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Effects of Dapagliflozin in Non-diabetic Patients With Proteinuria (DIAMOND)

Primary Purpose

Chronic Kidney Diseases, Proteinuria

Status
Unknown status
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Dapagliflozin 10mg
Sponsored by
Hiddo Lambers Heerspink
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Chronic Kidney Diseases focused on measuring chronic kidney disease, non diabetic

Eligibility Criteria

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

Inclusion Criteria:

  • Age ≥18 and ≤75 years
  • Urinary protein excretion > 500 mg/g and ≤ 3500 mg/g in a 24-hr urine collection eGFR ≥ 25 mL/min/1.73m2
  • On a stable dose of an ACEi or ARB for at least 4 weeks prior to randomization
  • Willing to sign informed consent
  • Women of Child-Bearing Potential (WOCBP):
  • WOCBP must be using an acceptable method of contraception to avoid pregnancy throughout the study and for up to 4 weeks after the last dose of study drug in such a manner that the risk of pregnancy is minimized.
  • WOCBP must have a negative serum or urine pregnancy test result (minimum sensitivity 25 IU/L or equivalent units of HCG) within 0 to 72 hours before the first dose of study drug.
  • Women must not be breast-feeding.

WOCBP comprises women who have experienced menarche and who have not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or who are not post-menopausal.

Exclusion Criteria:

  • Diagnosis of type 1 or type 2 diabetes mellitus
  • Urinary protein excretion > 3500 mg/day
  • Autosomal dominant polycystic kidney disease or autosomal recessive polycystic kidney disease, lupus nephritis, or ANCA-associated vasculitis
  • Indication for immunosuppressants as per the treating physician's judgment.
  • Receiving cytotoxic therapy, immunosuppressive therapy, or other immunotherapy for primary or secondary renal disease within 6 months prior to enrolment.
  • Active malignancy aside from treated squamous cell or basal cell carcinoma of the skin.
  • Any medication, surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or excretion of medications including, but not limited to any of the following:

    • History of active inflammatory bowel disease within the last six months;
    • Major gastrointestinal tract surgery such as gastrectomy, gastroenterostomy, or bowel resection;
    • Gastro-intestinal ulcers and/or gastrointestinal or rectal bleeding within last six months;
    • Pancreatic injury or pancreatitis within the last six months;
    • Evidence of hepatic disease as determined by any one of the following: ALT or AST values exceeding 3x ULN at the screening visit, a history of hepatic encephalopathy, a history of esophageal varices, or a history of portocaval shunt;
    • Evidence of urinary obstruction of difficulty in voiding at screening
  • History of severe hypersensitivity or contraindications to dapagliflozin
  • Subject who, in the assessment of the investigator, may be at risk for dehydration or volume depletion that may affect the interpretation of efficacy or safety data
  • Participation in any clinical investigation within 3 months prior to initial dosing.
  • Donation or loss of 400 ml or more of blood within 8 weeks prior to initial dosing.
  • History of drug or alcohol abuse within the 12 months prior to dosing, or evidence of such abuse as indicated by the laboratory assays conducted during the screening.
  • History of noncompliance to medical regimens or unwillingness to comply with the study protocol.
  • Any surgical or medical condition, which in the opinion of the investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study.
  • Pregnancy or breastfeeding
  • WOCBP who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and up to 4 weeks after the last dose of study drug.

Sites / Locations

  • Nephrology Dept., Vancouver Coastal Health Research Institute
  • Division of Nephrology University Health Network, University of Toronto
  • Nephrology Unit, University Kebangsaan Malaysia
  • University Malaya Medical Centre, Ward 8TE
  • Dept Internal Medicine, division of Nephrology Hospital Group Twente
  • Dept.of Nephrology, VU University Medical Center
  • Dept. Nephrology, University Medical Center Groningen

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Dapagliflozin 10mg Tablet

Placebo Matching Dapagliflozin Tablet

Arm Description

10 mg Green, plain, diamond shaped, film coated tablet (orally)

Green, plain, diamond shaped, film coated tablet. Does not contain active ingredient

Outcomes

Primary Outcome Measures

Change in 24-hr proteinuria with dapagliflozin for six weeks relative to placebo in patients with non-diabetic kidney disease and proteinuria 500 mg/day on stable angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker treatment.
bioequivalence

Secondary Outcome Measures

Effect of dapagliflozin 10 mg/d compared to placebo on Glomerular Filtration Rate (GFR) using iohexol clearance
bioequivalence
Effect of dapagliflozin 10 mg/d compared to placebo on systolic/diastolic blood pressure
bioequivalence
Effect of dapagliflozin 10 mg/d compared to placebo on body weight
bioequivalence
Effect of dapagliflozin 10 mg/d compared to placebo on selected neurohormones/ biomarkers
bioequivalence
Safety of dapagliflozin vs. placebo - the number of hypoglycemia episodes between groups and serious adverse events
safety

