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Ferric Citrate for the Prevention of Renal Failure in Adults With Advanced Chronic Kidney Disease (FRONTIER)

Primary Purpose

Anemia, Iron Deficiency, Hyperphosphatemia, Renal Insufficiency, Chronic

Status
Active
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Ferric Citrate 1 GM Oral Tablet [AURYXIA]
Placebo
Sponsored by
USRC Kidney Research
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Anemia, Iron Deficiency focused on measuring ferric citrate

Eligibility Criteria

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

Inclusion Criteria:

  1. Adult patients greater or equal to 18 years old.
  2. Diagnosis of NDD advanced CKD, regardless of etiology. Advanced CKD is defined as at least one local laboratory determined estimated glomerular filtration rate (eGFR) ≤20 ml/min/1.73m2 (calculated per any commonly used method or equation for estimating eGFR) within 90 days of Day 1.
  3. Most recent transferrin saturation (TSAT) less than or equal to 45% within 45 days of Day 1.
  4. Most recent serum phosphate is greater or equal to 3.0 mg per dL within 45 days of Day 1.
  5. Most recent ferritin is less than or equal to 500 ng per mL within 45 days of Day 1.
  6. Women of child-bearing potential must have a negative serum or urine pregnancy test within 28 days prior to Day 1.
  7. Understands the procedures and requirements of the study and provides written informed consent and authorization for protected health information disclosure.

Exclusion Criteria:

  1. Patients who, in the opinion of the Investigator, have acute kidney injury rather than CKD.
  2. Patients with planned/imminent maintenance dialysis, or that are anticipated to begin maintenance dialysis within 8 weeks from Screening, in the opinion of the Investigator.
  3. A known allergy or intolerance to ferric citrate or any of its constituents.
  4. Hypersensitivity reaction to previous oral iron therapy.
  5. History of hemochromatosis or iron overload syndrome (e.g., hereditary sideroblastic anemia, thalassemia, polycythemia vera).
  6. Active malignancy requiring current treatment except for non-melanoma skin cancer regardless of treatment.
  7. Active drug or alcohol dependence or abuse (excluding tobacco use or use of medical or recreational marijuana) within the 12 months prior to Screening or evidence of such abuse, in the opinion of the Investigator.
  8. Limited life expectancy (less than 6 months) in the opinion of the Investigator.
  9. Females who are known to be pregnant or are breast-feeding during Screening or are planning to become pregnant and breastfeeding during the study period.
  10. Evidence of a clinically active infection requiring antibiotics at Randomization.
  11. Unable to comply with study requirements or in the opinion of the Investigator, not clinically stable to participate in the study.
  12. Use of an investigational medication or participation in an investigational study within 30 days prior to Day 1.
  13. Patients with a scheduled date for receipt of living donor kidney transplant

Sites / Locations

  • Arkansas Nephrology & Hypertension Clinic
  • Balboa Research SMO
  • Balboa Research SMO
  • Balboa Research SMO
  • Balboa Research SMO
  • Balboa Research SMO - Kearney Mesa
  • Rocky Mountain Kidney Care
  • Associates in Nephrology
  • Dialysis Clinic, Inc.
  • Nephrology and Hypertension Specialists, PC
  • Major Health Partners
  • Kidney Associates of Kansas City
  • Nephrology-Hypertension Associates of Central NJ
  • High Desert Nephrology Associates
  • Nephrology Associates of Western NY
  • Spartanburg Nephrology Associates
  • Dialysis Clinic, Inc.
  • South Texas Renal Care Group
  • South Texas Renal Care Group
  • South Texas Renal Care Group
  • Clinical Advancement Center, PLLC
  • South Texas Renal Care Group
  • South Texas Renal Care Group

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Ferric citrate

Placebo

Arm Description

Supplied as tablets for oral administration containing 1 gram ferric citrate (210 milligrams of ferric iron). Administered orally with meals or snacks.

Tablets, matching in color and size to ferric citrate.

Outcomes

Primary Outcome Measures

Time to a composite endpoint of initiation of maintenance dialysis or all-cause mortality
Time to a composite endpoint of initiation of maintenance dialysis or all-cause mortality

Secondary Outcome Measures

Time to first hospitalization event reported as a serious adverse event (SAE) (excluding disease-related hospitalization [e.g., dialysis access placement, dialysis initiation, kidney transplant] and elective procedures)
Time to first hospitalization event reported as a serious adverse event (SAE) (excluding disease-related hospitalization [e.g., dialysis access placement, dialysis initiation, kidney transplant] and elective procedures)
Component of Primary - Time to Initiation of Maintenance Dialysis
Component of Primary - Time to Initiation of Maintenance Dialysis
Component of Primary - Time to All-Cause Mortality
Component of Primary - Time to All-Cause Mortality

