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Oral Paricalcitol in Stage 3 - 5 Chronic Kidney Disease

Primary Purpose

Chronic Kidney Disease

Status
Completed
Phase
Not Applicable
Locations
Hong Kong
Study Type
Interventional
Intervention
paricalcitol
Sponsored by
The University of Hong Kong
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Kidney Disease focused on measuring paricalcitol, chronic kidney disease, cardiac hypertrophy

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patient with stage 3 -5 chronic kidney disease (that is, eGFR < 60 ml/min per 1.73m2) diagnosed for more than 2 months and not expected to start dialysis within the next 12 months, and
  • Patient with screening echocardiography showing evidence of left ventricular hypertrophy
  • Patient has not received vitamin D therapy in the previous 4 weeks
  • For entry into the Treatment Phase, the subject must have:

    • screening iPTH >= 55 pg/ml or 5.8pmol/L (determined by the Nichols second-generation assay or similar assay)
    • serum calcium < 10.2 mg/dL (2.55 mmol/L)
    • serum phosphorus =< 5.2mg/dL (1.68mmol/L)
    • Ca*P product < 54 mg2/dL2 (4.36mmol2/L2)
    • If female, subject is either not of childbearing potential, defined as postmenopausal for at least 1 year or surgically sterile (bilateral tubal ligation, bilateral oophorectomy, or hysterectomy), or is of childbearing potential and practicing birth control measures.
  • Patients who provide informed consent for the study

Exclusion Criteria:

  • Patient with a history of an allergic reaction or significant sensitivity to vitamin D or vitamin D related compounds.
  • Patient with history of renal stones
  • Patient with current malignancy
  • Patients with clinically significant gastrointestinal disease or liver disease
  • Patient with acute renal failure in the recent three months
  • Patient with a history of drug or alcohol abuse within six months prior to the screening phase
  • Patient is known to be human immunodeficiency virus (HIV) positive.
  • Patient with evidence of poor compliance with diet and medication.
  • Patient currently receiving medications that may affect calcium, phosphorus metabolism such as calcitonin, cinacalcet, bisphophonates or vitamin D compounds (other than study drug), or other drugs that may affect calcium or bone metabolism, other than females on stable estrogen and/or progestin therapy.
  • Patients with active granulomatous disease
  • Patient with pregnancy
  • Patients currently receiving glucocorticoid steroid or other immunosuppressive treatment or had been administered glucocorticoid or other immunosuppressive treatment for more than 14 days within recent 6 months.
  • Patients with contraindication for MRI examination

Sites / Locations

  • Queen Mary Hospital
  • University of Hong Kong, Queen Mary Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

1

2

Arm Description

paricalcitol

placebo

Outcomes

Primary Outcome Measures

Change in left ventricular mass index determined by MRI

Secondary Outcome Measures

Change in left atrial and ventricular volumes, systolic and diastolic function, carotid intima-media thickness, flow mediated dilation, pulse wave velocity, serum inflammatory and cardiac biomarkers, intact PTH, 24-hour urine protein and renal function

Full Information

First Posted
November 20, 2008
Last Updated
January 7, 2017
Sponsor
The University of Hong Kong
Collaborators
Abbott
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1. Study Identification

Unique Protocol Identification Number
NCT00796679
Brief Title
Oral Paricalcitol in Stage 3 - 5 Chronic Kidney Disease
Official Title
A Prospective, Double-Blind, Randomized, Placebo-Controlled Study to Evaluate the Efficacy of Oral Paricalcitol in Retarding Cardiac Hypertrophy, Reducing Inflammation and Atherosclerosis in Stage 3 - 5 Chronic Kidney Disease
Study Type
Interventional

2. Study Status

Record Verification Date
January 2017
Overall Recruitment Status
Completed
Study Start Date
October 2008 (undefined)
Primary Completion Date
June 2011 (Actual)
Study Completion Date
June 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
The University of Hong Kong
Collaborators
Abbott

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to test the hypothesis that selective vitamin D receptor activation reduces left ventricular hypertrophy and ameliorates inflammation and atherosclerosis in stage 3 -5 chronic kidney disease.
Detailed Description
Cardiovascular disease is the leading cause of mortality and morbidity in patients with chronic kidney disease. According to a previous study, only 15.6% of the patients beginning dialysis therapy had a normal echocardiogram, with left ventricular hypertrophy, left ventricular dilatation and systolic dysfunction occurring in 40.7%, 28% and 15.6% of patients, respectively. In addition, these patients are at an accelerated risk of developing atherosclerosis. The Kidney Disease Outcome Quality Initiative guideline recently raised concerns of a high prevalence of vitamin D deficiency in chronic kidney disease patients not yet requiring dialysis treatment. In addition, very recent data suggested that vitamin D deficiency is an important predictor of mortality in end-stage renal disease patients. Furthermore, hemodialysis patients treated with paricalcitol, a selective vitamin D receptor activator, showed a significantly lower risk of cardiovascular death than those not receiving vitamin D therapy. A number of studies also showed positive benefit of vitamin D receptor activator treatment on regression of left ventricular hypertrophy in dialysis patients. However, there is so far no data in patients with stage 3 and 4 chronic kidney disease where a high prevalence of vitamin D deficiency and cardiac hypertrophy has been reported.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Kidney Disease
Keywords
paricalcitol, chronic kidney disease, cardiac hypertrophy

