Clinical Evaluation of Low Sodium Peritoneal Dialysis (PD) Solution on Hypertensive Patients Treated With PD

Fresenius Medical Care Deutschland GmbH140 enrolled

Overview

The aim of this study is to assess the superiority of the new low sodium peritoneal dialysis (PD) solution PDsol 12 in comparison with a conventional, already marketed solution, Gambrosol trio 40, in the treatment of the hypertensive peritoneal dialysis patients with aim to decrease hypertension and to improve the sodium/water balance.

Hypertension as well as sodium and water retention are common in end-stage renal disease patients on peritoneal dialysis and expose patients to left ventricular hypertrophy and increase cardiovascular mortality. Moreover the poor control of dry weight and sodium/water balance results in increased morbidity. A previous low sodium study and computer simulations show that sodium removal can be improved with a low sodium fluid, which allows achieving a negative sodium balance without altering water balance. The aim of this study is to assess whether treatment with one low sodium bag can substitute for one isotonic glucose bag every day in order to reduce the blood pressure and/or medication for hypertension, defined as the primary endpoint. In order to evaluate the main criteria, blood pressure, a 24hours Ambulatory Blood Pressure Monitoring (ABPM) will be performed twice during the study, at Baseline and at 8 weeks of treatment, according to the EMEA guidance recommendations for anti-hypertensive treatments. In addition, the self measurement of blood pressure will be performed by patients at home during three consecutive days before each visit as well as in case of symptoms of hypotension. The study is designed in three periods: * Run-in period during 1 month: a reference product Gambrosol Trio 40, one bag/ day will be used by all patients. This period is dedicated to train the patient in using of study product, to stabilize the patient in the PD treatment and to randomize the patient, by performing the 24h ABPM. * Efficacy \& Safety period during 6 months: each patient will be treated with one of two product : PDsol 12 (studied product) or Gambrosol Trio 40 (reference product) during 6 months. The aim of this period is to evaluate the efficacy and long-term tolerance of new PD fluid. * Follow-up period during 2 months: without treatment. This period is dedicated to ensure the safety of the patients after the study product treatment was stopped and to obtain the information about the reversibility of product effect.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

140

Conditions

Chronic Kidney Failure

Interventions

Solution for Peritoneal DialysisDRUG

Treatment with one bag per day during 6 months

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Chronic renal failure * Stable patients on PD treatment * Treatment at the study site for at least three months * Treated in a CAPD program with a minimum of 3 bag exchanges with 6 or 7 days per week including at least one with duration of 4-6 hours, and at least one low strength bag per day, or in an APD program with at least one daytime exchange with duration of 4-6 hours using one low strength bag * Hypertensive patients with high blood pressure at inclusion visit (Office SBP ≥ 140 and/or DBP ≥ 90 mmHg) or hypertensive patients receiving anti hypertensive medication including diuretics, disregarded blood pressure values * Patients aged 18 years or more * Written consent to participate in the study (informed consent) * Able to use a three-compartment bag * Life expectancy and expected technical survival ≥ 9 months Exclusion Criteria: * Low blood pressure (Office sitting SBP ≤ 120 mmHg and confirmed by ABPM \< or = to 105 mean 24h SBP) * Orthostatic hypotension defined as Systolic OBP with a drop of \> 20mmHg and symptomatic after standing for at least 1 minute * Natremia \< 130 mmol/l, after two consecutive measurements * Chronic arrhythmia * Pregnancy or lactation * Participation in other studies during the study period which may affect the outcome of the present study * Peritonitis within one month prior to the study start * Exit site and /or tunnel infection * Patients unable to tolerate 2 L bag exchanges * Patients on non-compatible PD system

Locations (29)

Rigshospitalet

Copenhagen, Denmark

Outcomes

Primary Outcomes

The primary criterion is the ambulatory 24 h mean systolic blood pressure measurement and drug doses management after 2 months of treatment compared to Baseline.

Time frame: At the beginning and after 8 weeks of treatment

Secondary Outcomes

Measurement of Residual Renal Function

Time frame: At the beginning, at two and six months of treatment

Follow-up of frequency of hyponatremia, of AE and SAE

Time frame: During whole period of the study

Assessment of changes in sodium removal

Time frame: At the beginning and at two months of treatment

Assessment of decrease in total body water (extra and intra cellular water)and of the body weigh changes

Time frame: At the beginning, at two and at six months of treatment

Measurement of 24hours peritoneal clearance

Time frame: At the beginning and at 2 months of treatment

Office systolic and diastolic blood pressure measurement at month 2 and 6 versus T0

Time frame: At the beginning, at two and six months of treatment

Office systolic and diastolic blood pressure measurement during follow up period

Time frame: End of treatment, follow-up period

Data from ClinicalTrials.gov

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