Full Information

First Posted
October 6, 2021
Last Updated
October 19, 2023
Sponsor
USRC Kidney Research
Collaborators
Akebia Therapeutics
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1. Study Identification

Unique Protocol Identification Number
NCT05085275
Brief Title
Ferric Citrate for the Prevention of Renal Failure in Adults With Advanced Chronic Kidney Disease
Acronym
FRONTIER
Official Title
Multicenter, Randomized, Double-blind, Placebo-controlled Trial to Determine the Effect of Ferric Citrate on Time to a Composite Endpoint of Initiation of Maintenance Dialysis or All-cause Mortality vs Placebo in Adults With Advanced CKD
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
March 30, 2022 (Actual)
Primary Completion Date
August 2024 (Anticipated)
Study Completion Date
August 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
USRC Kidney Research
Collaborators
Akebia Therapeutics

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
A 9-month randomized, double-blind, placebo-controlled study to compare the effect of fixed dose ferric citrate versus placebo in patients with advanced chronic kidney disease (eGFR ≤20 ml/min/1.73m2) on the composite endpoint of time to initiation of maintenance dialysis or all-cause mortality.
Detailed Description
This multicenter, randomized, double-blind, placebo-controlled clinical trial is being conducted to determine the effect of ferric citrate on the time to a composite endpoint of initiation of maintenance dialysis or all-cause mortality in patients with non-dialysis dependent, advanced CKD. Up to 400 subjects will be randomized in 1:1 ratio to receive either ferric citrate or matching placebo. All subjects will initiate dosing at 2 tablets per meal or snacks, up to 3 times per day (maximum of 6 tablets per day). The dose of ferric citrate/placebo will only be adjusted based on safety and/or tolerability. Given the double-blind design of this trial, investigators will be instructed to not prescribe commercial Auryxia to either study arm. Study visits during the treatment period are to be conducted as part of routine scheduled clinical encounters. Standard of care local laboratory results will be collected however no study specific laboratory tests other than a pregnancy test in women of child-bearing potential will be required.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Anemia, Iron Deficiency, Hyperphosphatemia, Renal Insufficiency, Chronic, Renal Anemia, Disease Progression, Cardiovascular, Iron
Keywords
ferric citrate

