Intermittent Pneumatic Compression Device for Vein Dilation in Kidney Disease Patients to Enable AVF Creation (FACT) (FACT)
Primary Purpose
Kidney Diseases
Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Fist Assist
Sponsored by
About this trial
This is an interventional supportive care trial for Kidney Diseases
Eligibility Criteria
Inclusion Criteria:
- 18 and older
- Followed in the University of Chicago Medical Center's Nephrology Clinic
- Expected to initiate hemodialysis
- Estimated Glomerular Filtration Rate (eGFR) <30 mL/min.1.73m
Exclusion criteria:
- Refusal/inability to give informed consent
- Inability to comply with trial requirements,
- Arm infections and/or skin disorders that require frequent medical attention.
- Patients with obvious scarring from IV drug use
- Previous phlebitis.
- Previous occluded arteriovenous grafts or fistulae
- Arterial aneurysms
- Arm deep vein thrombosis
- Any previous vascular surgery on the non-dominant arm.
- Limited cognitive ability
- Motor or sensory deficits in the upper arm
- Upon preliminary evaluation of the cephalic vein (measured 5 cm proximal to the styloid process of the radius, and at the antecubital fossa) there are no detectable superficial veins of at least 1.0 mm diameter, or superficial vein of more than 3.0 mm is present in this lower arm location.
Sites / Locations
- University of Chicago Medical Center
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Fist Assist device (all subjects)
Arm Description
All study subjects will have Stage 4 or 5 Chronic Kidney Disease (CKD) that requires them to start hemodialysis. In preparation for hemodialysis, they will have an arteriovenous fistula (AVF) procedure which provides access to the veins for dialysis. This study is testing a device called the Fist Assist to dilate the vein in preparation for dialysis. The device is similar to a blood pressure cuff (worn around the arm and applies pressure). All study participants will wear the Fist Assist twice a day up to three months before their AVF procedure.
Outcomes
Primary Outcome Measures
Vein Diameter
The primary outcome will be the difference in the vein diameter measured in millimeters with use of a vascular ultrasound device before and after Fist Assist use. The standard deviation of the change in vein diameter will be approximately 0.75mm.
Secondary Outcome Measures
AVF Creation
Whether or not an arteriovenous fistula was created, as defined by a procedure performed by surgery or interventional radiology connecting an artery to a vein.
AVF Maturation
Whether the resultant AVF matured, as defined successful cannulation with two needles for three hemodialysis treatments.
Subsequent Exposure to Central Venous Catheters
The subject's subsequent exposure of patients to central venous catheters during their first year for hemodialysis. We measured the total number of patients who had exposed to central venous catheters over the first year.
Full Information
NCT ID
NCT04063787
First Posted
August 14, 2019
Last Updated
October 11, 2023
Sponsor
University of Chicago
Collaborators
Fist Assist Devices, LLC
1. Study Identification
Unique Protocol Identification Number
NCT04063787
Brief Title
Intermittent Pneumatic Compression Device for Vein Dilation in Kidney Disease Patients to Enable AVF Creation (FACT)
Acronym
FACT
Official Title
Use of an Intermittent Pneumatic Compression Device to Promote Vein Dilation in Patients With Kidney Disease to Enable Creation of Arteriovenous Fistulas
Study Type
Interventional
2. Study Status
Record Verification Date
October 2023
Overall Recruitment Status
Completed
Study Start Date
May 13, 2019 (Actual)
Primary Completion Date
July 27, 2022 (Actual)
Study Completion Date
July 27, 2022 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Chicago
Collaborators
Fist Assist Devices, LLC
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Device Product Not Approved or Cleared by U.S. FDA
Yes
Data Monitoring Committee
No
5. Study Description
Brief Summary
This is a single center pilot study that is seeking to determine whether the use of the Fist Assist® device for 360 hours over 90 days by patients with advanced CKD prior to AVF surgery results in significant increases in cephalic vein diameters prior to AVF surgery.
Detailed Description
METHODOLOGY:
Intervention: The Fist Assist® device will be assigned to each enrolled subject by randomization code. All subjects will be asked to use their assigned device twice daily, for two 2-hour sessions, once in the morning and once in the evening. Patients will apply the device to the non-dominant arm above the level of the elbow, and to keep a written log to record use, complications and any problems.
Blood Draws: 10 mL of blood will be obtained from patients being enrolled at the time of their next routine standard of care phlebotomy. These samples will be frozen for future assays of endothelial biomarkers of nitric oxide production and venous dilation, such as asymmetric dimethyl arginine (ADMA) and its metabolites.
Doppler: Patients will undergo examination of their cephalic veins in the Nephrology Clinic, using a portable vascular ultrasound device operated by a co-investigator trained by the University of Chicago Medical Center Vascular Lab in this technique. The cephalic vein, a superficial vein originating in the wrist, is the most common vein used for AVF creation. In order to standardize these measurements, the diameter of the cephalic vein and vein wall thickness will be measured in both arms at: (a) 5 cm proximal to the styloid process of the radius, and (b) at the antecubital fossa. The diameter and thickness of the vein will be measured using a B-mode image acquired using a standard ultrasound machine with vascular probe going from outer walls per protocol. Patients will be seated with arms supported at the level of the heart on an exam table with in a room with a temperature of at least 20 degrees Celsius. A layer of at least 1 cm of gel will be applied locally to optimize the ultrasound image quality. Vascular Doppler measurements will be obtained on both arms at the time of consent (baseline), and at the conclusion of therapy. Measurements will be recorded.
