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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT05228574
Other study ID # NL72836.340.10
Secondary ID
Status Recruiting
Phase Phase 4
First received
Last updated
Start date March 11, 2022
Est. completion date December 31, 2024

Study information

Verified date September 2023
Source Erasmus Medical Center
Contact L. Xue, MSc
Phone (0031)107040704
Email l.xue@erasmusmc.nl
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease characterized by cystic kidneys and caused by mutations in the polycystic kidney disease and other rare genes. It is associated with salt-sensitive hypertension, which accounts for the majority of morbidity and mortality. About 70% of patients with ADPKD develop hypertension, prior to the onset of kidney function decline. Early onset hypertension, despite its treatment, is independently associated with rapid kidney function decline. The investigators hypothesize that a high-sodium diet in patients with ADPKD is required for the development of vascular stiffness, which precedes hypertension, and that treatment with amiloride reverses this phenomenon.


Description:

Objective of the study: The investigators aim to investigate if arterial stiffness is exacerbated due to a high-salt diet in patients with ADPKD. The investigators also aim to explore whether treatment with amiloride prevents the arterial stiffness caused by a high-salt diet. Study design: Randomized, double blinded and placebo-controlled clinical trial with open-label treatment with amiloride Study population: Adults with ADPKD with an estimated glomerular filtration rate (CKD-EPI) of ≥ 60 ml/min/1.73m2 Intervention: All participants will be subjected to a low-salt diet (3,5 grams/day) throughout the study for a total of 6 weeks. After a run-in period of 2 weeks, participants will be randomized into two treatment groups: Group 1: Sodium chloride capsules (6 grams/day) for 2 weeks, combined with amiloride (20 mg/day) in last 2 weeks Group 2: Placebo capsules for 2 weeks, combined with amiloride (20 mg/day) in last 2 weeks. Primary study parameters/outcome of the study: The three primary outcomes of this study are a difference in central arterial stiffness (pulse wave velocity, PWV) between: 1. The high-salt group versus low-salt group; 2. The high-salt group: before versus after amiloride treatment; 3. The low-salt group: before versus after amiloride treatment. The burden of participation includes: - A dietary salt restriction of 3.5 grams/day for a total period of 6 weeks - Salt supplementation or placebo for a total period of 4 weeks - Drug intervention with amiloride during the last 2 weeks - Hospital visits


Recruitment information / eligibility

Status Recruiting
Enrollment 54
Est. completion date December 31, 2024
Est. primary completion date December 31, 2024
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Adults with typical ADPKD diagnosed based on Ravine criteria and/or a documented Pkd 1 or 2 mutation - Chronic kidney disease epidemiology collaboration equation estimated glomerular filtration rate =60 ml/min/1.73m2 - Ability to provide informed consent Exclusion Criteria: - Uncontrolled hypertension, defined as an office blood pressure of =160/ =90 mmHg with or without antihypertensive treatment - Concomitant use of = 3 antihypertensive medications - When antihypertensive treatment is prescribed for any other treatment indication than hypertension (e.g. cardia arrhythmia) - Serum potassium levels >5.5 mmol/L (measured within last 6 months) - History of liver disease (excluding liver cysts due to ADPKD) - History of heart failure (cardiac ejection fraction < 35%) or cardiac arrhythmia - History of diabetes mellitus - Active infection or antibiotic therapy - Immunosuppressive therapy within the last year - Concomitant use of drugs that could influence blood pressure and/or disease progression (Tolvaptan/non-steroidal anti-inflammatory drugs (NSAIDs)/chemotherapy), excluding < 3 antihypertensive drugs - Actual pregnancy or unwillingness to adhere to reproductive precautions during the duration of the study

Study Design


Related Conditions & MeSH terms


Intervention

Dietary Supplement:
Sodium chloride (NaCl)
Sodium chloride capsules 6 grams per day for 4 weeks.
Placebo
Placebo capsules, 6 grams per day for 4 weeks.
Drug:
Amiloride Hcl 5mg Tab
Amiloride 5mg tablets, 20 mg per day for two weeks in open-label setting.

Locations

Country Name City State
Netherlands Erasmus University Medical Centre Rotterdam Rotterdam South-Holland

Sponsors (1)

Lead Sponsor Collaborator
Erasmus Medical Center

Country where clinical trial is conducted

Netherlands, 

Outcome

Type Measure Description Time frame Safety issue
Primary Arterial stiffness induced by high salt diet Difference in central arterial stiffness, measured as the pulse wave velocity (PWV), in high-salt group versus low-salt group. At week 3, week 5
Primary Effect of treatment with amiloride on arterial stiffness in high-salt group Difference in central arterial stiffness, measured as the pulse wave velocity (PWV), before versus after amiloride treatment in high-salt group. At week 5 and at week 7
Primary Effect of treatment with amiloride on arterial stiffness in low-salt group Difference in central arterial stiffness, measured as the pulse wave velocity (PWV), before versus after amiloride treatment in low-salt group. At week 5 and at week 7
Secondary Blood pressure 24-hours ambulatory blood pressure measurement (Mobil-O-Graph). At week 3, week 5 and at at week 7
Secondary Salt tasting thresholds Sodium chloride (NaCl) solutions with different concentrations to assess the salt tasting thresholds. At inclusion, week 3, week 5 and at week 7
Secondary Skin sodium accumulation In a subgroup of participants, tissue sodium concentration (23Na) will be assessed noninvasively using a contrast-free 23 Na-MRI scan. At week 3, week 5 and at week 7
Secondary Markers of (vascular) inflammation and endothelial dysfunction Blood biomaterials will be collected at the visits. We will measure inflammatory markers including the high-sensitivity C-reactive protein, interleukin-6 and tumor necrosis factor-a, and other relevant markers for endothelial dysfunction including the adhesion molecules intercellular cell adhesion molecules-1, vascular cell adhesion molecules-1 and endothelin-1. At inclusion, week 3, week 5 and at week 7
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