochlorothiazide/amiloride, indomethacin, placebo for calcitonin, placebo for sildenafil
Intervention Type
Drug
Intervention Name(s)
sildenafil
Other Intervention Name(s)
Viagra
Intervention Description
25 mg quaque die (QD) or 50 mg QD x 4 days based on subject weight
Intervention Type
Drug
Intervention Name(s)
calcitonin
Other Intervention Name(s)
Miacalcic
Intervention Description
one nasal spray daily for 4 days
Intervention Type
Drug
Intervention Name(s)
hydrochlorothiazide/amiloride
Other Intervention Name(s)
Moduret, Moduretic
Intervention Description
25 mg/2.5 mg BID or 50 mg/5 mg BID x 8 days depending on subject weight
Intervention Type
Drug
Intervention Name(s)
indomethacin
Other Intervention Name(s)
Indocin
Intervention Description
50 mg QD or 50 mg BID x 8 days depending on subject weight
Intervention Type
Drug
Intervention Name(s)
Placebo for sildenafil
Intervention Description
one tablet daily for 4 days
Intervention Type
Drug
Intervention Name(s)
placebo for calcitonin
Intervention Description
one nasal spray daily
Primary Outcome Measure Information:
Title
24h Urine Volume
Description
urine volume in mL/d
Time Frame
4-days

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
5 Years
Maximum Age & Unit of Time
25 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Known diagnosis of Congenital Nephrogenic Diabetes Insipidus (CNDI) Age 5 to 25 years Normal kidney function Post-void residual urine < 200 ml (determined by bladder ultrasound) Exclusion Criteria: Impaired kidney function Known urinary retention or bladder dysfunction High blood pressure Other significant chronic medical disease (e.g., heart failure, liver disease, etc.) Allergy to study drugs
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Melissa A Cadnapaphornchai, MD
Organizational Affiliation
University of Colorado, Denver
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Colorado at Denver and Health Sciences Center
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
University of Aarhus
City
Aarhus
Country
Denmark

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
16580609
Citation
Bichet DG. Nephrogenic diabetes insipidus. Adv Chronic Kidney Dis. 2006 Apr;13(2):96-104. doi: 10.1053/j.ackd.2006.01.006.
Results Reference
background
PubMed Identifier
16093448
Citation
Fujiwara TM, Bichet DG. Molecular biology of hereditary diabetes insipidus. J Am Soc Nephrol. 2005 Oct;16(10):2836-46. doi: 10.1681/ASN.2005040371. Epub 2005 Aug 10.
Results Reference
background
PubMed Identifier
12565698
Citation
Schrier RW, Cadnapaphornchai MA. Renal aquaporin water channels: from molecules to human disease. Prog Biophys Mol Biol. 2003 Feb;81(2):117-31. doi: 10.1016/s0079-6107(02)00049-4.
Results Reference
background
PubMed Identifier
11975794
Citation
Schrier RW, Cadnapaphornchai MA, Umenishi F. Water-losing and water-retaining states: role of water channels and vasopressin receptor antagonists. Heart Dis. 2001 May-Jun;3(3):210-4. doi: 10.1097/00132580-200105000-00014.
Results Reference
background
PubMed Identifier
17222168
Citation
Nielsen S, Kwon TH, Frokiaer J, Agre P. Regulation and dysregulation of aquaporins in water balance disorders. J Intern Med. 2007 Jan;261(1):53-64. doi: 10.1111/j.1365-2796.2006.01760.x.
Results Reference
background
PubMed Identifier
15644490
Citation
Kotnik P, Nielsen J, Kwon TH, Krzisnik C, Frokiaer J, Nielsen S. Altered expression of COX-1, COX-2, and mPGES in rats with nephrogenic and central diabetes insipidus. Am J Physiol Renal Physiol. 2005 May;288(5):F1053-68. doi: 10.1152/ajprenal.00114.2004. Epub 2005 Jan 11.
Results Reference
background
PubMed Identifier
11773613
Citation
Nielsen S, Frokiaer J, Marples D, Kwon TH, Agre P, Knepper MA. Aquaporins in the kidney: from molecules to medicine. Physiol Rev. 2002 Jan;82(1):205-44. doi: 10.1152/physrev.00024.2001.
Results Reference
background
PubMed Identifier
15644488
Citation
Bouley R, Pastor-Soler N, Cohen O, McLaughlin M, Breton S, Brown D. Stimulation of AQP2 membrane insertion in renal epithelial cells in vitro and in vivo by the cGMP phosphodiesterase inhibitor sildenafil citrate (Viagra). Am J Physiol Renal Physiol. 2005 Jun;288(6):F1103-12. doi: 10.1152/ajprenal.00337.2004. Epub 2005 Jan 11.
Results Reference
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Links:
URL
http://www.ndif.org
Description
Nephrogenic Diabetes Insipidus Foundation

Learn more about this trial

Pharmacologic Treatment of Congenital Nephrogenic Diabetes Insipidus

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