Endstage Renal Disease Clinical Trial
Official title:
Risk Assessment by Cardiovascular Biomarkers in Chronic Dialysis Patients
Patients undergoing chronic dialysis are at a substantially increased risk of cardiac death.
The reasons for this excess cardiovascular mortality are only partly understood. Classical
complicated artherosclerotic disease does not appear to be the primary cause of cardiac death
in chronic dialysis patients. In fact, the predictive potential of classic cardiovascular
risk factors such as hypertension, obesity and hyperlipidemia appears to be reduced in
dialysis. In contrast, in a series of pilot studies we found cardiac biomarkers to adequately
reflect dialysis induced myocardial stunning, progressive cardiovascular disease, and the
risk of death.
To extend and corroborate these results, we are planning a large, prospective, observational
study enrolling unselected hemo- and peritoneal dialysis patients. The proposed study, its
power calculation and hypotheses are based on our pilot studies
Eligible patients will be identified through the clinical care team by undergoing chronic
dialysis at one of the study centres. Dialysis patients will be initially approached during a
routine dialysis session by a member of the clinical team to discuss the study and a
participant information sheet will be provided. A minimum of 2 days after the provision of
the participant information sheet, the clinical team will inform the research team about the
patients who are interested in this study. Potential participants will be re-approached in
person by a trained research physician to determine whether they are willing to participate
in the study. If they are interested, the information sheet will be discussed with them and
any questions will be answered. The investigators will explain the nature of the study, its
purpose, the procedures involved, the expected duration, the potential risks and benefits and
any discomfort it may entail to each potential participant. Each participant will be informed
that the participation in the study is voluntary and that he/she may withdraw from the study
at any time and that withdrawal of consent will not affect his/her subsequent medical
assistance and treatment.
All potential study participants will be provided with a participant information sheet and a
consent form describing the study and providing sufficient information for the participant to
make an informed decision about their participation in the study.
The participant will be given a copy of the signed document. The consent form must also be
signed and dated by the investigator (or his designee) and it will be retained as part of the
study records. After consent is obtained, the participant will be allocated an unique study
identification (ID) code.
Patients are free to discontinue their participation in the study at any time, without having
to give a reason for their withdrawal.
Patient exposure will be censored for discontinuation of dialysis because of regaining renal
function or patient's wish, study withdrawal and transfer of the patient to a
non-participating dialysis unit. Patients undergoing renal transplantation during the
observational period will not be censored, but will be reassessed 3 and 6 months after
transplantation.
First, written informed consent will be obtained from the patient. After we have obtained
informed consent patients will undergo their standard three times weekly hemodialysis
sessions or their daily peritoneal dialysis session. At the time of enrolment into the trial
all patients will undergo a detailed clinical assessment including a medical history and a
physical examination. At the beginning and the end of the dialysis session, at the time of
the monthly routine blood tests additional venous blood samples will be collected. Serial
assessments will be performed in 6 monthly intervals until the enrollment target has been
met. After reaching the enrollment target the observational period will continue for another
year.
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