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Multi-Center Trial Utilizing Low Frequency Ultrasound in the Prevention of Post-Contrast Acute Kidney Injury (LOTUS)

Primary Purpose

Contrast-induced Nephropathy, Chronic Kidney Diseases

Status
Terminated
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Low-frequency therapeutic ultrasound (LOTUS)
LOTUS System with Ultrasound Disabled
Sponsored by
Sonogenix
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Contrast-induced Nephropathy focused on measuring coronary arteriography, nitric oxide

Eligibility Criteria

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

Inclusion Criteria:

  • Participant is greater than or equal to 18 years
  • Baseline renal dysfunction defined as one of the following:

    1. eGFR greater than 30
    2. eGFR 30-45, with or without risk factors for AKI defined as diabetes mellitus, congestive heart failure, proteinuria (defined as albuminuria greater than 300mg/day).
    3. eGFR 45-60, with at least one risk factor for AKI defined as diabetes mellitus, congestive heart failure, proteinuria (defined as albuminuria greater than 300mg/day).
  • Participant is presenting for a planned percutaneous coronary intervention (PCI)
  • Participant scheduled to undergo cardiac catheterization including coronary arteriography that is anticipated to require at least 100 ml of iso-osmolar or low- osmolar contrast, and that is anticipated to include single-vessel stent implantation that does not include chronic total occlusion.
  • Participant had not been hospitalized or treated for a change in renal function within 30 days of enrollment.
  • Participant has provided written informed consent.
  • Participant is willing to comply with study follow-up requirements.

Exclusion Criteria

  • Participant is anuric or currently undergoing renal replacement therapy.
  • Participant is currently taking oral nitrates.
  • Participant is undergoing a procedure requiring selective cannulation and injection of contrast into the renal arteries.
  • Participant presented with ST-segment elevation myocardial infarction.
  • Participant has a metal implant in the hip or lumbar spine.
  • Participant received or is anticipated to receive additional intravenous or intraarterial contrast from 7 days prior to cardiac catheterization to 4 days after cardiac catheterization.
  • Addition, discontinuation, or dose change of angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, diuretic, trimethoprim, non-steroidal anti-inflammatory drugs, cimetidine, or metoclopramide with 7 days prior to cardiac catheterization.
  • Participant has a known allergy to contrast medium that cannot be adequately pre-medicated.
  • Participant has new-onset heart failure with New York Heart Association (NYHA) classification of III or IV within 30 days prior to the index procedure.
  • Recent stroke within 90 days prior to the index procedure.
  • Participant has known or suspected active infection at the time of the index procedure.
  • Participant is pregnant and/or breast-feeding or intends to become pregnant during the time of the study.
  • Participant is unwilling or unable to comply with procedures specified in the protocol or has difficulty or inability to return for follow-up visits as specified by the protocol.
  • Participant is known to be incarcerated, mentally incompetent, and/or alcohol or drug abuser.
  • Participant is participating in another investigational drug or medical device study that has not completed primary endpoint(s) evaluation or clinically interferes with the endpoints from this study or subject is planning to participate in such studies prior to the completion of this study.

Sites / Locations

  • Henry Ford Hopsital
  • McLaren Northern Michigan
  • University of Pennsylvania Medical Center
  • UT Health San Antonio

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Sham Comparator

Arm Label

Low-Frequency Therapeutic Ultrasound

Sham Control

Arm Description

LOTUS system will be operated per operated per normal instructions

LOTUS system will be set to Control setting

Outcomes

Primary Outcome Measures

Primary Efficacy Endpoint
Incidence of acute kidney injury (AKI) defined as a greater than 0.3 mg/dl increase in serum creatinine (SCr)
Primary Safety Endpoint
Composite of all Adverse Events (AE) including RENOBOOST (device) related adverse events, and major adverse events (MAE)

Secondary Outcome Measures

Incidence of Post Contrast Acute Kidney Injury
defined as greater than or equal to 0.3 mg/dl or greater than or equal to 25 percent rise in SCr
Incidence of Post Contrast Acute Kidney Injury
defined as greater than or equal to 0.5 mg/dl or greater than or equal to 25 percent rise in SCr
Incidence of contrast-induced nephropathy
defined as greater than or equal to 0.3 mg/dl or greater than or equal to 25 percent rise in SCr
Occurrence of (stage 1, 2, or 3) acute kidney injury (AKI)
defined as greater than or equal to 2-fold rise in SCr, increase in SCr to greater than or equal to 4.0 mg/dl, or initiation of RRT
Incidence of Post Contrast Acute Kidney Injury
defined as greater than or equal to 0.3 mg/dl or greater than or equal to 25 percent rise in SCr
Occurrence of (stage 1, 2, or 3) acute kidney injury (AKI)
defined as Stage 1 - Serum Creatinine 1.5-1.9 times baseline or greater than or equal to 0.3 mg/dL increase, Stage 2 - Serum Creatinine 2-2.9 times baseline, Stage 3 - Serum Creatinine 3 times baseline or Increase in serum creatinine to greater than or equal to 4 mg/dL or Initiation of renal replacement therapy
Maximum percent-change
Maximum percent-change in SCr
Absolute and percent-change in estimated glomerular filtration rate (eGFR)
as calculated using the Modification of Diet in Renal Disease Study Group (MDRD)
Total urine output
defined as the amount of urine collected in cc/hour.
Hospitalization
Hospital length of stay
Intensive Care
Intensive care unit length of stay

