A Safety, Tolerability, Efficacy and QoL Study of Human recAP in the Treatment of Patients With SA-AKI (STOP-AKI)
Acute Kidney Injury
About this trial
This is an interventional treatment trial for Acute Kidney Injury focused on measuring SA-AKI, Sepsis, AKI, Recombinant Alkaline Phosphatase, recAP
Eligibility Criteria
Inclusion Criteria:
- Signed Informed Consent Form (patient, legal representative or independent investigator)
- Age 18 to 85 years, inclusive
- Is admitted to the ICU or Intermediate Care Unit
Has diagnosis of sepsis (< 96 hrs prior to first study drug), according to criteria defined by the American College of Chest Physicians/Society of Critical Care Medicine:
- Has a proven or strongly suspected bacterial infection.
- Has at least 2 of 4 SIRS criteria 72 hrs < screening and 96 hrs < first study drug
First diagnosis of AKI: AKI Stage 1 or greater, according to the AKIN criteria (time-window adjusted):
- Increase in serum creatinine > 26.2 µmol/L (0.30 mg/dL) in 48 hrs prior to screening, or
- Increase in serum creatinine to > 150% (> 1.5-fold) from reference creatinine value in 48 hrs prior to screening
- Urinary output < 0.5 mL/kg/h for > 6 hours following adequate fluid resuscitation
- Continuing AKI needs to be confirmed by a confirmative fluid corrected serum creatinine measure, or
- When the AKI diagnosis was made according to the AKIN urine output criteria (urinary output < 0.5 mL/kg/h for > 6 hours), the oliguria or anuria should still meet the AKIN urine output criteria prior to randomization.
Exclusion Criteria:
- Woman of childbearing potential with a positive pregnancy test, pregnant, or breastfeeding.
- Weighs more than 115 kg (253 lb).
- Has life support limitations.
- Is known to be human immunodeficiency virus positive.
- Has urosepsis.
- Is already on dialysis (RRT) or anticipated to receive RRT within 24 hours after study drug dosing due to the underlying disease.
- Is receiving immunosuppressant treatment or is on chronic high doses of steroids equivalent to prednisone/prednisolone 0.5 mg/kg/day, including solid organ transplant patients. Patients with septic shock treated with hydrocortisone (e.g., 3 × 100 mg) can be included.
- Is expected to have rapidly fatal outcome (within 24 hours).
- Has known, confirmed fungal sepsis.
- Has advanced chronic liver disease, confirmed by a Child-Pugh score of 10 to 15.
- Has acute pancreatitis with no established source of infection.
- Has participated in another investigational study within 30 days prior to enrollment.
- Is not expected to survive for 28 days due to medical conditions other than SA AKI, including cancer, end-stage cardiac disease, cardiac arrest requiring cardiopulmonary resuscitation or with pulseless electrical activity or asystole within the past 30 days, end stage lung disease, and end stage liver disease.
- Has known prior history of Chronic Kidney Disease with a documented estimated Glomerular Filtration Rate (eGFR) < 60 mL/min by Modification of Diet in Renal Disease MDRD or CKD-EPI formula, known GFR < 60 mL/min, or a known history of persistent creatinine level > 150 µmol/L (1.70 mg/dL) for reasons other than the current sepsis condition.
- Has diagnosis of malaria or other parasite infections.
- Has burns on > 20% of body surface.
- Has had AKI diagnosis according to inclusion criteria > 24 hours prior to study drug administration.
- Is anticipated to be treated with non-continuous RRT from Day 1 to Day 7.
- During Day 1 to Day 7 continuous RRT is anticipated to be started or stopped not according to per protocol criteria.
- The AKI is most likely attributable to other causes than sepsis, such as nephrotoxic drugs and renal perfusion-related.
- Improvement in serum creatinine of at least 0.30 mg/dL or (26.2 µmol/L) prior to administration of the study drug.
- Patients who use nephrotoxic medication and who fulfill the SA-AKI inclusion criteria at screening are not eligible if the use of this nephrotoxic medication is to continue when alternative, medically appropriate, non-nephrotoxic medication is available.
- Has a history of known IV drug abuse.
- Is an employee or family member of the investigator or study site personnel.
- Has active hematological malignancy.
Sites / Locations
- University of Alabama at Birmingham
- Tampa General Hospital, Division Emergency Medicine
- Eastern Idaho Medical Consultants LLC
- University of Cincinnati Medical Center
- UPMC
- University of Texas Houston Medical School
- Medizinische Universität Innsbruck
- Universitätsklinik für Allgemeine und Chirurgische Intensivmedizin
- Hôpital Erasme
- CHU UCL Mont Godinne
- University Hospital Ghent
- University Hospital Antwerpen
- Cliniques Universitaires Saint Luc-UCL
- CHU Brugmann
- UZ Brussel
- Fakultni nemocnice u sv. Anny v Brne
- Oblastni nemocnice Kolin, a.s.
- Fakultni nemocnice Plzen
- Helsingin Yliopistollinen Keskussairaala
- Kuopion Yliopistollinen Sairaala
- Tampereen yliopistollinen sairaala
- Hôpital Universitaire Dupuytren
- Hôpital Charles Nicolle
- Centre Hospitalier Departemental de Vendee
- CHU Angers
- Centre Hospitalier Victor Dupouy - hopital
- CHRU Nantes - Hospital
- Hôpital Lariboisière
- Hôpitaux Universitaires de Strasbourg
- University Hospital Frankfurt, Anaesthesia, Intensive Care Medicine & Pain Therapy
- Universitätsmedizin Greifswald Klinik für Anästhesiologie, IntensivmedizinNotfallmedizin und Schmerzmedizin
- Medizinische Hochschule Hannover Hospital - Zentrum Innere Medizin - Klinik fuer Pneumologie
- Universitätsklinikum Schleswig-Holstein - Klinik für Anästhesiologie und Operative Intensivmedizin
- Helios Klinikum Erfurt -Klinik fur Anaesthesie, Intensivmedizin und Schmerztherapie
- Universitatsklinikum Jena - Klinik für Anästhesiologie und Intensivmedzin
- Universitätsklinikum Hamburg Eppendorf Department Intensive Care Medicine
- St. Vincent's University Hospital
- Medical Center Leeuwarden
- Radboud University Nijmegen
- Canisius Wilhelmina Ziekenhuis
- Jeroen Bosch Ziekenhuis
- VU Medisch Centrum
- Medisch Spectrum Twente
- Erasmus Medisch Centrum
- Ikazia Ziekenhuis
- Gelre Ziekenhuizen - Hospital
- Hospital Universitario Germans Trias i Pujol Medicina Intensiva Hospital General,
- Hospital de La Santa Creu i Sant Pau
- Corporacio Sanitaria Parc Tauli
- Hospital Mutua de Terrassa
- Hospital Universitario Vall d'Hebron
- Hospital Universitario 12 de Octubre, Unidad de Cuidados Intensivos Hospital General
- Hospital Universitari de Tarragona Joan XXIII
- Royal Surrey County Hospital - Intensive Care Unit
- Royal Infirmary of Edinburgh
- Royal London Hospital
- University College London
- St James University Hospital
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Placebo Comparator
Experimental
Experimental
Experimental
Placebo
0.4 mg/kg (250 U/kg) recAP
0.8 mg/kg (500 U/kg) recAP
1.6 mg/kg (1000 U/kg) recAP
1 hour IV infusion once daily for 3 days
1 hour IV infusion once daily for 3 days
1 hour IV infusion once daily for 3 days
1 hour IV infusion once daily for 3 days