Chronic Kidney Disease Clinical Trial
Official title:
The Use of Bisphosphonates to Prevent or Delay the Progression of Vascular Calcification in End-Stage Renal Disease: A Randomized Controlled Trial
Kidney disease is a fundamental part of medicine because of its prominence in Western
society. Common conditions such as diabetes, hypertension and kidney infections can all
progress to End-Stage Renal Disease (ESRD) also known as Stage 5 chronic kidney disease (CKD
5). Once ESRD has begun, kidney function is poor at best, thus the body is unable to
effectively clear harmful toxins from the blood.
A common feature of ESRD is vascular calcification, a process where blood vessels
(especially arteries) attract deposits of the mineral calcium. Over time, these deposits
harden and thicken in the layers of blood vessels, which limit blood flow to body tissues
and can produce significant disease including hypertension, heart disease and stroke.
Although the process of vascular calcification is unknown, there is mounting evidence that
it is mediated by cellular events that are similar to those seen in bone formation with in
the body (osteogenesis). With this point in mind, it has been suggested that agents medicine
employs to limit excess bone formation will reduce the rate of vascular calcification in CKD
Stage 5.
This study will employ one group of drugs called bisphosphonates which have been used to
limit bone formation. It will study their effect on vascular calcification in adult dialysis
patients.
Presently, there exist few therapies aimed at retarding the progression of vascular
calcification. One study showed that agents that limit the absorption of phosphate from food
(phosphate binders) slow the progression of vascular calcification, and as a result,
treatments emphasize phosphate control through diet and phosphate binders. Other studies
have shown that the use of statins, to lower LDL cholesterol levels may reduce the
progression of coronary calcification in non-ESRD patients, but data from ESRD are lacking.
While these treatments have been helpful, the improvements in patients' outcomes have not
been overwhelming positive.
This proposed study is not the first to study the use of bisphosphonates on vascular
calcification. Repeated studies have shown impressive reduction in calcification rates in
several animal models, which begs the question, how will bisphosphonates fare in human
subjects? Preliminary research has begun, but clearly an expansive trial on humans is needed
to explore the use of a promising therapy. Our study hopes to provide insight into this area
of cardiovascular research.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver), Primary Purpose: Treatment
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