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Novel Pathways to Manage Inflammation and Atherosclerosis in Dialysis Patients: Role of Nicotinic Acid

Primary Purpose

Dialysis, Cardiovascular Disease, Atherosclerosis

Status
Terminated
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Extended Release Nicotinic Acid (Niaspan)
Sponsored by
Brigham and Women's Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Dialysis

Eligibility Criteria

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

Inclusion Criteria:

  • A signed consent form;
  • Male or Female, 18 years or older;
  • Diagnosed with ESRD, on maintenance hemodialysis for at least six (6) months;
  • Subject must be able to understand and provide informed consent;
  • No known contraindications to therapy with nicotinic acid;
  • Female subjects of childbearing potential must be willing to be on an acceptable form of birth control for the duration of the study and for two month after they have stopped taking the study drug.

Exclusion Criteria:

  • Any patient with a medical condition or taking any medications that would be contraindicated with the use of extended release niacin, such as active peptic ulcer disease;
  • History of severe allergic reactions to the study medication;
  • History of active infection or acute gouty attack within 2 weeks prior to enrollment;
  • Known serological positivity for HIV, HBsAg, or HCV Ab;
  • HbA1C > 9;
  • Total CK of more than three times of the upper limit of normal;
  • Elevation of liver function tests at time of entry (AST and/or ALT > 2 times the upper limit of normal);
  • History of drug, alcohol, or chemical abuse within 6 months prior to enrollment;
  • History of malignancy except adequately treated in-situ cervical carcinoma, or adequately treated basal or squamous cell carcinoma of the skin;
  • History of an inflammatory disease such as SLE, rheumatoid arthritis or ulcerative colitis;
  • Patients currently on pharmacological doses of nicotinic acid;
  • Patients receiving chronic anti-inflammatory therapy;
  • Patients with average baseline hs-CRP levels of > 20 mg/L or < 1 mg/L;
  • Patients in whom FDG-PET/CT dual scans are contraindicated (e.g., pregnant patients or those with severe allergy to IV contrast; a pregnancy test will be performed in each female subject between 18 and 45 years of age prior to each scan)

Sites / Locations

  • Brigham and Women's Hospital
  • BWH/FH/DCI Outpatient Dialysis Unit
  • DCI Dialysis Unit-Somerville

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

This study has only one arm.

Arm Description

Blood sample and scan results to be compared before and after intervention in each subject.

Outcomes

Primary Outcome Measures

Changes in FDG-PET/CT Dual Scan Score
Changes in Hs-CRP Level
Change in hs-CRP level before and after treatment in each subject
Changes in IL-6 Level
Change in IL-6 level before and after treatment in each subject

Secondary Outcome Measures

Albumin Level
Pre and Post levels.
ESA (Erythorpoietic Stimulating Agent) Dose Requirement
Comparison of the average ESA dose used in the 3 month before and the last 3 months of the study.
Hemoglobin Level
Pre and Post Levels
Rate of Cardiovascular Events
Comparison of the average major cardiovascular events (myocardial infarction and/or stroke) in the 3 month before and the last 3 months of the study.
Hemodialysis Access Stenosis/Thrombosis
Comparison of the average hemodialysis access stenosis/thrombosis requiring intervention in the 3 month before and the last 3 months of the study.
Number of Completed Subjects With Significant Increase in ALT (Alanine Aminotransferase).
The number of subjects with significant rise in ALT but not to the extent requiring removal from the study (rise to more than 3 times the upper limit of the normal range)

Full Information

First Posted
July 7, 2010
Last Updated
May 26, 2017
Sponsor
Brigham and Women's Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT01159054
Brief Title
Novel Pathways to Manage Inflammation and Atherosclerosis in Dialysis Patients: Role of Nicotinic Acid
Official Title
Novel Pathways to Manage Inflammation and Atherosclerosis in Dialysis Patients: Role of Nicotinic Acid
Study Type
Interventional

2. Study Status

Record Verification Date
May 2017
Overall Recruitment Status
Terminated
Why Stopped
The funding source is not going to fund this anymore. Only two subjects completed the study therefore meaningful analysis not possible.
Study Start Date
July 2010 (undefined)
Primary Completion Date
December 2014 (Actual)
Study Completion Date
December 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Brigham and Women's Hospital

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Patients with kidney failure on hemodialysis have an extremely high rate of cardiovascular disease including atherosclerotic cardiovascular disease. This, at least in part, is due to the chronic inflammatory status usually seen in these patients. Here we try to see if treatment with extended release nicotinic acid (Niaspan) can reduce their overall inflammatory burden (in general) and the atherosclerotic plaque inflammation (in particular).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Dialysis, Cardiovascular Disease, Atherosclerosis, Inflammation

