Active clinical trials for "Kidney Failure, Chronic"

Peritoneal dialysis (PD) is an established dialysis modality in patients with end stage renal disease (ESRD). However, there is growing awareness of the deleterious effect of high glucose content in PD solutions on the peritoneal membrane over time (1). Accordingly, development of new solutions to minimize glucose-induced toxicity and/or containing an alternative osmotic agent to glucose such as icodextrin and amino-acid were developed. Icodextrin is a mixture of high molecular weight, water soluble glucose polymers isolated by fractionation of hydrolyzed cornstarch (2). Unlike glucose which is absorbed from the peritoneal cavity primarily by diffusion across the peritoneal capillary endothelium, its absorption occurs mainly due to convective fluid movement out of the peritoneal cavity via the lymphatics (2). As a result, relatively constant osmotic pressure is created by icodextrin, thus it can provide sustained ultrafiltration during the long dwell. A number of studies have reported that icodextrin-based solution provides various clinical benefits compared with conventional glucose-based solutions (3-7). In particular, icodextrin has been successfully used in the fluid management of PD patients (4-5, 7). However, excessive ultrafiltration may induce underhydration, resulting in faster decline in residual renal function. This concern was first raised by Konings et al (8). In this study, a greater fall in residual glomerular filtration rate (GFR) was observed in patients using icodextrin compared to those using 1.36% glucose solution. In contrast, contradictory findings were also reported from the two studies indicating that residual renal function can be preserved by icodextrin solution (4, 9). Although the mechanisms are not clear, possible explanation includes the presence of high-molecular-weight icodextrin metabolites in plasma, which in turn may increase plasma oncotic pressure and hence preserve plasma volume and renal perfusion as suggested by Davies et al (10). Such discrepant findings may be explained by differences in study design, baseline fluid status, and other factors affecting residual renal function during the study. In the study by Konings et al (8), the comparative solution was 1.36% glucose, whereas 2.27% glucose was used in the study by Davies et al (4). Therefore, it can be speculated that volume status might differ depending on different concentration of glucose solution, thus leading to conflicting results. Also, these two prior studies are limited by residual renal function as secondary outcome, a short follow-up duration (4 mo vs. 6 mo), and small number of patients (32 vs. 50). To further explore the effects of icodextrin solution on residual renal function, the investigators will conduct a multicenter prospective randomized controlled open-label trial. Briefly, incident or prevalent adult CAPD patients with residual urine volume > 750 ml will be included. Patients on APD will be excluded. After a 4-week screening period, patients will be randomly assigned to icodextrin or 2.5% glucose solution for the long dwell. Residual GFR and fluid status will be assessed at baseline, 6, and 12 months. Residual GFR will be calculated as an average of urea and creatinine clearance from a 24-hour urine collection. To assess fluid status, the investigators will use three different assessment tools; 1) echocardiography for measuring intra vena cava (IVC) diameter and left ventricular end diastolic diameter, 2) measurement of plasma atrial natriuretic peptide, 3) bioimpedence analysis. Primary outcome is residual GFR change at 1-year and secondary outcome is change of fluid status during the study period. Also, biochemical laboratory data such as hemoglobin, hsCRP, plasma osmolality, and lipid profile, peritoneal equilibration test, dialysis adequacy, and daily peritoneal glucose exposure will be monitored. At least 50 subjects (a total of 100) would be required for each group to detect 50% difference of residual GFR between the two groups if type I error rate is 5% and type II error is 20% given 30% of drop-out rate during the study period. Preservation of residual renal function is of paramount importance because it is an independent risk factor of mortality in PD patients. In addition, achievement of adequate ultrafiltration is another crucial therapeutic goal to improve clinical outcomes in these patients. In this regard, if these two goals can be accomplished by icodextrin, it would be an ideal dialysis solution in PD practice. The investigators study will address this issue to answer the unresolved question on the effect of icodextrin on residual renal function."

The purpose of this study is to look at the tolerability and safety of LY3113593. Study doctors will see how safe it is and whether it produces side effects following a single injection into a vein or under the skin in healthy participants (Part A) and participants with chronic kidney disease treated with hemodialysis (Part B). The study will also measure how much of the study drug gets into the blood stream, how long it takes the body to get rid of the study drug and what effects the study drug has on the body. This is the first time that this study drug is being given to participants. This study is for research purposes only and is not intended to treat any medical condition. For each participant, the study will last about 85 days, not including screening. Screening is required within 28 days prior to the start of the study.