Full Information

First Posted
April 27, 2021
Last Updated
April 10, 2023
Sponsor
Sonogenix
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1. Study Identification

Unique Protocol Identification Number
NCT04877847
Brief Title
Multi-Center Trial Utilizing Low Frequency Ultrasound in the Prevention of Post-Contrast Acute Kidney Injury
Acronym
LOTUS
Official Title
Low Frequency Therapeutic Ultrasound System Pivotal Clinical Trial
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Terminated
Why Stopped
Low Recruitment
Study Start Date
September 24, 2021 (Actual)
Primary Completion Date
January 23, 2023 (Actual)
Study Completion Date
January 23, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sonogenix

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
Yes

5. Study Description

Brief Summary
Multi-center randomized trial to assess the safety and performance of low-frequency therapeutic ultrasound for maintaining renal function after contrast exposure.
Detailed Description
This is a multi-center, randomized, controlled clinical trial designed to assess the safety and performance of the Sonogenix RENOBOOST as an adjunctive therapy for maintaining renal function after contrast exposure. The trial will enroll up to 234 subjects not taking oral nitrates and at high-risk of developing PC-AKI undergoing coronary arteriography for a planned percutaneous coronary intervention in up to 10 clinical sites in the US and up to 3 clinical sites outside the US. All subjects will be pre- treated with 0.9 percent NaCl at 3 ml/kg/h 1 hour before and 1 ml/kg/h during and 6 hours post procedure. Participants will be randomized in a 2:1 fashion to either active adjunctive therapy with the Sonogenix RENOBOOST or sham control. Subjects will have clinical follow-up examination 30 days post index procedure.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Contrast-induced Nephropathy, Chronic Kidney Diseases
Keywords
coronary arteriography, nitric oxide

