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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03483272
Other study ID # 17001401
Secondary ID
Status Completed
Phase
First received
Last updated
Start date January 8, 2018
Est. completion date April 21, 2021

Study information

Verified date August 2021
Source Hvidovre University Hospital
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

Heptorenal syndrome (HRS) is divided into two types. A non-acute kidney injury (NAKI-HRS), which is predominantly related to end-stage disease and a more acute kidney injury (HRS-AKI). HRS-AKI is potentially reversible and develops subsequent to aggravation of a systemic circulatory vasodilatation, that triggers renal vasoconstriction and deteriorates renal perfusion and function. The albumin and terlipressin response is evaluated clinically, routinely for a week and reduces mortality with 23% compared to no treatment. Only 40-50% of the patients with HRS-AKI respond to the treatment with terlipressin. The treatment of hepatorenal syndrome (HRS-AKI) is aimed at improving blood flow to the kidneys. Flow changes associated to development of HRS have only sparsely been studied and not previously by MR technique and no previous studies have evaluated changes in flow induced by terlipressin. It has been hypothesized that development of HRS is associated to a deterioration in heart function with development of cardiomyopathy, which together with renal vasoconstriction leads to renal failure. Simultaneous MR-assessments of cardiac function and flows (especially the renal flow) in HRS-AKI have not previously been performed. The aim of the project is to develop new, fast and non-invasive methods to evaluate hemodynamic changes and individual pharmacological terlipressin response in patients with acute hepatorenal syndrome (type HRS-AKI) We expect a higher increase in renal blood flow in terlipressin-responders compared to terlipressin-non-responders and non-responders will generally have a lower basic renal flow and a decreased cardiac output. Study design and patients The study design is experimental and includes 30 cirrhotic patients with HRS-AKI. Patients with HRS-AKI are MR scanned before and 17 minutes after their first dose of terlipressin. ECHO is performed before first dose of Terlipressin and is repeated after one of the first doses of terlipressin. Clinically efficacy is defined in accordance to international guidelines at day-7 and 90 days mortality is registered. The screening period and treatments follow international and national guidelines for acute renal failure in patients with cirrhosis.


Recruitment information / eligibility

Status Completed
Enrollment 11
Est. completion date April 21, 2021
Est. primary completion date April 15, 2021
Accepts healthy volunteers No
Gender All
Age group 18 Years to 78 Years
Eligibility Inclusion Criteria: - Patients with cirrhosis and acute hepatorenal syndrome (HRS-AKI) - Patient of more than 18 and less than 78 years of age Exclusion Criteria: - Patients who are unable to give informed consent - Patients with absolute contraindication for MRI - Patients with absolute contraindication for terlipressin - Pregnant women - Patient with severe hemodynamic comorbidity

Study Design


Locations

Country Name City State
Denmark Centre of Gastroenterology, Dept. of medicine. Hvidovre University Hospital Hvidovre
Denmark Hvidovre University Hospital Hvidovre Capital Region

Sponsors (1)

Lead Sponsor Collaborator
Hvidovre University Hospital

Country where clinical trial is conducted

Denmark, 

Outcome

Type Measure Description Time frame Safety issue
Primary Flow (mL/min) in kidney and splanchnic vessels in patients with HRS-AKI and cirrhotic patients without kidney impairment i) To characterize and compare changes in flow with MR and ECHO in patients with HRS-AKI compared to cirrhotic patients without kidney impairment Baseline (mL/min)
Secondary Flow changes (mL/min) in HRS-AKI patients with terlipressin non-response vs. response. To investigate whether flow changes measured with MR and echocardiography induced by a single dose of terlipressin can predict the clinical (7 days) response to terlipressin treatment.
Full terlipressin response is if creatinine level returns to baseline after 7 days treatment.
Partial response is a reduction in creatinine of 25% after 7 days terlipressin treatment
Response after 7 days treatment (mL/min)
Secondary Flow changes (mL/min) after terlipressin administration compared to mortality. To investigate whether flow changes measured with MR and echocardiography induced by a single dose of terlipressin can predict the mortality after 90 days 90 days
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