Because of the deceased donor organ shortage, more kidney patients are considering whether to receive kidneys from family and friends, a process called living donor kidney transplantation (LDKT). Although Blacks are 3.4 times more likely to develop end stage renal disease, they are less likely to receive LDKTs. To address this disparity, this randomized controlled trial will assess whether Black and White transplant patients' knowledge and receipt of LDKTs can be increased when they receive access to the Your Path to Transplant computerized Expert System (YPT). This trial will also examine how other known patient, family, and healthcare system barriers to LDKT impact YPT's effectiveness. Nine hundred (900) Black,White and Hispanic ESRD patients presenting for transplant medical evaluation at University of California-Los Angeles Kidney and Pancreas Transplant Program (UCLA-KPTP) in Los Angeles, California will be stratified by race and randomly assigned to one of two education conditions (YPT vs. Usual Care Education). As they undergo transplant evaluation, patients in the YPT condition will receive individually-tailored feedback reports, coaching, and socioeconomic resource guidance associated with reducing barriers to access to LDKT. Control patients will receive usual care transplant education provided by UCLA-KPTP. Changes in knowledge, readiness to pursue LDKT, pros/cons to LDKT, and self-efficacy will be assessed at four time points: prior to presenting at the transplant center (baseline), during transplant evaluation (approximately 2 months post-baseline), and 4- and 8-months post-baseline. Completion of transplant evaluation and receipt of LDKTs will be assessed 18-months post-baseline. At the conclusion of the study, we will have developed an innovative and cost-effective YPT Computerized Expert System that could be utilized to tailor LDKT discussion and education in different medical settings based on the needs of individual patients of different races.

The purpose of this study is to evaluate how quickly and to what extent different immunosuppressants are absorbed into the blood (this is called pharmacokinetics) in renal transplant candidates who have undergone a laparoscopic sleeve gastrectomy. The immune system is the body's defense against diseases. It also attacks "foreign" tissues such as a transplanted kidney. Immunosuppressant medications such as Astagraf sustained release (XL), Prograf, and mycophenolate mofetil may be given to suppress the immune system following kidney transplantation and prevent rejection of a transplanted kidney. This study is being performed to determine if patients who undergo laparoscopic sleeve gastrectomy need different doses of immunosuppressant medications.

The purpose of this study is to investigate the effect of decreasing fluid overload by hemodialysis on the severity of obstructive sleep apnea, in patients with end stage chronic kidney disease on intermittent hemodialysis. It aims further to investigate the relationship between overhydration, nocturnal rostral fluid shift and the severity of sleep apnea.

The purpose of this study was to measure how much of the study drug, LY2409021, gets into the blood stream and how long it takes the body to get rid of it when given to participants with different levels of kidney function. There were five study groups. Each participant only enrolled in one group. Participants in groups 1 through 4 were healthy or have mild, moderate, or severe kidney disease. They completed one study period lasting about 29 days. Study group 5 enrolled participants with kidney disease who were on dialysis. They have completed two study periods which together last about 59 days. Screening was required within 21 days prior to the start of the study for all participants.

The purpose of this study is to evaluate the effect of renal function on the biological activity of telavancin using blood samples obtained from subjects with normal renal function, severe renal impairment, and end stage renal disease.

The purpose of this study is to determine how levels of this newly-discovered hormone, called FGF-23, changes in the blood in response to a high calcium dialysis bath during a hemodialysis (HD) treatment, and how this relates to changes in the calcium and PTH levels. We are also studying the effects of dialysis and inflammation on the levels of Fetuin A. We intend to prospectively study a cohort of end stage renal disease (ESRD) patients on hemodialysis in order to determine whether FDF-23 levels independently affect non-suppressible PTH levels. The relationship between Fetuin A and inflammatory markers will also be determined. By dialyzing patients on 3.5 mEq/L calcium dialysate bath, we seek any relationship between ionized calcium, FGF-23 and PTH.

Short-daily hemodialysis is increasingly becoming a preferred alternative to the conventional intermittent (three times per week) hemodialysis schedule. Studies have shown that short-daily dialysis improves a patient's quality of life, high blood pressure, anemia and calcium-phosphorus balance. Infection, however, will likely remain a persistent problem for dialysis patients regardless of the frequency of treatments. There is currently a wealth of information to guide doctors on how much and how frequently to give an antibiotic for patients who receive intermittent (thrice weekly) hemodialysis. However, there is very little information on how to prescribe antibiotics for patient's receiving short-daily hemodialysis. This study will develop drug dose guidelines for patients receiving short-daily hemodialysis for three frequently used antibiotics, vancomycin, levofloxacin and gentamicin. These guidelines will assist doctors so that patients receive the most effective dose and frequency of an antibiotic to treat their infection. The following is the study hypothesis which will be tested with two-sided, one sample t-tests comparing the AUC observed to historical measures8. 1) Vancomycin, levofloxacin and gentamicin are removed to a greater extent by short-daily hemodialysis than intermittent hemodialysis. The following are the specific aims: Determine the interdialytic pharmacokinetics of vancomycin, gentamicin, and levofloxacin by short-daily HD. Determine the extent of vancomycin removal when administered during the last hour of short-daily HD. Develop drug-dosing guidelines for vancomycin, gentamicin and levofloxacin for patients receiving short-daily HD.

This study will test the hypothesis that by slightly lowering the acidity of blood (or increasing the pH), dialysis patients utilize protein and amino acids more efficiently.