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
A total of up to 234 participants will be randomized 2:1
Masking
ParticipantCare Provider
Masking Description
Participant and clinical staff will be blinded to which arm the participant is randomized.
Allocation
Randomized
Enrollment
2 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Low-Frequency Therapeutic Ultrasound
Arm Type
Experimental
Arm Description
LOTUS system will be operated per operated per normal instructions
Arm Title
Sham Control
Arm Type
Sham Comparator
Arm Description
LOTUS system will be set to Control setting
Intervention Type
Device
Intervention Name(s)
Low-frequency therapeutic ultrasound (LOTUS)
Intervention Description
Participants will wear low-frequency therapeutic ultrasound system for procedure. Device will be turned on per normal operating instructions.
Intervention Type
Device
Intervention Name(s)
LOTUS System with Ultrasound Disabled
Intervention Description
Participants will wear low-frequency therapeutic ultrasound system for procedure. Device will be turned on and set to Control Setting.
Primary Outcome Measure Information:
Title
Primary Efficacy Endpoint
Description
Incidence of acute kidney injury (AKI) defined as a greater than 0.3 mg/dl increase in serum creatinine (SCr)
Time Frame
48 hours
Title
Primary Safety Endpoint
Description
Composite of all Adverse Events (AE) including RENOBOOST (device) related adverse events, and major adverse events (MAE)
Time Frame
30 days
Secondary Outcome Measure Information:
Title
Incidence of Post Contrast Acute Kidney Injury
Description
defined as greater than or equal to 0.3 mg/dl or greater than or equal to 25 percent rise in SCr
Time Frame
at 72 hours post-contrast exposure or need for renal replacement therapy (RRT)
Title
Incidence of Post Contrast Acute Kidney Injury
Description
defined as greater than or equal to 0.5 mg/dl or greater than or equal to 25 percent rise in SCr
Time Frame
at 72 hours post-contrast exposure or need for renal replacement therapy (RRT)
Title
Incidence of contrast-induced nephropathy
Description
defined as greater than or equal to 0.3 mg/dl or greater than or equal to 25 percent rise in SCr
Time Frame
within 96 hours post-contrast exposure or need for RRT
Title
Occurrence of (stage 1, 2, or 3) acute kidney injury (AKI)
Description
defined as greater than or equal to 2-fold rise in SCr, increase in SCr to greater than or equal to 4.0 mg/dl, or initiation of RRT
Time Frame
within 30 days after index procedure
Title
Incidence of Post Contrast Acute Kidney Injury
Description
defined as greater than or equal to 0.3 mg/dl or greater than or equal to 25 percent rise in SCr
Time Frame
within 96 hours post-contrast exposure or need for RRT
Title
Occurrence of (stage 1, 2, or 3) acute kidney injury (AKI)
Description
defined as Stage 1 - Serum Creatinine 1.5-1.9 times baseline or greater than or equal to 0.3 mg/dL increase, Stage 2 - Serum Creatinine 2-2.9 times baseline, Stage 3 - Serum Creatinine 3 times baseline or Increase in serum creatinine to greater than or equal to 4 mg/dL or Initiation of renal replacement therapy
Time Frame
within 96 hours of index procedure
Title
Maximum percent-change
Description
Maximum percent-change in SCr
Time Frame
within 96 hours after contrast exposure
Title
Absolute and percent-change in estimated glomerular filtration rate (eGFR)
Description
as calculated using the Modification of Diet in Renal Disease Study Group (MDRD)
Time Frame
from baseline within 96 hours after contrast exposure.
Title
Total urine output
Description
defined as the amount of urine collected in cc/hour.
Time Frame
through baseline procedure
Title
Hospitalization
Description
Hospital length of stay
Time Frame
following the baseline procedure through discharge from the hospital up to 30 days
Title
Intensive Care
Description
Intensive care unit length of stay
Time Frame
following the baseline procedure through discharge from the Intensive Care Unit up to 30 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participant is greater than or equal to 18 years Baseline renal dysfunction defined as one of the following: eGFR greater than 30 eGFR 30-45, with or without risk factors for AKI defined as diabetes mellitus, congestive heart failure, proteinuria (defined as albuminuria greater than 300mg/day). eGFR 45-60, with at least one risk factor for AKI defined as diabetes mellitus, congestive heart failure, proteinuria (defined as albuminuria greater than 300mg/day). Participant is presenting for a planned percutaneous coronary intervention (PCI) Participant scheduled to undergo cardiac catheterization including coronary arteriography that is anticipated to require at least 100 ml of iso-osmolar or low- osmolar contrast, and that is anticipated to include single-vessel stent implantation that does not include chronic total occlusion. Participant had not been hospitalized or treated for a change in renal function within 30 days of enrollment. Participant has provided written informed consent. Participant is willing to comply with study follow-up requirements. Exclusion Criteria Participant is anuric or currently undergoing renal replacement therapy. Participant is currently taking oral nitrates. Participant is undergoing a procedure requiring selective cannulation and injection of contrast into the renal arteries. Participant presented with ST-segment elevation myocardial infarction. Participant has a metal implant in the hip or lumbar spine. Participant received or is anticipated to receive additional intravenous or intraarterial contrast from 7 days prior to cardiac catheterization to 4 days after cardiac catheterization. Addition, discontinuation, or dose change of angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, diuretic, trimethoprim, non-steroidal anti-inflammatory drugs, cimetidine, or metoclopramide with 7 days prior to cardiac catheterization. Participant has a known allergy to contrast medium that cannot be adequately pre-medicated. Participant has new-onset heart failure with New York Heart Association (NYHA) classification of III or IV within 30 days prior to the index procedure. Recent stroke within 90 days prior to the index procedure. Participant has known or suspected active infection at the time of the index procedure. Participant is pregnant and/or breast-feeding or intends to become pregnant during the time of the study. Participant is unwilling or unable to comply with procedures specified in the protocol or has difficulty or inability to return for follow-up visits as specified by the protocol. Participant is known to be incarcerated, mentally incompetent, and/or alcohol or drug abuser. Participant is participating in another investigational drug or medical device study that has not completed primary endpoint(s) evaluation or clinically interferes with the endpoints from this study or subject is planning to participate in such studies prior to the completion of this study.
Facility Information:
Facility Name
Henry Ford Hopsital
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48202
Country
United States
Facility Name
McLaren Northern Michigan
City
Petoskey
State/Province
Michigan
ZIP/Postal Code
49770
Country
United States
Facility Name
University of Pennsylvania Medical Center
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15213
Country
United States
Facility Name
UT Health San Antonio
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78229
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Multi-Center Trial Utilizing Low Frequency Ultrasound in the Prevention of Post-Contrast Acute Kidney Injury

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