QUICK: Queen's University Investigation of Calcification in Chronic Kidney Disease

Sponsor

Queen's University (Other)

Overall Status

Completed

CT.gov ID

NCT00687661

Collaborator

(none)

Enrollment

Location

Arms

Duration (Months)

0.4

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Kidney disease is a fundamental part of medicine because of its prominence in Western society. Common conditions such as diabetes, hypertension and kidney infections can all progress to End-Stage Renal Disease (ESRD) also known as Stage 5 chronic kidney disease (CKD 5). Once ESRD has begun, kidney function is poor at best, thus the body is unable to effectively clear harmful toxins from the blood.

A common feature of ESRD is vascular calcification, a process where blood vessels (especially arteries) attract deposits of the mineral calcium. Over time, these deposits harden and thicken in the layers of blood vessels, which limit blood flow to body tissues and can produce significant disease including hypertension, heart disease and stroke. Although the process of vascular calcification is unknown, there is mounting evidence that it is mediated by cellular events that are similar to those seen in bone formation with in the body (osteogenesis). With this point in mind, it has been suggested that agents medicine employs to limit excess bone formation will reduce the rate of vascular calcification in CKD Stage 5.

This study will employ one group of drugs called bisphosphonates which have been used to limit bone formation. It will study their effect on vascular calcification in adult dialysis patients.

Condition or Disease	Intervention/Treatment	Phase
Chronic Kidney Disease	Drug: Bisphosphonate Drug: Placebo	Phase 3

Detailed Description

Presently, there exist few therapies aimed at retarding the progression of vascular calcification. One study showed that agents that limit the absorption of phosphate from food (phosphate binders) slow the progression of vascular calcification, and as a result, treatments emphasize phosphate control through diet and phosphate binders. Other studies have shown that the use of statins, to lower LDL cholesterol levels may reduce the progression of coronary calcification in non-ESRD patients, but data from ESRD are lacking. While these treatments have been helpful, the improvements in patients' outcomes have not been overwhelming positive.

This proposed study is not the first to study the use of bisphosphonates on vascular calcification. Repeated studies have shown impressive reduction in calcification rates in several animal models, which begs the question, how will bisphosphonates fare in human subjects? Preliminary research has begun, but clearly an expansive trial on humans is needed to explore the use of a promising therapy. Our study hopes to provide insight into this area of cardiovascular research.

Study Design

Study Type:

Interventional

Actual Enrollment :

25 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Double (Participant, Care Provider)

Primary Purpose:

Treatment

Official Title:

The Use of Bisphosphonates to Prevent or Delay the Progression of Vascular Calcification in End-Stage Renal Disease: A Randomized Controlled Trial

Study Start Date :

Oct 1, 2008

Actual Primary Completion Date :

Jun 1, 2013

Actual Study Completion Date :

Jun 1, 2013

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: 1 Arm #1 will include patients randomized to receive bisphosphonate therapy for 24 months.	Drug: Bisphosphonate 35mg given orally once weekly for 24 months Other Names: Residronate
Placebo Comparator: 2 Arm #2 will include patients randomized to receive placebo therapy for 24 months	Drug: Placebo identical placebo pill once weekly for 24 months

Arm

Intervention/Treatment

Active Comparator: 1

Arm #1 will include patients randomized to receive bisphosphonate therapy for 24 months.

Drug: Bisphosphonate

35mg given orally once weekly for 24 months

Other Names:

Residronate

Placebo Comparator: 2

Arm #2 will include patients randomized to receive placebo therapy for 24 months

Drug: Placebo

identical placebo pill once weekly for 24 months

Outcome Measures

Primary Outcome Measures

Absolute change in coronary artery calcification score (CaSc) from baseline to study completion. [24 months]

Secondary Outcome Measures

Change in bone density score (wrist/hip) as calculated by Ct scanning method, # fractures, MI, Stroke, amputation/surgery for peripheral revascularization. [24 months]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

18 years of age
receiving maintenance renal replacement therapy for less than 12 months
incident patients starting renal replacement therapy for the first time

Exclusion Criteria:

active vasculitis
severe hypocalcemia
previous adverse side effect to bisphosphonate use
current use of corticosteroids
weight greater than 300 pounds
pregnancy
not expected to survive greater than one year
expected to discontinue renal replacement therapy during the study period or recover renal function
evidence of adynamic bone disease
current bisphosphonate use