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A Double Blind Randomized Placebo Trial of Maintenance of Normal Serum Phosphorus in CKD

Primary Purpose

Chronic Kidney Disease

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Calcium acetate
Lanthanum Carbonate
Sevelamer Carbonate
Placebo
Sponsored by
Denver Nephrologists, P.C.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Chronic Kidney Disease focused on measuring phosphorus, secondary hyperparathyroidism, vascular calcification

Eligibility Criteria

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

Inclusion Criteria:

  • Men or women > 18 years of age;
  • Has signed and dated the most recent informed consent form approved by an IRB;
  • Will, in the opinion of the PI, be compliant with prescribed phosphate binder therapy;
  • Must be able to communicate with the investigator, and be able to understand and comply with the requirements of the study;
  • Has a life expectancy >12 months;
  • An eGFR rate (estimated by the MDRD equation) ≥ 20 and ≤ 45 mL/min/1.73m2 obtained by screening laboratory values and in the opinion of the investigator felt to have CKD without evidence of recent acute kidney injury or unexpected decline in renal function;
  • A screening serum phosphorus value > 3.5 mg/dL and ≤ 6.0 mg/dL;
  • Must consume a minimum of 2 meals per day and be willing to avoid intentional changes in diet;
  • Women of child bearing potential must be practicing an acceptable form of birth control.

Exclusion Criteria:

  • Receiving or has received an investigational drug (or is currently using an investigational device) within 30 days prior to baseline;
  • Subject is pregnant, is breast feeding or is of child bearing potential and not using acceptable birth control measures;
  • Has had a previous renal transplant;
  • Has a chronic reliance on enemas or laxatives;
  • Has a known sensitivity or previous intolerance to any of the products to be administered during the study;
  • Clinical evidence of active malignancy and/or receiving systemic chemotherapy/radiotherapy with the exception of basal cell or squamous carcinoma of the skin;
  • Currently has an active infection or is being treated with antibiotics (within 14 days prior to baseline);
  • Has been hospitalized within 30 days prior to baseline (with the exception of hospitalizations due to vascular access procedures);
  • Any surgical or medical condition which might significantly alter the function of phosphorus binders or which may jeopardize the subject in case of participation in the study. The investigator should be guided by evidence of any of the following: Severe gastrointestinal motility disorder,Bowel obstruction,Dysphagia or other disorders of swallowing, Acute peptic ulcer, Ulcerative colitis or Crohn's disease, History of major gastrointestinal tract surgery, Severe malabsorption;
  • Currently taking any of the following within 14 days prior to baseline; Calcitriol or its analogs, Cinacalcet hydrochloride, Medications prescribed for the purpose of phosphorus binding;
  • Screening serum intact PTH >500 pg/mL;
  • Screening corrected calcium < 8.0 mg/dL or > 10.4 mg/dL;
  • Uncontrolled hyperlipidemia in the opinion of the PI;
  • Initiation of chronic maintenance hemodialysis planned within 12 months;
  • Relocation to another area planned within 12 months;
  • Has a known history of immunodeficiency diseases, including a positive HIV test result;
  • Active drug or alcohol dependence or abuse (excluding tobacco use) within the 12 months prior to dosing or evidence of such abuse;
  • Evidence of active liver disease with AST or ALT levels greater than 3X the upper limit of normal;
  • Has had a major cardiovascular event within 180 days of screening.

Sites / Locations

  • Denver Nephrologists, PC

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Active Comparator

Active Comparator

Active Comparator

Placebo Comparator

Arm Label

Calcium Acetate

Lanthanum Carbonate

Sevelamer Carbonate

Placebo

Arm Description

667 mg with meals

500 mg with meals

800 mg with meals

with meals

Outcomes

Primary Outcome Measures

Serum Phosphorus
mean serum phosphorus from months 3-9

Secondary Outcome Measures

Full Information

First Posted
November 4, 2008
Last Updated
September 28, 2012
Sponsor
Denver Nephrologists, P.C.
Collaborators
Shire, Fresenius Medical Care North America, Genzyme, a Sanofi Company, Novartis Pharmaceuticals, DaVita Dialysis
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1. Study Identification

Unique Protocol Identification Number
NCT00785629
Brief Title
A Double Blind Randomized Placebo Trial of Maintenance of Normal Serum Phosphorus in CKD
Official Title
A Double Blind Randomized Placebo Controlled Trial of Maintenance of Normal Serum Phosphorus in Chronic Kidney Disease (CKD)
Study Type
Interventional

2. Study Status

Record Verification Date
September 2012
Overall Recruitment Status
Completed
Study Start Date
February 2009 (undefined)
Primary Completion Date
July 2011 (Actual)
Study Completion Date
July 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Denver Nephrologists, P.C.
Collaborators
Shire, Fresenius Medical Care North America, Genzyme, a Sanofi Company, Novartis Pharmaceuticals, DaVita Dialysis