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
1
Arm Type
Experimental
Arm Description
paricalcitol
Arm Title
2
Arm Type
Placebo Comparator
Arm Description
placebo
Intervention Type
Drug
Intervention Name(s)
paricalcitol
Other Intervention Name(s)
Zemplar
Intervention Description
oral paricalcitol capsule 1 microgram once daily if iPTH <500pg/mL or 2 microgram once daily if iPTH >=500pg/mL. Thereafter, dose titration in 1 microgram decrement will be done based on safety reasons (that is, for low PTH or high calcium and phosphorus level). The duration of treatment will be for 1 year.
Primary Outcome Measure Information:
Title
Change in left ventricular mass index determined by MRI
Time Frame
1 year
Secondary Outcome Measure Information:
Title
Change in left atrial and ventricular volumes, systolic and diastolic function, carotid intima-media thickness, flow mediated dilation, pulse wave velocity, serum inflammatory and cardiac biomarkers, intact PTH, 24-hour urine protein and renal function
Time Frame
1 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient with stage 3 -5 chronic kidney disease (that is, eGFR < 60 ml/min per 1.73m2) diagnosed for more than 2 months and not expected to start dialysis within the next 12 months, and Patient with screening echocardiography showing evidence of left ventricular hypertrophy Patient has not received vitamin D therapy in the previous 4 weeks For entry into the Treatment Phase, the subject must have: screening iPTH >= 55 pg/ml or 5.8pmol/L (determined by the Nichols second-generation assay or similar assay) serum calcium < 10.2 mg/dL (2.55 mmol/L) serum phosphorus =< 5.2mg/dL (1.68mmol/L) Ca*P product < 54 mg2/dL2 (4.36mmol2/L2) If female, subject is either not of childbearing potential, defined as postmenopausal for at least 1 year or surgically sterile (bilateral tubal ligation, bilateral oophorectomy, or hysterectomy), or is of childbearing potential and practicing birth control measures. Patients who provide informed consent for the study Exclusion Criteria: Patient with a history of an allergic reaction or significant sensitivity to vitamin D or vitamin D related compounds. Patient with history of renal stones Patient with current malignancy Patients with clinically significant gastrointestinal disease or liver disease Patient with acute renal failure in the recent three months Patient with a history of drug or alcohol abuse within six months prior to the screening phase Patient is known to be human immunodeficiency virus (HIV) positive. Patient with evidence of poor compliance with diet and medication. Patient currently receiving medications that may affect calcium, phosphorus metabolism such as calcitonin, cinacalcet, bisphophonates or vitamin D compounds (other than study drug), or other drugs that may affect calcium or bone metabolism, other than females on stable estrogen and/or progestin therapy. Patients with active granulomatous disease Patient with pregnancy Patients currently receiving glucocorticoid steroid or other immunosuppressive treatment or had been administered glucocorticoid or other immunosuppressive treatment for more than 14 days within recent 6 months. Patients with contraindication for MRI examination
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Angela YM Wang, MD, FRCP
Organizational Affiliation
Queen Mary Hospital, University of Hong Kong
Official's Role
Principal Investigator
Facility Information:
Facility Name
Queen Mary Hospital
City
Hong Kong
ZIP/Postal Code
0000
Country
Hong Kong
Facility Name
University of Hong Kong, Queen Mary Hospital
City
Hong Kong
ZIP/Postal Code
0000
Country
Hong Kong

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
24052631
Citation
Wang AY, Fang F, Chan J, Wen YY, Qing S, Chan IH, Lo G, Lai KN, Lo WK, Lam CW, Yu CM. Effect of paricalcitol on left ventricular mass and function in CKD--the OPERA trial. J Am Soc Nephrol. 2014 Jan;25(1):175-86. doi: 10.1681/ASN.2013010103. Epub 2013 Sep 19. Erratum In: J Am Soc Nephrol. 2019 Mar;30(3):516.
Results Reference
derived

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Oral Paricalcitol in Stage 3 - 5 Chronic Kidney Disease

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