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Study Assessing Safety & Effectiveness of a Catheter Lock Solution in Dialysis Patients to Prevent Bloodstream Infection

Primary Purpose

Kidney Failure, Chronic, Catheter-Related Infections

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Neutrolin
Heparin
Sponsored by
CorMedix
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Kidney Failure, Chronic focused on measuring Kidney Failure, Chronic, Catheter-Related Infections, Central Venous Catheter

Eligibility Criteria

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

Inclusion Criteria:

  1. Subject has ESRD and undergoes chronic HD at least two times per week
  2. Subject has a HD catheter that has demonstrated the ability to achieve a minimum blood flow of at least 250 mL/min for at least two consecutive dialysis sessions blood flow to enable successful HD
  3. The HD catheter is implanted with the tip in a jugular or subclavian vein
  4. The subject is not expected to expire within 180 days
  5. The subject is likely to require the use of a CVC for at least 90 days
  6. The subject (or the legal guardian) understands the nature of the study and provides written informed consent prior to the study enrollment
  7. The subject is willing to comply with specified follow-up evaluations and prescribed dialysis therapy and
  8. If female and of childbearing potential, the subject must have a negative pregnancy test at the screening visit (i.e., subject is not pregnant); not be lactating; and use an acceptable method of contraception, including abstinence, a barrier method (diaphragm or condom), Depo-Provera, or hormonal contraceptive (oral, implant, ring, patch) for the duration of the study. (NOTE: The subject must have used the chosen method of birth control for at least 1 month/cycle prior to enrollment into the study).

Exclusion Criteria:

  1. Subjects who received antibiotics within the last 14 days
  2. Visible evidence of compromised skin integrity is present at the catheter exit site or evidence of a catheter exit site infection
  3. Subject has received any thrombolytic treatment (i.e., tPA) in their current catheter within 30 days of randomization
  4. Fill volume of HD catheter is unknown or cannot be determined
  5. Subjects using any type of antimicrobial-coated or heparin-coated catheter
  6. Documented chronic bleeding diathesis, active or recurrent bleeding within 1 month prior to randomization
  7. Documented history of an atrial thrombus or known hypercoagulable state
  8. Subjects with open, non-healing skin ulcers
  9. Current requirement for systemic immunosuppression that would increase risk of infection
  10. Active malignancy requiring or anticipated to require chemotherapy likely to cause leukopenia and/or immunosuppression
  11. Known allergy or absolute contraindication to citrate, taurolidine or heparin or a history of heparin-induced thrombocytopenia
  12. Unstable malignancy
  13. Cirrhosis with encephalopathy
  14. Subject is currently taking another medication with known systemic drug interaction with citrate, taurolidine, or heparin
  15. Subject is currently enrolled in another investigational device and/or drug trial or has participated in another investigational device and/or drug trial within 30 days prior to enrollment
  16. Subject is anticipated to receive a renal transplant within 90 days (subjects can be on the transplant list, but a subject with a known or anticipated transplant date within the next 90 days should be excluded)
  17. Any other medical condition which renders the subject unable to or unlikely to complete the study, or which would interfere with optimal participation in the study or produce significant risk to the subject.

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Sites / Locations

  • Riverside Nephrology Physicians/Van Buren Dialysis center
  • North America Research Institute
  • North Beach Dialysis Center Inc.
  • Lower Manhattan Dialysis Center
  • Diagnostic Clinic of Houston

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Neutrolin arm

Heparin arm

Arm Description

Neutrolin: Neutrolin will be added to the central venous catheter after dialysis as a lock solution

Heparin: Heparin will be added to the central venous catheter after dialysis as a lock solution

Outcomes

Primary Outcome Measures

Presence of a CAC-Adjudicated Catheter-Related Bloodstream Infection (CRBSI) in Subjects Receiving Hemodialysis for the Treatment of End Stage Renal Disease (ESRD): Final Analysis
CRBSI was defined as the same organism grown from at least one positive blood culture from a peripheral site or bloodline sample, or either the arterial or venous catheter hub. The final assessment of CRBSI was determined by a Clinical Adjudication Committee (CAC) who used both clinical documentation and blood culture results in their assessment.

