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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03923933
Other study ID # DI/19/105-B/03/018
Secondary ID
Status Completed
Phase Phase 2
First received
Last updated
Start date June 18, 2019
Est. completion date October 28, 2019

Study information

Verified date November 2020
Source Hospital General de México Dr. Eduardo Liceaga
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This study aims to demonstrate the possible benefit of a treatment based on double diuretic in patients with chronic kidney disease and severely impaired glomerular filtration rate. This is based on previous observations where the investigators found that volume overload is a frequent condition within this population and is strongly linked to an increase in morbidity and mortality. The investigators consider that this therapy could be beneficial given that most of these patients are treated with loop diuretics, however, with the passage of time, adaptive changes in the distal nephron occur that promote a decrease in the treatment effect. In this sense, thiazide diuretics at appropriate doses could 'break' the resistance, since their mechanism of action antagonizes the resistance mechanism. Unfortunately, to this day, this treatment has not been fully evaluated. Particularly in this type of population. The investigators developed a study proposed as a double blind randomized clinical trial, where the population will be divided into two groups. A group will be given the standard treatment based on loop diuretic (bumetanide), while the other group will receive the intervention (bumetanide plus chlorthalidone). After a 30-day follow-up period, the results will be measured. With respect to the effectiveness of the treatment, the decrease in volume overload by bioimpedance will be measured. While the occurrence of adverse effects during the same monitoring period will be observed.


Recruitment information / eligibility

Status Completed
Enrollment 34
Est. completion date October 28, 2019
Est. primary completion date October 28, 2019
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - glomerular filtration rate less than 30 ml / min / 1.73m - Without replacement therapy (dialysis or hemodialysis) - Volume overload - At least 100 ml per day of residual diuresis - Use of a loop diuretic for at least one month Exclusion Criteria: - Allergies known to diuretics - Patients with severe infections - Patients with hemodynamic instability - Amputees - Patients with cognitive impairment - Patients with acute renal failure - Patients with graft loss

Study Design


Intervention

Drug:
Chlorthalidone
Chlorthalidone
Bumetanide
Bumetanide

Locations

Country Name City State
Mexico Hospital General de Mexico Mexico City

Sponsors (1)

Lead Sponsor Collaborator
Hospital General de México Dr. Eduardo Liceaga

Country where clinical trial is conducted

Mexico, 

References & Publications (49)

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Ekinci C, Karabork M, Siriopol D, Dincer N, Covic A, Kanbay M. Effects of Volume Overload and Current Techniques for the Assessment of Fluid Status in Patients with Renal Disease. Blood Purif. 2018;46(1):34-47. doi: 10.1159/000487702. Epub 2018 Apr 12. Review. — View Citation

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Hassinger AB, Wald EL, Goodman DM. Early postoperative fluid overload precedes acute kidney injury and is associated with higher morbidity in pediatric cardiac surgery patients. Pediatr Crit Care Med. 2014 Feb;15(2):131-8. doi: 10.1097/PCC.0000000000000043. — View Citation

Hoorn EJ, Ellison DH. Diuretic Resistance. Am J Kidney Dis. 2017 Jan;69(1):136-142. doi: 10.1053/j.ajkd.2016.08.027. Epub 2016 Nov 1. Review. — View Citation

Hung SC, Lai YS, Kuo KL, Tarng DC. Volume overload and adverse outcomes in chronic kidney disease: clinical observational and animal studies. J Am Heart Assoc. 2015 May 5;4(5). pii: e001918. doi: 10.1161/JAHA.115.001918. — View Citation

James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC Jr, Svetkey LP, Taler SJ, Townsend RR, Wright JT Jr, Narva AS, Ortiz E. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb 5;311(5):507-20. doi: 10.1001/jama.2013.284427. Erratum in: JAMA. 2014 May 7;311(17):1809. — View Citation

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* Note: There are 49 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Change in Total Body Water Measured by bioelectrical impedance analysis, compared to the initial measurement Change from Basal to day 28
Secondary Change in Mean Arterial Pressure decrease in blood pressure compared wit baseline measure (mmhg) Change from Basal to day 28
Secondary Change in the Fractional Excretion of Sodium Increase in the fractional excretion of sodium compared with the baseline measure Change from Basal to day 28
Secondary Change in Extracellular Water Decrease in extracellular water measured by bioelectrical impedance analysis Change from Basal to day 28
Secondary Change in Extracellular Water / Total Body Water Ratio Decrease in extracellular water / total body water ratio measured by bioelectrical impedance analysis Change from Basal to day 28
Secondary Change in Systolic Blood Pressure Change from Basal to day 28
Secondary Change in Diastolic Blood Pressure Change from Basal to day 28
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