This is a randomized, placebo-controlled, double-blinded crossover trial testing the effects of amiloride in patients with chronic kidney disease (CKD) and proteinuria. In CKD with proteinuria, there is aberrant filtration of serine proteases and complement precursors into the tubular lumen. The interaction of these factors leads to proinflammatory complement activation, which may promote inflammation, opsonization, and formation of the membrane-attack complex, causing cell injury. With the aim of preserving kidney function, reducing cardiovascular morbidity, and delaying renal replacement therapy in CKD, this study tests whether amiloride (10 mg/day) protects the filtration barrier, lowers albuminuria, and mitigates kidney inflammation through urokinase inhibition, independent of blood pressure effects. Participants are randomized to receive amiloride (10 mg/day) or placebo for one week, with a 2-3-week washout period in between. Blood and urine samples are collected before and after each treatment period. Additionally, ECG, body composition measurements, blood pressure, and body weight are monitored. The primary outcome measures are urinary C3a, soluble C5-9 (sTCC/MAC), and kidney injury biomarkers KIM-1 and NGAL. Secondary endpoints include the urinary albumin/creatinine ratio, protein/creatinine ratio, and blood pressure.
Please refer to the protocol
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
40
Department of Nephrology, Odense University Hospital
Odense, Denmark
RECRUITINGUrine-C3a (ng/ml)
Urine-C3a is measured in spot urine samples and expressed as u-C3a/creatinine (µg/g) to account for the dilution factor.
Time frame: Measured before (day one) and after (day 8) each treatment period
Urine C5-9-sTCC/MAC (U/ml)
Membrane Attack Complex (MAC) of the complement system, specifically targeting the C5 to C9 proteins. u-C5-9 is measured in spot urine samples and expressed as u-C5-9/creatinine U/µmol to account for the dilution factor.
Time frame: Measured before (day one) and after (day 8) each treatment period
Kidney Injury Molecule-1 (KIM-1) pg/ml
KIM-1 is a protein that serves as a biomarker used particularly in the context of kidney injury
Time frame: Measured before (day one) and after (day 8) each treatment period
Neutrophil Gelatinase-Associated Lipocalin (NGAL) (pg/mL)
NGAL is a protein associated with neutrophils used as a biomarker in the context of kidney injury.
Time frame: Measured before and after each treatment period
Urine albumin/creatinin ratio (mg/g)
In spot urine samples, albumin and creatinin are measured
Time frame: Measured before (day one) and after (day 8) each treatment period
Urine protein/creatinin ratio
In spot urine samples, albumin and creatinin are measured
Time frame: Measured before (day one) and after (day 8) each treatment period
Home blood pressure (mmHg)
Home blood pressure are measured according to standard guidelines
Time frame: Measured before (day one) and after (day 8) each treatment period
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