Follow Up: Those who are subsequently able to undergo successful AVF creation will be followed clinically for up to 12 months.
Protocol: Informed consent will be obtained by the co-investigators using a written consent form approved by the Institutional Review Board. After informed consent is obtained, patients will receive: physical examination of both forearms; and a vascular Doppler to determine cephalic vein diameters of the nondominant arm. A 10 mL blood sample will be drawn at the next routine phlebotomy.
Patients will be asked to apply the Fist Assist® to the upper half of the non-dominant arm. Patients will be asked to use the device twice daily for two 2-hour periods, and report any complications or problems, using a log (see log attached at end of References). Patients will have follow up examinations with measurement of cephalic vein diameter at three months after enrollment.
DURATION OF STUDY: All subjects will be enrolled and treated for three months. The duration of the study including data analysis and statistical analysis is expected to be 12 months.
STATISTICAL ANALYSES: The primary outcome of interest will be the difference in the diameter of the cephalic vein between baseline (Pre) and 3 months (Post) in patients treated with the Fist Assist® device. Based on prior work, mean vein diameters at baseline are anticipated to be approximately 1.8 mm with a standard deviation of 0.5 mm,44 and investigators anticipate that the standard deviation of the change in diameter is likely to be approximately 0.75 mm.
Effect =[(DSPost)-(DSPre)]
Investigators would consider calculated effect sizes of 0.25-1.0 mm to be clinically meaningful changes that would increase the numbers of patients with vein diameters that meet commonly accepted thresholds for surgical suitability (normally 2.5-3.0 mm). Sample size calculations for a variety of effects are presented in table 1 (below), based on paired t-tests with alpha error of 0.05, standard deviation of the effect size of 0.75 mm, for power of 80% and 90%.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Kidney Diseases
7. Study Design
Primary Purpose
Supportive Care
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
46 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Fist Assist device (all subjects)
Arm Type
Experimental
Arm Description
All study subjects will have Stage 4 or 5 Chronic Kidney Disease (CKD) that requires them to start hemodialysis. In preparation for hemodialysis, they will have an arteriovenous fistula (AVF) procedure which provides access to the veins for dialysis.
This study is testing a device called the Fist Assist to dilate the vein in preparation for dialysis. The device is similar to a blood pressure cuff (worn around the arm and applies pressure). All study participants will wear the Fist Assist twice a day up to three months before their AVF procedure.
Intervention Type
Device
Intervention Name(s)
Fist Assist
Intervention Description
The Fist Assist device works by applying pressure to the subject's arm in the area where their arteriovenous fistula will eventually be created. The device is mobile and battery powered.
The Fist Assist device will be assigned to each enrolled subject by randomization code. All subjects will be asked to use their assigned device twice daily, for two 2-hour sessions, once in the morning and once in the evening. Patients will apply the device to the non-dominant arm above the level of the elbow, and to keep a written log to record use, complications and any problems. They will be asked to do this for 3 months, and will come in to be evaluated via study visits at Months 3, 6, 9 and 12.
Primary Outcome Measure Information:
Title
Vein Diameter
Description
The primary outcome will be the difference in the vein diameter measured in millimeters with use of a vascular ultrasound device before and after Fist Assist use. The standard deviation of the change in vein diameter will be approximately 0.75mm.
Time Frame
3 months
Secondary Outcome Measure Information:
Title
AVF Creation
Description
Whether or not an arteriovenous fistula was created, as defined by a procedure performed by surgery or interventional radiology connecting an artery to a vein.
Time Frame
12 months
Title
AVF Maturation
Description
Whether the resultant AVF matured, as defined successful cannulation with two needles for three hemodialysis treatments.
Time Frame
12 months
Title
Subsequent Exposure to Central Venous Catheters
Description
The subject's subsequent exposure of patients to central venous catheters during their first year for hemodialysis. We measured the total number of patients who had exposed to central venous catheters over the first year.
Time Frame
12 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
18 and older
Followed in the University of Chicago Medical Center's Nephrology Clinic
Expected to initiate hemodialysis
Estimated Glomerular Filtration Rate (eGFR) <30 mL/min.1.73m
Exclusion criteria:
Refusal/inability to give informed consent
Inability to comply with trial requirements,
Arm infections and/or skin disorders that require frequent medical attention.
Patients with obvious scarring from IV drug use
Previous phlebitis.
Previous occluded arteriovenous grafts or fistulae
Arterial aneurysms
Arm deep vein thrombosis
Any previous vascular surgery on the non-dominant arm.
Limited cognitive ability
Motor or sensory deficits in the upper arm
Upon preliminary evaluation of the cephalic vein (measured 5 cm proximal to the styloid process of the radius, and at the antecubital fossa) there are no detectable superficial veins of at least 1.0 mm diameter, or superficial vein of more than 3.0 mm is present in this lower arm location.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mary Hammes, MD
Organizational Affiliation
University of Chicago
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Chicago Medical Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60637
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
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Intermittent Pneumatic Compression Device for Vein Dilation in Kidney Disease Patients to Enable AVF Creation (FACT)
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