Full Information

First Posted
June 15, 2017
Last Updated
September 25, 2019
Sponsor
Hiddo Lambers Heerspink
Collaborators
AstraZeneca
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1. Study Identification

Unique Protocol Identification Number
NCT03190694
Brief Title
Effects of Dapagliflozin in Non-diabetic Patients With Proteinuria
Acronym
DIAMOND
Official Title
A Study to Assess the Renoprotective Effects of the SGLT2 Inhibitor Dapagliflozin in Non-Diabetic Patients With Proteinuria: a Randomized Double Blind 6-Weeks Cross-Over Trial
Study Type
Interventional

2. Study Status

Record Verification Date
September 2019
Overall Recruitment Status
Unknown status
Study Start Date
November 12, 2017 (Actual)
Primary Completion Date
November 1, 2019 (Anticipated)
Study Completion Date
December 1, 2019 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Hiddo Lambers Heerspink
Collaborators
AstraZeneca

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This study tests the hypothesis that dapagliflozin lowers proteinuria in patients with non-diabetic chronic kidney disease.
Detailed Description
Despite optimal treatment with renin-angiotensin-aldosterone-system (RAAS) inhibitors, many patients with non-diabetic kidney disease show progressive kidney function loss, which is associated with high residual proteinuria. Novel treatment strategies are therefore required to further decrease proteinuria and to slow kidney function decline. Dapagliflozin is a sodium-glucose transport (SGLT2) inhibitor and inhibits the reabsorption of glucose and sodium in the proximal tubule. The increased natriuresis following dapagliflozin administration normalizes tubuloglomerular feedback resulting in a reduction in intra-glomerular hypertension, which is in turn manifested by acute reversible reductions in glomerular filtration rate and albuminuria. Since many etiologies of non-diabetic nephropathy are characterized by intraglomerular hypertension, we hypothesize that dapagliflozin acutely decreases GFR and proteinuria in patients without diabetes at risk of progressive kidney function loss via a glucose independent hemodynamic mechanism.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Kidney Diseases, Proteinuria
Keywords
chronic kidney disease, non diabetic

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Model Description
A Randomized Double Blind 6-Weeks Cross-over
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
50 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Dapagliflozin 10mg Tablet
Arm Type
Experimental
Arm Description
10 mg Green, plain, diamond shaped, film coated tablet (orally)
Arm Title
Placebo Matching Dapagliflozin Tablet
Arm Type
Placebo Comparator
Arm Description
Green, plain, diamond shaped, film coated tablet. Does not contain active ingredient
Intervention Type
Drug
Intervention Name(s)
Dapagliflozin 10mg
Other Intervention Name(s)
Placebo Matching Dapagliflozin 10mg
Intervention Description
Tablet
Primary Outcome Measure Information:
Title
Change in 24-hr proteinuria with dapagliflozin for six weeks relative to placebo in patients with non-diabetic kidney disease and proteinuria 500 mg/day on stable angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker treatment.
Description
bioequivalence
Time Frame
6 weeks
Secondary Outcome Measure Information:
Title
Effect of dapagliflozin 10 mg/d compared to placebo on Glomerular Filtration Rate (GFR) using iohexol clearance
Description
bioequivalence
Time Frame
6 weeks
Title
Effect of dapagliflozin 10 mg/d compared to placebo on systolic/diastolic blood pressure
Description
bioequivalence
Time Frame
week 0, 2, 4, 5, 6, 12, 15, 18, 24
Title
Effect of dapagliflozin 10 mg/d compared to placebo on body weight
Description
bioequivalence
Time Frame
week 0, 2, 4, 5, 6, 12, 15, 18, 24
Title
Effect of dapagliflozin 10 mg/d compared to placebo on selected neurohormones/ biomarkers
Description
bioequivalence
Time Frame
week 0, 3, 6, 12, 15, 18, 24
Title
Safety of dapagliflozin vs. placebo - the number of hypoglycemia episodes between groups and serious adverse events
Description
safety
Time Frame
week 0-26

