This study evaluates RMC-035 compared to placebo for the prevention of acute kidney injury (AKI) in subjects who are at high risk for AKI following cardiac surgery. Half of the subjects will receive RMC-035 and the other half will receive placebo.
This is a Phase 2, randomized, double-blind, adaptive, parallel group clinical study that will evaluate RMC-035 compared to placebo in subjects at high risk for acute kidney injury (AKI) following cardiac surgery. Subjects are randomized in a 1:1 ratio.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
177
Percentage of Subjects Developing AKI, as Defined Per Kidney Disease Improving Global Outcomes (KDIGO) Criteria
Percentage of subjects developing AKI based on Serum Creatinine and/or Urine Output per KDIGO definition
Time frame: 72 hours
Area Under the Curve (AUC) of Serum Creatinine (SCr)
Time-corrected area under the curve (AUC) of serum creatinine calculated as follows: The area under the SCr concentration versus time curve following drug administration were calculated using timepoints at Day 1 (12 hour), Day 2 (24 hour), Day 3 (48 hour) and Day 4 (72 hour). The individual log-transformed SCr values were determined, and the AUC (utilizing planned times) were calculated using the right Riemann sum: AUC = 0.5 x SCr(12h) + 0.5 x SCr(24h) + 1 x SCr(48h) + 1 x SCr(72h) The time-corrected AUC (log-scale) was then calculated as AUC/3
Time frame: 72 hours
Duration of AKI
Duration of AKI defined as the number of days meeting the definition of AKI (KDIGO definition) starting within 72 hours after first dose of IMP until resolution
Time frame: 90 days
Change in SCr Values Over Time
SCr at 12, 24, 48, and 72 hours, respectively, and at Day 7/discharge, Day 30 and Day 90
Time frame: 90 days
Peak Cystatin C Value
Change from baseline of peak cystatin C from baseline to Day 7
Time frame: 7 days
AUC of Cystatin C
Time-corrected AUC of cystatin C for Day 1 to Day 4 (72 hours after first dose of IMP) calculated as follows: The area under the cystatin C concentration versus time curve following drug administration were calculated using timepoints at Day 1 (12 hour), Day 2 (24 hour), Day 3 (48 hour) and Day 4 (72 hour). The individual log-transformed cystatin C values were determined, and the AUC (utilizing planned times) were calculated using the right Riemann sum: AUC = 0.5 x cystatin C(12h) + 0.5 x cystatin C(24h) + 1 x cystatin C(48h) + 1 x cystatin C(72h) The time-corrected AUC (log-scale) was then calculated as AUC/3
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Indiana Ohio Heart
Fort Wayne, Indiana, United States
Bryan Heart
Lincoln, Nebraska, United States
Rochester Regional Health - Rochester General Hospital
Rochester, New York, United States
Duke University Hospital
Durham, North Carolina, United States
Baylor Scott and White Research Institute - Dallas
Dallas, Texas, United States
University of Virginia (UVA) Health - University Hospital
Charlottesville, Virginia, United States
University of Wisconsin
Madison, Wisconsin, United States
Aurora Health Care - Aurora St. Luke's Medical Center
Milwaukee, Wisconsin, United States
Hamilton Health Sciences
Hamilton, Canada
CHUM
Montreal, Canada
...and 19 more locations
Time frame: 72 hours
Number of Participants Requiring Renal Replacement Therapy (Dialysis)
Renal replacement therapy (dialysis treatment) required by any participant for any reason
Time frame: 7 days
Number of Days Without Need for Dialysis
Number of days that participants were not requiring dialysis
Time frame: 90 days
Major Adverse Kidney Event (MAKE) - SCr
MAKE at Day 30 and Day 90, defined as death, any dialysis, or ≥25% reduction of eGFR compared to baseline. eGFR calculated based on Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation using SCr.
Time frame: 90 days
AKI Within 72 Hours Based on Cystatin C and UO
AKI based on cystatin C and/or urine output (UO)
Time frame: 72 hours
AKI Within 7 Days
AKI based on SCr and/or UO criteria, or cystatin C and/or UO criteria
Time frame: 7 days
Persistence of AKI
AKI persistence, defined as an AKI (KDIGO definition) developing within 72 hours after first dose of IMP and with a duration of ≥72 hours
Time frame: 7 days
Severity of AKI
AKI severity stage 1, 2 or 3 per KDIGO criteria, with 1 being mildest stage and 3 being most severe stage. Reference: KDIGO (2012). "Clinical Practice Guideline for Acute Kidney Injury." JOURNAL OF THE INTERNATIONAL SOCIETY OF NEPHROLOGY 2(1).
Time frame: 7 days
Change in Urine Albumin to Creatinine Ratio (UACR) and Urine Protein to Creatinine Ratio (UPCR)
Post-baseline changes in UACR and UPCR at Day 4, Day 30, and Day 90
Time frame: 90 days
Pharmacokinetics of RMC-035 (AUC)
AUC(0-24) of RMC-035 concentrations in plasma (Day 3)
Time frame: 4 days
Pharmacokinetics of RMC-035 (Cmax)
Cmax of RMC-035 concentrations in plasma Day 3
Time frame: 7 days
Presence of Anti-drug Antibodies (ADA)
Presence of ADA at Day 1 (pre-surgery), Day 30, and Day 90; positive samples
Time frame: 90 days
Characteristics of ADA (Cross-reactivity)
Characteristics of ADA developed at Day 30 and Day 90 with regards cross-reactivity with endogenous alpha-1-microglobulin (A1M)
Time frame: 90 days
Peak SCr Value
Change from baseline of peak SCr from baseline to Day 7
Time frame: 7 days
Major Adverse Kidney Event (MAKE) - Cystatin C
MAKE at Day 30 and Day 90, defined as death, any dialysis, or ≥25% reduction of eGFR compared to baseline. eGFR calculated based on Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation using Cystatin C.
Time frame: 90 days
Major Adverse Kidney Event (MAKE) - SCr and Cystatin C
MAKE at Day 30 and Day 90, defined as death, any dialysis, or ≥25% reduction of eGFR compared to baseline. eGFR calculated based on Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation using SCr and Cystatin C.
Time frame: 90 days
Change in Serum Cystatin C Values Over Time
Cystatin C measurement in serum at 12, 24, 48, and 72 hours, respectively, and at Day 7/discharge, Day 30 and Day 90
Time frame: 90 days