Secondary Outcome Measures

Participants With a Study Catheter Removal for Any Reason
Analysis of all catheter removals during the study or until the catheter was removed

Full Information

First Posted
January 7, 2016
Last Updated
August 5, 2021
Sponsor
CorMedix
Collaborators
PPD, JMI Laboratories, Spectra Clinical Research, Davita Clinical Research, Frenova Renal Research
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1. Study Identification

Unique Protocol Identification Number
NCT02651428
Brief Title
Study Assessing Safety & Effectiveness of a Catheter Lock Solution in Dialysis Patients to Prevent Bloodstream Infection
Official Title
Phase 3 Prospective, Multicenter, Double-blind, Randomized, Active Control Study to Demonstrate Safety & Effectiveness of Neutrolin in Preventing Catheter-related Bloodstream Infection in Subjects on Hemodialysis for End Stage Renal Disease
Study Type
Interventional

2. Study Status

Record Verification Date
August 2021
Overall Recruitment Status
Completed
Study Start Date
December 2015 (undefined)
Primary Completion Date
October 2018 (Actual)
Study Completion Date
October 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
CorMedix
Collaborators
PPD, JMI Laboratories, Spectra Clinical Research, Davita Clinical Research, Frenova Renal Research

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is determine safety and effectiveness of Neutrolin, a catheter lock solution, for prevention of central venous catheter associated bloodstream infection in hemodialysis patients.
Detailed Description
The objective of this study is to demonstrate the efficacy and safety of Neutrolin® as a catheter lock solution (CLS) on prevention of catheter-related bloodstream infection (CRBSI), and the incidence of treatment-emergent adverse events in subjects receiving hemodialysis (HD) for the treatment of End Stage Renal Disease (ESRD) when compared with heparin 4,000 USP Units/4mL (1,000 USP Units/mL). This is a randomized, double-blind, active control, parallel-arm, multicenter study. Six hundred and thirty two subjects will be randomized in a 1:1 ratio to receive either Neutrolin® or the active control heparin (Heparin sodium USP 1,000 units/mL, Benzyl alcohol 9.45 mg/mL and Sodium chloride 9.0 mg/mL) as a CLS. Approximately 632 randomized subjects are planned for this trial. In this study, one-half of the subjects (316 subjects) will receive Neutrolin as a study drug and the other half will receive heparin 4,000 USP Units/4mL (1,000 USP Units/mL) with benzyl alcohol preservative as a comparator. Subjects will be assigned in a 1:1 ratio using permuted blocks without additional stratification for both groups. The primary objective of this study is to demonstrate the effectiveness of Neutrolin® as a CLS in ESRD subjects undergoing HD treatment using a permanent, cuffed, tunneled silicone or polyurethane HD catheter. The study will evaluate whether Neutrolin® is superior to the active control heparin by documenting the time to CRBSI and consequently delaying the time until the occurrence of CRBSI.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Kidney Failure, Chronic, Catheter-Related Infections
Keywords
Kidney Failure, Chronic, Catheter-Related Infections, Central Venous Catheter

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
806 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Neutrolin arm
Arm Type
Experimental
Arm Description
Neutrolin: Neutrolin will be added to the central venous catheter after dialysis as a lock solution
Arm Title
Heparin arm
Arm Type
Active Comparator
Arm Description
Heparin: Heparin will be added to the central venous catheter after dialysis as a lock solution
Intervention Type
Drug
Intervention Name(s)
Neutrolin
Other Intervention Name(s)
1.35% taurolidine, 3.5% citrate, heparin 1,000 USP Units/mL
Intervention Description
Neutrolin® will be instilled into central venous HD catheters at the discontinuation of all dialysis sessions and will be withdrawn prior to the initiation of the next dialysis session
Intervention Type
Drug
Intervention Name(s)
Heparin
Other Intervention Name(s)
Heparin Sodium
Intervention Description
Heparin will be instilled into central venous HD catheters at the discontinuation of all dialysis sessions and will be withdrawn prior to the initiation of the next dialysis session
Primary Outcome Measure Information:
Title
Presence of a CAC-Adjudicated Catheter-Related Bloodstream Infection (CRBSI) in Subjects Receiving Hemodialysis for the Treatment of End Stage Renal Disease (ESRD): Final Analysis
Description
CRBSI was defined as the same organism grown from at least one positive blood culture from a peripheral site or bloodline sample, or either the arterial or venous catheter hub. The final assessment of CRBSI was determined by a Clinical Adjudication Committee (CAC) who used both clinical documentation and blood culture results in their assessment.
Time Frame
The event time was the number of days from randomization until the occurrence of a CAC-Adjudicated CRBSI or until the subject was censored. The mean participant duration of exposure to study drug was 174 days (range 4-884 days).
Secondary Outcome Measure Information:
Title
Participants With a Study Catheter Removal for Any Reason
Description
Analysis of all catheter removals during the study or until the catheter was removed
Time Frame
The event time was the number of days from randomization until catheter removal for any reason or until the subject was censored. The mean participant duration of exposure to study drug was 174 days (range 4-884 days).