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
Randomized, placebo controlled, double-blind, parallel assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
400 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Ferric citrate
Arm Type
Experimental
Arm Description
Supplied as tablets for oral administration containing 1 gram ferric citrate (210 milligrams of ferric iron). Administered orally with meals or snacks.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Tablets, matching in color and size to ferric citrate.
Intervention Type
Drug
Intervention Name(s)
Ferric Citrate 1 GM Oral Tablet [AURYXIA]
Other Intervention Name(s)
Auryxia
Intervention Description
All subjects will be instructed to take study drug (ferric citrate or placebo) at a fixed dose of 2 tablets per meal or snacks, up to three times per day. The maximum dose is 6 tablets per day. No additional tablets (beyond a total of 6 per day) should be taken. Tablets should not be crushed or chewed.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
All subjects will be instructed to take study drug (ferric citrate or placebo) at a fixed dose of 2 tablets per meal or snacks, up to three times per day. The maximum dose is 6 tablets per day. No additional tablets (beyond a total of 6 per day) should be taken. Tablets should not be crushed or chewed.
Primary Outcome Measure Information:
Title
Time to a composite endpoint of initiation of maintenance dialysis or all-cause mortality
Description
Time to a composite endpoint of initiation of maintenance dialysis or all-cause mortality
Time Frame
9 months
Secondary Outcome Measure Information:
Title
Time to first hospitalization event reported as a serious adverse event (SAE) (excluding disease-related hospitalization [e.g., dialysis access placement, dialysis initiation, kidney transplant] and elective procedures)
Description
Time to first hospitalization event reported as a serious adverse event (SAE) (excluding disease-related hospitalization [e.g., dialysis access placement, dialysis initiation, kidney transplant] and elective procedures)
Time Frame
9 months
Title
Component of Primary - Time to Initiation of Maintenance Dialysis
Description
Component of Primary - Time to Initiation of Maintenance Dialysis
Time Frame
9 months
Title
Component of Primary - Time to All-Cause Mortality
Description
Component of Primary - Time to All-Cause Mortality
Time Frame
9 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Adult patients greater or equal to 18 years old. Diagnosis of NDD advanced CKD, regardless of etiology. Advanced CKD is defined as at least one local laboratory determined estimated glomerular filtration rate (eGFR) ≤20 ml/min/1.73m2 (calculated per any commonly used method or equation for estimating eGFR) within 90 days of Day 1. Most recent transferrin saturation (TSAT) less than or equal to 45% within 45 days of Day 1. Most recent serum phosphate is greater or equal to 3.0 mg per dL within 45 days of Day 1. Most recent ferritin is less than or equal to 500 ng per mL within 45 days of Day 1. Women of child-bearing potential must have a negative serum or urine pregnancy test within 28 days prior to Day 1. Understands the procedures and requirements of the study and provides written informed consent and authorization for protected health information disclosure. Exclusion Criteria: Patients who, in the opinion of the Investigator, have acute kidney injury rather than CKD. Patients with planned/imminent maintenance dialysis, or that are anticipated to begin maintenance dialysis within 8 weeks from Screening, in the opinion of the Investigator. A known allergy or intolerance to ferric citrate or any of its constituents. Hypersensitivity reaction to previous oral iron therapy. History of hemochromatosis or iron overload syndrome (e.g., hereditary sideroblastic anemia, thalassemia, polycythemia vera). Active malignancy requiring current treatment except for non-melanoma skin cancer regardless of treatment. Active drug or alcohol dependence or abuse (excluding tobacco use or use of medical or recreational marijuana) within the 12 months prior to Screening or evidence of such abuse, in the opinion of the Investigator. Limited life expectancy (less than 6 months) in the opinion of the Investigator. Females who are known to be pregnant or are breast-feeding during Screening or are planning to become pregnant and breastfeeding during the study period. Evidence of a clinically active infection requiring antibiotics at Randomization. Unable to comply with study requirements or in the opinion of the Investigator, not clinically stable to participate in the study. Use of an investigational medication or participation in an investigational study within 30 days prior to Day 1. Patients with a scheduled date for receipt of living donor kidney transplant
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Geoff Block, MD
Organizational Affiliation
USRC Kidney Research
Official's Role
Principal Investigator
Facility Information:
Facility Name
Arkansas Nephrology & Hypertension Clinic
City
Pine Bluff
State/Province
Arkansas
ZIP/Postal Code
71603
Country
United States
Facility Name
Balboa Research SMO
City
Chula Vista
State/Province
California
ZIP/Postal Code
91910
Country
United States
Facility Name
Balboa Research SMO
City
El Centro
State/Province
California
ZIP/Postal Code
92243
Country
United States
Facility Name
Balboa Research SMO
City
Escondido
State/Province
California
ZIP/Postal Code
92025
Country
United States
Facility Name
Balboa Research SMO
City
La Mesa
State/Province
California
ZIP/Postal Code
91942
Country
United States
Facility Name
Balboa Research SMO - Kearney Mesa
City
San Diego
State/Province
California
ZIP/Postal Code
92111
Country
United States
Facility Name
Rocky Mountain Kidney Care
City
Lone Tree
State/Province
Colorado
ZIP/Postal Code
80124
Country
United States
Facility Name
Associates in Nephrology
City
Fort Myers
State/Province
Florida
ZIP/Postal Code
33908
Country
United States
Facility Name
Dialysis Clinic, Inc.
City
Albany
State/Province
Georgia
ZIP/Postal Code
31701
Country
United States
Facility Name
Nephrology and Hypertension Specialists, PC
City
Dalton
State/Province
Georgia
ZIP/Postal Code
30720
Country
United States
Facility Name
Major Health Partners
City
Shelbyville
State/Province
Indiana
ZIP/Postal Code
46176
Country
United States
Facility Name
Kidney Associates of Kansas City
City
Kansas City
State/Province
Missouri
ZIP/Postal Code
64131
Country
United States
Facility Name
Nephrology-Hypertension Associates of Central NJ
City
S. River
State/Province
New Jersey
ZIP/Postal Code
08882
Country
United States
Facility Name
High Desert Nephrology Associates
City
Gallup
State/Province
New Mexico
ZIP/Postal Code
87301
Country
United States
Facility Name
Nephrology Associates of Western NY
City
Amherst
State/Province
New York
ZIP/Postal Code
14228
Country
United States
Facility Name
Spartanburg Nephrology Associates
City
Spartanburg
State/Province
South Carolina
ZIP/Postal Code
29302
Country
United States
Facility Name
Dialysis Clinic, Inc.
City
Knoxville
State/Province
Tennessee
ZIP/Postal Code
37920
Country
United States
Facility Name
South Texas Renal Care Group
City
Live Oak
State/Province
Texas
ZIP/Postal Code
78233
Country
United States
Facility Name
South Texas Renal Care Group
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78202
Country
United States
Facility Name
South Texas Renal Care Group
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78211
Country
United States
Facility Name
Clinical Advancement Center, PLLC
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78212
Country
United States
Facility Name
South Texas Renal Care Group
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78221
Country
United States
Facility Name
South Texas Renal Care Group
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78251
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Ferric Citrate for the Prevention of Renal Failure in Adults With Advanced Chronic Kidney Disease

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