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Kidney Fat in Type 2 Diabetes and the Effects of Ezetimibe (DiaKidZ)

Primary Purpose

Diabetes Mellitus, Type 2, Diabetic Kidney Disease

Status
Active
Phase
Phase 3
Locations
Denmark
Study Type
Interventional
Intervention
Ezetimibe 10mg
Placebo
Sponsored by
Steno Diabetes Center Copenhagen
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetes Mellitus, Type 2

Eligibility Criteria

40 Years - 75 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion criteria for the intervention trial

  • Age ≥ 40 and ≤ 75 years
  • T2D (World Health Organization criteria)
  • eGFR ≥ 30ml/min/1,73m2 at screening
  • Persistent UACR ≥ 30mg/g (in more than two out of three valid measurements over a minimum of three months)
  • LDL > 1.5mmol/L at screening
  • Ability to communicate with the investigator and give informed consent

Exclusion criteria for the intervention trial

  • Chronic kidney disease primarily ascribed to other causes than diabetes
  • Acute kidney disease within 3 months
  • No UACR ≥ 3000mg/g in history
  • Current or recent (within 3 months) treatment with ezetimibe
  • Initiation or adjustment in dosage within 1 month of an angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB), glucagon-like peptide-1 receptor (GLP-1RA) agonists, sodium-glucose cotransporter 2 (SGLT-2) inhibitors or anti-dyslipidemia drug, e.g. a statin
  • Any contraindication to MR-examination (e.g. magnetic foreign body that cannot easily be removed from the body prior to the examination, claustrophobia or body size not compatible with the scanner)
  • Intolerance to trial drug components
  • Any previous major organ transplantation
  • Elective major surgery during the trial
  • Pregnancy, planned pregnancy or breastfeeding during the trial
  • Insufficient contraception during the trial in women of childbearing potential
  • Severe alcohol consumption or abuse of recreational drugs
  • Moderate to severe liver failure (Child Pugh 7-15)
  • Any surgical or medical condition which can be expected to significantly alter the absorption of the trial drug (e.g. major gastrointestinal tract surgery or inflammatory bowel disease)
  • Recent (within 30 days or 5-half-lives, whichever is longer) or current participation in another clinical study in which an investigational medicinal product or device has been received
  • Any medical condition or history thereof or any deviation from normal laboratory values that, in the opinion of the investigator, clinically contraindicates or hinders the completion of the trial
  • Any reason for suspecting a considerable lack of compliance to the trial

Inclusion criteria for the control group (cross-sectional study alone):

  • Age ≥ 40 and ≤ 75 years
  • eGFR ≥60ml/min/1,73m2 at screening
  • Ability to communicate with the investigator and give informed consent

Exclusion criteria for the control group (cross-sectional study alone):

  • Any major chronic disease, e.g. diabetes mellitus, chronic kidney disease, ischemic heart disease, chronic obstructive pulmonary disease (this criterium does not include conditions that may be considered risk factors for chronic diseases, e.g. essential hypertension, primary hypercholesterolemia)
  • Acute kidney disease within 3 months
  • History of persistent UACR ≥ 30mg/g (in more than two out of three valid measurements over a minimum of three months including those at screening) or a previous diagnosis of micro- or macroalbuminuria
  • Current or recent (within 3 months) treatment with ezetimibe
  • Any contraindication to an MR-examination (e.g. magnetic foreign body that cannot easily be removed from the body prior to the examination or claustrophobia)
  • Any previous major organ transplantation
  • Elective major surgery during the study
  • Pregnancy, planned pregnancy or breastfeeding during the study
  • Severe alcohol consumption or abuse of recreational drugs
  • Moderate to severe liver failure (Child Pugh 7-15)
  • Recent (within 30 days or 5-half-lives, whichever is longer) or current participation in another clinical study in which an investigational medicinal product or device has been received
  • Any medical condition or history thereof or any deviation from normal laboratory values that, in the opinion of the investigator, clinically contraindicates or hinders the completion of the study
  • Any reason for suspecting a considerable lack of compliance to the study

Inclusion criteria for the group of participants with T2D and no DKD (cross-sectional study alone):

  • Age ≥ 40 and ≤ 75 years
  • T2D (World Health Organization criteria)
  • eGFR ≥60ml/min/1,73m2 at screening
  • Ability to communicate with the Investigator and give informed consent