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
22 (Actual)

8. Arms, Groups, and Interventions

Arm Title
This study has only one arm.
Arm Type
Experimental
Arm Description
Blood sample and scan results to be compared before and after intervention in each subject.
Intervention Type
Drug
Intervention Name(s)
Extended Release Nicotinic Acid (Niaspan)
Other Intervention Name(s)
Extended Release Nicotinic Acid, Niaspan
Intervention Description
Subjects will start on 500 mg per day of Niaspan for 4 weeks, then the dose will be increased to 1000 mg per day of Niaspan for 4 weeks, then the dose will be increased to 1500 mg of Niaspan per day for 4 weeks, after this subjects with weight of less than 60 kg will continue at 1500 mg per day of Niaspan for another 12 weeks whereas in subjects with weight of more than 60 kg the dose will be increased to 2000 mg of Niaspan per day which will be continued for 12 weeks.
Primary Outcome Measure Information:
Title
Changes in FDG-PET/CT Dual Scan Score
Time Frame
6 months
Title
Changes in Hs-CRP Level
Description
Change in hs-CRP level before and after treatment in each subject
Time Frame
6 months
Title
Changes in IL-6 Level
Description
Change in IL-6 level before and after treatment in each subject
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Albumin Level
Description
Pre and Post levels.
Time Frame
6 months
Title
ESA (Erythorpoietic Stimulating Agent) Dose Requirement
Description
Comparison of the average ESA dose used in the 3 month before and the last 3 months of the study.
Time Frame
6 months
Title
Hemoglobin Level
Description
Pre and Post Levels
Time Frame
6 months
Title
Rate of Cardiovascular Events
Description
Comparison of the average major cardiovascular events (myocardial infarction and/or stroke) in the 3 month before and the last 3 months of the study.
Time Frame
6 months
Title
Hemodialysis Access Stenosis/Thrombosis
Description
Comparison of the average hemodialysis access stenosis/thrombosis requiring intervention in the 3 month before and the last 3 months of the study.
Time Frame
6 months
Title
Number of Completed Subjects With Significant Increase in ALT (Alanine Aminotransferase).
Description
The number of subjects with significant rise in ALT but not to the extent requiring removal from the study (rise to more than 3 times the upper limit of the normal range)
Time Frame
6 months (checked monthly)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: A signed consent form; Male or Female, 18 years or older; Diagnosed with ESRD, on maintenance hemodialysis for at least six (6) months; Subject must be able to understand and provide informed consent; No known contraindications to therapy with nicotinic acid; Female subjects of childbearing potential must be willing to be on an acceptable form of birth control for the duration of the study and for two month after they have stopped taking the study drug. Exclusion Criteria: Any patient with a medical condition or taking any medications that would be contraindicated with the use of extended release niacin, such as active peptic ulcer disease; History of severe allergic reactions to the study medication; History of active infection or acute gouty attack within 2 weeks prior to enrollment; Known serological positivity for HIV, HBsAg, or HCV Ab; HbA1C > 9; Total CK of more than three times of the upper limit of normal; Elevation of liver function tests at time of entry (AST and/or ALT > 2 times the upper limit of normal); History of drug, alcohol, or chemical abuse within 6 months prior to enrollment; History of malignancy except adequately treated in-situ cervical carcinoma, or adequately treated basal or squamous cell carcinoma of the skin; History of an inflammatory disease such as SLE, rheumatoid arthritis or ulcerative colitis; Patients currently on pharmacological doses of nicotinic acid; Patients receiving chronic anti-inflammatory therapy; Patients with average baseline hs-CRP levels of > 20 mg/L or < 1 mg/L; Patients in whom FDG-PET/CT dual scans are contraindicated (e.g., pregnant patients or those with severe allergy to IV contrast; a pregnancy test will be performed in each female subject between 18 and 45 years of age prior to each scan)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kambiz ZANDI-NEJAD, MD
Organizational Affiliation
Brigham and Women's Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Brigham and Women's Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
BWH/FH/DCI Outpatient Dialysis Unit
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02130
Country
United States
Facility Name
DCI Dialysis Unit-Somerville
City
Somerville
State/Province
Massachusetts
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Novel Pathways to Manage Inflammation and Atherosclerosis in Dialysis Patients: Role of Nicotinic Acid

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