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: Age ≥18 and ≤75 years Urinary protein excretion > 500 mg/g and ≤ 3500 mg/g in a 24-hr urine collection eGFR ≥ 25 mL/min/1.73m2 On a stable dose of an ACEi or ARB for at least 4 weeks prior to randomization Willing to sign informed consent Women of Child-Bearing Potential (WOCBP): WOCBP must be using an acceptable method of contraception to avoid pregnancy throughout the study and for up to 4 weeks after the last dose of study drug in such a manner that the risk of pregnancy is minimized. WOCBP must have a negative serum or urine pregnancy test result (minimum sensitivity 25 IU/L or equivalent units of HCG) within 0 to 72 hours before the first dose of study drug. Women must not be breast-feeding. WOCBP comprises women who have experienced menarche and who have not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or who are not post-menopausal. Exclusion Criteria: Diagnosis of type 1 or type 2 diabetes mellitus Urinary protein excretion > 3500 mg/day Autosomal dominant polycystic kidney disease or autosomal recessive polycystic kidney disease, lupus nephritis, or ANCA-associated vasculitis Indication for immunosuppressants as per the treating physician's judgment. Receiving cytotoxic therapy, immunosuppressive therapy, or other immunotherapy for primary or secondary renal disease within 6 months prior to enrolment. Active malignancy aside from treated squamous cell or basal cell carcinoma of the skin. Any medication, surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or excretion of medications including, but not limited to any of the following: History of active inflammatory bowel disease within the last six months; Major gastrointestinal tract surgery such as gastrectomy, gastroenterostomy, or bowel resection; Gastro-intestinal ulcers and/or gastrointestinal or rectal bleeding within last six months; Pancreatic injury or pancreatitis within the last six months; Evidence of hepatic disease as determined by any one of the following: ALT or AST values exceeding 3x ULN at the screening visit, a history of hepatic encephalopathy, a history of esophageal varices, or a history of portocaval shunt; Evidence of urinary obstruction of difficulty in voiding at screening History of severe hypersensitivity or contraindications to dapagliflozin Subject who, in the assessment of the investigator, may be at risk for dehydration or volume depletion that may affect the interpretation of efficacy or safety data Participation in any clinical investigation within 3 months prior to initial dosing. Donation or loss of 400 ml or more of blood within 8 weeks prior to initial dosing. History of drug or alcohol abuse within the 12 months prior to dosing, or evidence of such abuse as indicated by the laboratory assays conducted during the screening. History of noncompliance to medical regimens or unwillingness to comply with the study protocol. Any surgical or medical condition, which in the opinion of the investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study. Pregnancy or breastfeeding WOCBP who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and up to 4 weeks after the last dose of study drug.
Facility Information:
Facility Name
Nephrology Dept., Vancouver Coastal Health Research Institute
City
Vancouver
State/Province
British Columbia
ZIP/Postal Code
V5Z 1M9
Country
Canada
Facility Name
Division of Nephrology University Health Network, University of Toronto
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 2C4
Country
Canada
Facility Name
Nephrology Unit, University Kebangsaan Malaysia
City
Kuala Lumpur
ZIP/Postal Code
5600
Country
Malaysia
Facility Name
University Malaya Medical Centre, Ward 8TE
City
Kuala Lumpur
ZIP/Postal Code
59100
Country
Malaysia
Facility Name
Dept Internal Medicine, division of Nephrology Hospital Group Twente
City
Almelo
ZIP/Postal Code
7609 PP
Country
Netherlands
Facility Name
Dept.of Nephrology, VU University Medical Center
City
Amsterdam
ZIP/Postal Code
1081 HV
Country
Netherlands
Facility Name
Dept. Nephrology, University Medical Center Groningen
City
Groningen
ZIP/Postal Code
9713 GZ
Country
Netherlands

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
33587286
Citation
van der Aart-van der Beek AB, Koomen JV, Dekkers CCJ, Barbour SJ, Boulton DW, Gansevoort RT, Greasley PJ, Abdul Gafor AH, Laverman GD, Li Q, Lim SK, Stevens J, Vervloet MG, Singh S, Cattran DC, Reich HN, Cherney DZI, Heerspink HJL. Evaluation of the Pharmacokinetics and Exposure-Response Relationship of Dapagliflozin in Patients without Diabetes and with Chronic Kidney Disease. Clin Pharmacokinet. 2021 Apr;60(4):517-525. doi: 10.1007/s40262-020-00956-1. Epub 2021 Feb 15.
Results Reference
derived
PubMed Identifier
32559474
Citation
Cherney DZI, Dekkers CCJ, Barbour SJ, Cattran D, Abdul Gafor AH, Greasley PJ, Laverman GD, Lim SK, Di Tanna GL, Reich HN, Vervloet MG, Wong MG, Gansevoort RT, Heerspink HJL; DIAMOND investigators. Effects of the SGLT2 inhibitor dapagliflozin on proteinuria in non-diabetic patients with chronic kidney disease (DIAMOND): a randomised, double-blind, crossover trial. Lancet Diabetes Endocrinol. 2020 Jul;8(7):582-593. doi: 10.1016/S2213-8587(20)30162-5. Erratum In: Lancet Diabetes Endocrinol. 2020 Jun 25;:
Results Reference
derived

Learn more about this trial

Effects of Dapagliflozin in Non-diabetic Patients With Proteinuria

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