Exclusion criteria for the group of participants with T2D and no DKD (cross-sectional study alone):

  • Any chronic kidney disease
  • Acute kidney disease within 3 months
  • History of persistent UACR ≥ 30mg/g (in more than two out of three valid measurements over a minimum of three months including those at screening) or a previous diagnosis of micro- or macroalbuminuria
  • Current or recent (within 3 months) treatment with ezetimibe
  • Any contraindication to an MR-examination (e.g. magnetic foreign body that cannot easily be removed from the body prior to the examination or claustrophobia)
  • Any previous major organ transplantation
  • Elective major surgery during the study
  • Pregnancy, planned pregnancy or breastfeeding during the study
  • Severe alcohol consumption or abuse of recreational drugs
  • Moderate to severe liver failure (Child Pugh 7-15)
  • Recent (within 30 days or 5-half-lives, whichever is longer) or current participation in another clinical study in which an investigational medicinal product or device has been received
  • Any medical condition or history thereof or any deviation from normal laboratory values that, in the opinion of the investigator, clinically contraindicates or hinders the completion of the study procedures
  • Any reason for suspecting a considerable lack of compliance to the study

Sites / Locations

  • Steno Diabetes Center Copenhagen

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Ezetimibe

Placebo

Arm Description

One treatment period of 16 weeks with1 capsule of ezetimibe 10mg per day, as add-on to standard care.

One treatment period of 16 weeks with 1 capsule of matching placebo per day, as add-on to standard care.

Outcomes

Primary Outcome Measures

Urinary albumin creatinine ratio (UACR)

Secondary Outcome Measures

Magnetic resonans estimate of kidney parenchymal triglyceride fraction

Full Information

First Posted
October 2, 2020
Last Updated
January 14, 2022
Sponsor
Steno Diabetes Center Copenhagen
Collaborators
Department of Clinical Physiology, Nuclear Medicine and PET at Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark, Aase Handberg, professor, dr.med., Department of Clinical Biochemistry, Aalborg University Hospital, Capital Region's Pharmacy (Region Hovedstadens Apotek), Marielundvej 25, 2730 Herlev, Denmark, Alessia Fornoni, MD PhD, Professor of Medicine, Chief, Katz Family Division of Nephrology and Hypertension
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1. Study Identification

Unique Protocol Identification Number
NCT04589351
Brief Title
Kidney Fat in Type 2 Diabetes and the Effects of Ezetimibe
Acronym
DiaKidZ
Official Title
Kidney Fat in Type 2 Diabetes & Diabetic Kidney Disease and the Effects of Ezetimibe: A Cross-Sectional Study and Randomized, Placebo-Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
January 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
October 1, 2020 (Actual)
Primary Completion Date
May 2022 (Anticipated)
Study Completion Date
May 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Steno Diabetes Center Copenhagen
Collaborators
Department of Clinical Physiology, Nuclear Medicine and PET at Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark, Aase Handberg, professor, dr.med., Department of Clinical Biochemistry, Aalborg University Hospital, Capital Region's Pharmacy (Region Hovedstadens Apotek), Marielundvej 25, 2730 Herlev, Denmark, Alessia Fornoni, MD PhD, Professor of Medicine, Chief, Katz Family Division of Nephrology and Hypertension