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject has ESRD and undergoes chronic HD at least two times per week Subject has a HD catheter that has demonstrated the ability to achieve a minimum blood flow of at least 250 mL/min for at least two consecutive dialysis sessions blood flow to enable successful HD The HD catheter is implanted with the tip in a jugular or subclavian vein The subject is not expected to expire within 180 days The subject is likely to require the use of a CVC for at least 90 days The subject (or the legal guardian) understands the nature of the study and provides written informed consent prior to the study enrollment The subject is willing to comply with specified follow-up evaluations and prescribed dialysis therapy and If female and of childbearing potential, the subject must have a negative pregnancy test at the screening visit (i.e., subject is not pregnant); not be lactating; and use an acceptable method of contraception, including abstinence, a barrier method (diaphragm or condom), Depo-Provera, or hormonal contraceptive (oral, implant, ring, patch) for the duration of the study. (NOTE: The subject must have used the chosen method of birth control for at least 1 month/cycle prior to enrollment into the study). Exclusion Criteria: Subjects who received antibiotics within the last 14 days Visible evidence of compromised skin integrity is present at the catheter exit site or evidence of a catheter exit site infection Subject has received any thrombolytic treatment (i.e., tPA) in their current catheter within 30 days of randomization Fill volume of HD catheter is unknown or cannot be determined Subjects using any type of antimicrobial-coated or heparin-coated catheter Documented chronic bleeding diathesis, active or recurrent bleeding within 1 month prior to randomization Documented history of an atrial thrombus or known hypercoagulable state Subjects with open, non-healing skin ulcers Current requirement for systemic immunosuppression that would increase risk of infection Active malignancy requiring or anticipated to require chemotherapy likely to cause leukopenia and/or immunosuppression Known allergy or absolute contraindication to citrate, taurolidine or heparin or a history of heparin-induced thrombocytopenia Unstable malignancy Cirrhosis with encephalopathy Subject is currently taking another medication with known systemic drug interaction with citrate, taurolidine, or heparin Subject is currently enrolled in another investigational device and/or drug trial or has participated in another investigational device and/or drug trial within 30 days prior to enrollment Subject is anticipated to receive a renal transplant within 90 days (subjects can be on the transplant list, but a subject with a known or anticipated transplant date within the next 90 days should be excluded) Any other medical condition which renders the subject unable to or unlikely to complete the study, or which would interfere with optimal participation in the study or produce significant risk to the subject. -
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Antony Pfaffle, MD
Organizational Affiliation
Chief Scientific Officer
Official's Role
Study Director
Facility Information:
Facility Name
Riverside Nephrology Physicians/Van Buren Dialysis center
City
Riverside
State/Province
California
ZIP/Postal Code
92503
Country
United States
Facility Name
North America Research Institute
City
San Dimas
State/Province
California
ZIP/Postal Code
91773
Country
United States
Facility Name
North Beach Dialysis Center Inc.
City
Miami Gardens
State/Province
Florida
ZIP/Postal Code
33169
Country
United States
Facility Name
Lower Manhattan Dialysis Center
City
New York
State/Province
New York
ZIP/Postal Code
10016
Country
United States
Facility Name
Diagnostic Clinic of Houston
City
Houston
State/Province
Texas
ZIP/Postal Code
77004
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Study Assessing Safety & Effectiveness of a Catheter Lock Solution in Dialysis Patients to Prevent Bloodstream Infection

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