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine the ability of 3 commercially available phosphorus binders (calcium acetate, sevelamer carbonate, and lanthanum carbonate) to achieve and maintain a phosphorus level in the normal range in patients with chronic kidney disease.
Detailed Description
It is the specific aim of this pilot study to assess the feasibility of achieving and maintaining a serum P less than or equal to 3.5 mg/dL (1.13 mmol/L) in patients with eGFR >20 and <45 mL/min with any of the 3 commercially available P lowering agents (calcium acetate, sevelamer carbonate, or lanthanum carbonate). Results of this study will clarify the degree of separation in serum P that can be achieved with the use of P lowering agents and the current standard of care (P binder initiation when P > 5.5 mg/dL or 1.78 mmol/L). Furthermore, this knowledge, combined with analyses of the secondary aims and outcomes of interest, will serve to facilitate the design of a properly powered, randomized, placebo controlled clinical outcomes trial that will firmly establish the necessity of achieving a specific target P in patients with CKD. The secondary aims of this pilot study are to provide insight into the optimal detection of progression of abnormalities in mineral metabolism and their relationship to vascular disease in CKD. The tertiary aim is to evaluate long term outcomes related to phosphorus normalization with respect to renal replacement therapy or death.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Kidney Disease
Keywords
phosphorus, secondary hyperparathyroidism, vascular calcification

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Calcium Acetate
Arm Type
Active Comparator
Arm Description
667 mg with meals
Arm Title
Lanthanum Carbonate
Arm Type
Active Comparator
Arm Description
500 mg with meals
Arm Title
Sevelamer Carbonate
Arm Type
Active Comparator
Arm Description
800 mg with meals
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
with meals
Intervention Type
Drug
Intervention Name(s)
Calcium acetate
Intervention Type
Drug
Intervention Name(s)
Lanthanum Carbonate
Other Intervention Name(s)
Fosrenol
Intervention Type
Drug
Intervention Name(s)
Sevelamer Carbonate
Other Intervention Name(s)
Renvela
Intervention Type
Drug
Intervention Name(s)
Placebo
Primary Outcome Measure Information:
Title
Serum Phosphorus
Description
mean serum phosphorus from months 3-9
Time Frame
months 3-9

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Men or women > 18 years of age; Has signed and dated the most recent informed consent form approved by an IRB; Will, in the opinion of the PI, be compliant with prescribed phosphate binder therapy; Must be able to communicate with the investigator, and be able to understand and comply with the requirements of the study; Has a life expectancy >12 months; An eGFR rate (estimated by the MDRD equation) ≥ 20 and ≤ 45 mL/min/1.73m2 obtained by screening laboratory values and in the opinion of the investigator felt to have CKD without evidence of recent acute kidney injury or unexpected decline in renal function; A screening serum phosphorus value > 3.5 mg/dL and ≤ 6.0 mg/dL; Must consume a minimum of 2 meals per day and be willing to avoid intentional changes in diet; Women of child bearing potential must be practicing an acceptable form of birth control. Exclusion Criteria: Receiving or has received an investigational drug (or is currently using an investigational device) within 30 days prior to baseline; Subject is pregnant, is breast feeding or is of child bearing potential and not using acceptable birth control measures; Has had a previous renal transplant; Has a chronic reliance on enemas or laxatives; Has a known sensitivity or previous intolerance to any of the products to be administered during the study; Clinical evidence of active malignancy and/or receiving systemic chemotherapy/radiotherapy with the exception of basal cell or squamous carcinoma of the skin; Currently has an active infection or is being treated with antibiotics (within 14 days prior to baseline); Has been hospitalized within 30 days prior to baseline (with the exception of hospitalizations due to vascular access procedures); Any surgical or medical condition which might significantly alter the function of phosphorus binders or which may jeopardize the subject in case of participation in the study. The investigator should be guided by evidence of any of the following: Severe gastrointestinal motility disorder,Bowel obstruction,Dysphagia or other disorders of swallowing, Acute peptic ulcer, Ulcerative colitis or Crohn's disease, History of major gastrointestinal tract surgery, Severe malabsorption; Currently taking any of the following within 14 days prior to baseline; Calcitriol or its analogs, Cinacalcet hydrochloride, Medications prescribed for the purpose of phosphorus binding; Screening serum intact PTH >500 pg/mL; Screening corrected calcium < 8.0 mg/dL or > 10.4 mg/dL; Uncontrolled hyperlipidemia in the opinion of the PI; Initiation of chronic maintenance hemodialysis planned within 12 months; Relocation to another area planned within 12 months; Has a known history of immunodeficiency diseases, including a positive HIV test result; Active drug or alcohol dependence or abuse (excluding tobacco use) within the 12 months prior to dosing or evidence of such abuse; Evidence of active liver disease with AST or ALT levels greater than 3X the upper limit of normal; Has had a major cardiovascular event within 180 days of screening.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Geoffrey A Block, MD
Organizational Affiliation
Denver Nephrologists, PC
Official's Role
Principal Investigator
Facility Information:
Facility Name
Denver Nephrologists, PC
City
Denver
State/Province
Colorado
ZIP/Postal Code
80230
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
27357090
Citation
Dougher CE, Rifkin DE, Anderson CA, Smits G, Persky MS, Block GA, Ix JH. Spot urine sodium measurements do not accurately estimate dietary sodium intake in chronic kidney disease. Am J Clin Nutr. 2016 Aug;104(2):298-305. doi: 10.3945/ajcn.115.127423. Epub 2016 Jun 29.
Results Reference
derived

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A Double Blind Randomized Placebo Trial of Maintenance of Normal Serum Phosphorus in CKD

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