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
In this study, we seek to explore the importance of fat accumulation in the kidneys in relation to diabetic kidney disease (DKD). To do this, we conduct an intervention trial in individuals with type 2 diabetes (T2D) and DKD where we investigate whether the inhibition of intestinal cholesterol absorption with ezetimibe affects albuminuria (a strong risk factor for diabetic complications) and kidney fat accumulation. At the same time and to confirm that kidney fat accumulation is, in fact, abnormal in T2D and DKD, we conduct a cross-sectional study in which we compare kidney fat accumulation in participants at baseline from the intervention trial with a group of individuals with T2D and no DKD and a group of healthy individuals.
Detailed Description
Objective: To compare cross-sectionally the fractions of kidney lipid between controls, individuals with type 2 diabetes and no diabetic kidney disease and individuals with type 2 diabetes and non-severe diabetic kidney disease. To assess by intervention trial whether ezetimibe reduces albuminuria and kidney parenchymal triglyceride fraction in individuals with type 2 diabetes and non-severe diabetic kidney disease. Design: Cross-sectional study on 30 controls, 30 individuals with type 2 diabetes and no diabetic kidney disease and 60 individuals with type 2 diabetes and non-severe diabetic kidney disease. Single-center, randomized, double-blinded, placebo-controlled and parallel intervention trial in 60 individuals with type 2 diabetes and non-severe diabetic kidney disease Comparative treatment regime: Ezetimibe 10mg per day versus placebo for 16 weeks Primary endpoint in cross-sectional study: Kidney parenchymal triglyceride fraction (estimated by magnetic resonance spectroscopy) Primary endpoint in intervention trial: Urinary albumin creatinine ratio Secondary endpoint in intervention trial: • Kidney parenchymal triglyceride fraction (estimated by magnetic resonance spectroscopy) Main eligibility criteria for control group (cross-sectional study alone): • Age 40-75 years • No diabetes mellitus • No kidney disease or urinary albumin creatinine ratio ≥ 30mg/g • No contraindication to examination by magnetic resonance Main eligibility criteria for group of individuals with type 2 diabetes and no diabetic kidney disease (cross-sectional study alone): • Age 40-75 years Type 2 diabetes No kidney disease or urinary albumin creatinine ratio ≥ 30mg/g No contraindication to examination by magnetic resonance Main eligibility criteria for group of individuals with type 2 diabetes and non-severe diabetic kidney disease (intervention trial): • Age 40-75 years Type 2 diabetes Estimated glomerular filtration rate ≥30ml/min/1,73m2 Urinary albumin creatinine ratio ≥ 30mg/g No contraindication to examination by magnetic resonance Recruitment Controls are recruited via announcements on relevant websites and, if necessary, in newspapers Individuals with type 2 diabetes are primarily recruited from the ambulatory at Steno Diabetes Center Copenhagen

