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The Effect of Diuretics on Mineral and Bone Disorder in Chronic Kidney Disease Patients

Primary Purpose

Secondary Hyperparathyroidism, Chronic Kidney Disease

Status
Unknown status
Phase
Not Applicable
Locations
Brazil
Study Type
Interventional
Intervention
Hydrochlorothiazide
Furosemide
Sponsored by
University of Sao Paulo General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Secondary Hyperparathyroidism focused on measuring diuretics, furosemide, hydrochlorothiazide, CKD-MBD, HRpQCT, parathyroid hormone

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Estimated Glomerular Filtration Rate (calculated by CKD-EPI) between 30 and 60 ml/min

Exclusion Criteria:

  • Diabetes;
  • chronic use of: steroid, bisphosphonates and calcium carbonate

Sites / Locations

  • Hospital das ClinicasRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Furosemide

Hydrochlorothiazide

Arm Description

Use of Furosemide, 40mg (1 tablet) per day, over 12 months

Use of Hydrochlorothiazide, 25mg (1 tablet) per day, over 12 months

Outcomes

Primary Outcome Measures

Parathyroid hormone (PTH) level.
Bone metabolism

Secondary Outcome Measures

Full Information

First Posted
February 27, 2017
Last Updated
October 25, 2017
Sponsor
University of Sao Paulo General Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT03082742
Brief Title
The Effect of Diuretics on Mineral and Bone Disorder in Chronic Kidney Disease Patients
Official Title
The Effect of Thiazide and Loop Diuretic on Mineral and Bone Disorder in Chronic Kidney Disease Patients
Study Type
Interventional

2. Study Status

Record Verification Date
October 2017
Overall Recruitment Status
Unknown status
Study Start Date
August 1, 2015 (Actual)
Primary Completion Date
June 2018 (Anticipated)
Study Completion Date
June 2018 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Sao Paulo General Hospital

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Chronic kidney disease (CKD) patients often have associated systemic hypertension due to volume retention, as one of the mechanisms, therefore the use of diuretics is widespread in this population. One of the major complications of CKD is mineral and bone metabolism disorder (CKD-MBD), which include changes in the levels of calcium, phosphorus, vitamin D deficiency, increased circulating levels of fibroblast growth factor (FGF-23) and parathyroid hormone (PTH). These alterations are responsible for fractures, cardiovascular disease and mortality among patients with CKD. According to diuretic mechanism of action, sometimes increasing serum calcium (in the case of furosemide), sometimes decreasing it (in the case of thiazide), it is expected that the serum calcium may be altered, even within the range of normality, with consequent impact on the levels of PTH. Although most studies have shown that the use of thiazide diuretics decreases the risk of fractures, some showed the opposite. Similarly, although most studies have shown increased risk of fracture in association to loop diuretics use, some have failed in demonstrated this outcome. Only one study, a cohort study in a population of CKD, showed that furosemide was directly related to increased calciuria and PTH levels and the use of thiazide, in turn, showed completely opposite effect. However, certain issues are still not completely solved, for example, the interference of renal function itself on calciuria. It is possible that calciuria is not a so simple explanation that justifies the PTH levels changes, as no correlation was seen between calciuria and PTH levels. Better understanding of the exact relationship between the use of diuretics and the impact on CKD-MBD may be an alternative intervention, easily accessible and relatively inexpensive. The purpose of this study is to evaluate the impact of diuretic, specifically hydrochlorothiazide and furosemide, on bone architecture and mineral metabolism.
Detailed Description
This is a prospective randomized study to test the effects of thiazide and furosemide in bone parameters, which will be assessed by peripheral micro-tomography at baseline and 12 months later. The role of calciuria in these possible changes will be tested.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Secondary Hyperparathyroidism, Chronic Kidney Disease
Keywords
diuretics, furosemide, hydrochlorothiazide, CKD-MBD, HRpQCT, parathyroid hormone

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Investigator
Allocation
Randomized
Enrollment
52 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Furosemide
Arm Type
Active Comparator
Arm Description
Use of Furosemide, 40mg (1 tablet) per day, over 12 months
Arm Title
Hydrochlorothiazide
Arm Type
Active Comparator
Arm Description
Use of Hydrochlorothiazide, 25mg (1 tablet) per day, over 12 months
Intervention Type
Drug
Intervention Name(s)
Hydrochlorothiazide
Intervention Type
Drug
Intervention Name(s)
Furosemide
Primary Outcome Measure Information:
Title
Parathyroid hormone (PTH) level.
Description
Bone metabolism
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Estimated Glomerular Filtration Rate (calculated by CKD-EPI) between 30 and 60 ml/min Exclusion Criteria: Diabetes; chronic use of: steroid, bisphosphonates and calcium carbonate
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Rosilene M Elias, M.D., Ph.D
Phone
+5511 26617167
Email
rosilenemotta@hotmail.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rosilene M Elias, M.D., Ph.D
Organizational Affiliation
University of Sao Paulo
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hospital das Clinicas
City
Sao Paulo
State/Province
SP
ZIP/Postal Code
05403-000
Country
Brazil
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Rosilene M Elias, M.D, Ph.D
Phone
+5511 2661-7167
Email
rosilenemotta@hotmail.com
First Name & Middle Initial & Last Name & Degree
Rosilene M Elias, M.D., Ph.D

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

The Effect of Diuretics on Mineral and Bone Disorder in Chronic Kidney Disease Patients

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