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Type 2, Diabetic Kidney Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
This study consists of a cross-sectional study and an intervention trial. The latter is a single-center, randomized, double-blinded, placebo-controlled and parallel trial in participants with T2D and non-severe diabetic kidney disease. Trial participants (n=60), by virtue of their baseline examinations (e.g. MR-examinations), also participate in the cross-sectional part of this study where they constitute one of three groups. The other two groups contain controls (n=30) and individuals with T2D and no diabetic kidney disease (n=30).
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
To ensure blinding to the trial drug, the tablets containing either ezetimibe or placebo are incapsulated with gelatin and thus identical in appearance (size, color and shape).
Allocation
Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Ezetimibe
Arm Type
Active Comparator
Arm Description
One treatment period of 16 weeks with1 capsule of ezetimibe 10mg per day, as add-on to standard care.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
One treatment period of 16 weeks with 1 capsule of matching placebo per day, as add-on to standard care.
Intervention Type
Drug
Intervention Name(s)
Ezetimibe 10mg
Intervention Description
Ezetimibe is a cholesterol absorption inhibitor with marketing approval. The recommended dose as per label is 10mg once a day.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Matching placebo
Primary Outcome Measure Information:
Title
Urinary albumin creatinine ratio (UACR)
Time Frame
Change over 16 weeks of treatment
Secondary Outcome Measure Information:
Title
Magnetic resonans estimate of kidney parenchymal triglyceride fraction
Time Frame
Change over 16 weeks of treatment
Other Pre-specified Outcome Measures:
Title
Urine metabolomic profile
Description
Metabolomic profiling of polar and non-polar urinary metabolites
Time Frame
Change over 16 weeks of treatment
Title
Plasma extracellular vesicles
Description
number, number from relevant cell types and for all extracellular vesicles the presence of fatty acid transporter proteins
Time Frame
Change over 16 weeks of treatment
Title
Urine extracellular vesicles
Description
number, number from relevant cell types and for all extracellular vesicles the presence of fatty acid transporter proteins
Time Frame
Change over 16 weeks of treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion criteria for the intervention trial Age ≥ 40 and ≤ 75 years T2D (World Health Organization criteria) eGFR ≥ 30ml/min/1,73m2 at screening Persistent UACR ≥ 30mg/g (in more than two out of three valid measurements over a minimum of three months) LDL > 1.5mmol/L at screening Ability to communicate with the investigator and give informed consent Exclusion criteria for the intervention trial Chronic kidney disease primarily ascribed to other causes than diabetes Acute kidney disease within 3 months No UACR ≥ 3000mg/g in history Current or recent (within 3 months) treatment with ezetimibe Initiation or adjustment in dosage within 1 month of an angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB), glucagon-like peptide-1 receptor (GLP-1RA) agonists, sodium-glucose cotransporter 2 (SGLT-2) inhibitors or anti-dyslipidemia drug, e.g. a statin Any contraindication to MR-examination (e.g. magnetic foreign body that cannot easily be removed from the body prior to the examination, claustrophobia or body size not compatible with the scanner) Intolerance to trial drug components Any previous major organ transplantation Elective major surgery during the trial Pregnancy, planned pregnancy or breastfeeding during the trial Insufficient contraception during the trial in women of childbearing potential Severe alcohol consumption or abuse of recreational drugs Moderate to severe liver failure (Child Pugh 7-15) Any surgical or medical condition which can be expected to significantly alter the absorption of the trial drug (e.g. major gastrointestinal tract surgery or inflammatory bowel disease) Recent (within 30 days or 5-half-lives, whichever is longer) or current participation in another clinical study in which an investigational medicinal product or device has been received Any medical condition or history thereof or any deviation from normal laboratory values that, in the opinion of the investigator, clinically contraindicates or hinders the completion of the trial Any reason for suspecting a considerable lack of compliance to the trial Inclusion criteria for the control group (cross-sectional study alone): Age ≥ 40 and ≤ 75 years eGFR ≥60ml/min/1,73m2 at screening Ability to communicate with the investigator and give informed consent Exclusion criteria for the control group (cross-sectional study alone): Any major chronic disease, e.g. diabetes mellitus, chronic kidney disease, ischemic heart disease, chronic obstructive pulmonary disease (this criterium does not include conditions that may be considered risk factors for chronic diseases, e.g. essential hypertension, primary hypercholesterolemia) Acute kidney disease within 3 months History of persistent UACR ≥ 30mg/g (in more than two out of three valid measurements over a minimum of three months including those at screening) or a previous diagnosis of micro- or macroalbuminuria Current or recent (within 3 months) treatment with ezetimibe Any contraindication to an MR-examination (e.g. magnetic foreign body that cannot easily be removed from the body prior to the examination or claustrophobia) Any previous major organ transplantation Elective major surgery during the study Pregnancy, planned pregnancy or breastfeeding during the study Severe alcohol consumption or abuse of recreational drugs Moderate to severe liver failure (Child Pugh 7-15) Recent (within 30 days or 5-half-lives, whichever is longer) or current participation in another clinical study in which an investigational medicinal product or device has been received Any medical condition or history thereof or any deviation from normal laboratory values that, in the opinion of the investigator, clinically contraindicates or hinders the completion of the study Any reason for suspecting a considerable lack of compliance to the study Inclusion criteria for the group of participants with T2D and no DKD (cross-sectional study alone): Age ≥ 40 and ≤ 75 years T2D (World Health Organization criteria) eGFR ≥60ml/min/1,73m2 at screening Ability to communicate with the Investigator and give informed consent Exclusion criteria for the group of participants with T2D and no DKD (cross-sectional study alone): Any chronic kidney disease Acute kidney disease within 3 months History of persistent UACR ≥ 30mg/g (in more than two out of three valid measurements over a minimum of three months including those at screening) or a previous diagnosis of micro- or macroalbuminuria Current or recent (within 3 months) treatment with ezetimibe Any contraindication to an MR-examination (e.g. magnetic foreign body that cannot easily be removed from the body prior to the examination or claustrophobia) Any previous major organ transplantation Elective major surgery during the study Pregnancy, planned pregnancy or breastfeeding during the study Severe alcohol consumption or abuse of recreational drugs Moderate to severe liver failure (Child Pugh 7-15) Recent (within 30 days or 5-half-lives, whichever is longer) or current participation in another clinical study in which an investigational medicinal product or device has been received Any medical condition or history thereof or any deviation from normal laboratory values that, in the opinion of the investigator, clinically contraindicates or hinders the completion of the study procedures Any reason for suspecting a considerable lack of compliance to the study
Facility Information:
Facility Name
Steno Diabetes Center Copenhagen
City
Gentofte
State/Province
Capital Region
ZIP/Postal Code
2820
Country
Denmark

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Kidney Fat in Type 2 Diabetes and the Effects of Ezetimibe

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