DIANA: CPAP Effect on Albuminuria in Patients With Diabetic Nephropathy and Obstructive Sleep Apnea
Study Details
Study Description
Brief Summary
Objectives: Main objective: To assess the effect of 12 months of CPAP treatment added to conventional drug treatment on the albuminuria in patients with diabetic nephropathy and obstructive sleep apnea (OSA). Secondary objectives: To evaluate the effect of CPAP treatment on the estimated glomerular filtration rate of patients with diabetic nephropathy and OSA; determine the additional longterm CPAP effect on glycemic control, insulin resistance, lipid profile, health-related quality of life and biomarkers of cardiac function, inflammation, oxidative stress, sympathetic tone and appetite-regulating hormones in patients with diabetic nephropathy and OSA; and to identify the subgroup of patients with diabetic nephropathy and OSA in which 12 months of treatment with CPAP achieve a more pronounced reduction in albuminuria.
Methodology: Randomized, multicenter, non-blinded, parallel groups, conventional treatment-controlled trial of 12 months of duration.
Subjects will randomize to conventional dietary and pharmacological treatment or conventional dietary and pharmacological treatment plus continuous positive airway pressure (CPAP). Study subjects: Subjects 18 to 80 years with overweight or obesity and a clinical diagnosis of diabetic nephropathy, increased urinary albumin/creatinine ratio of 30 mg/g and an estimated glomerular filtration rate >20 ml/min/1.73 m2, and treatment with stable doses of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) or anti-aldosterone drugs in the last four weeks. Efficacy variables:
urinary albumin/creatinine ratio and estimated glomerular filtration rate; glycosylated hemoglobin (HbA1c); fasting glucose and insulin; homeostatic model assessment (HOMA) and QUICKI indices; total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides; Troponin I, proBNP, homocysteine and high-sensitivity C-reactive protein; systemic biomarkers (inflammation [IL-6, IL-8 and tumor necrosis factor-α], oxidative stress [8-isoprostane], endothelial damage [endothelin, VCAM-1 and ICAM-1], sympathetic activity [neuropeptide Y] and appetite-regulating hormones [leptin and adiponectin]) and clinical questionnaires: short form (SF)-12, EuroQoL and iPAQ.
Condition or Disease | Intervention/Treatment | Phase |
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|
Phase 4 |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: CPAP treatment Diet and conventional pharmacological treatment with angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists or anti-aldosterone agents plus continuous positive airway pressure (CPAP) |
Device: Continuous positive airway pressure
Nocturnal continuous positive airway pressure by a nasal mask. CPAP pressure will be automatically titrated using a AutoSet device (ResMed).
Drug: Pharmacological treatment
Conventional pharmacological treatment with angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists or anti-aldosterone agents.
Other Names:
Other: Diet
Conventional anti-diabetic diet recommendations
|
Active Comparator: Control treatment Diet and conventional pharmacological treatment with angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists or anti-aldosterone agents. |
Drug: Pharmacological treatment
Conventional pharmacological treatment with angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists or anti-aldosterone agents.
Other Names:
Other: Diet
Conventional anti-diabetic diet recommendations
|
Outcome Measures
Primary Outcome Measures
- Change form baseline in albuminuria levels [12 months]
To compare the change in albuminuria levels between the patients allocated to CPAP group and the control group
Secondary Outcome Measures
- Change from baseline in glycated hemoglobin levels [12 months]
To compare the change in glycated hemoglobin levels between the patients allocated to CPAP group and the control group
- Change form baseline in HOMA index [12 months]
To compare the change in HOMA index between the patients allocated to CPAP group and the control group
- Change form baseline in QUICKI index [12 months]
To compare the change in QUICKI index between the patients allocated to CPAP group and the control group
- Change from baseline in cholesterol levels [12 months]
To compare the change in the levels of total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides between the patients allocated to CPAP group and the control group
- Change from baseline in the levels of C-reactive protein [12 months]
To compare the change in the levels of C-reactive protein between the patients allocated to CPAP group and the control group
- Change from baseline in the health-related quality of life assessed by the SF-12 questionnaire [12 months]
To compare the change in the total score and the domains of the questionnaire SF-12 between the CPAP group and the control group
- Change from baseline in the health-related quality of life assessed by the EuroQoL questionnaire [12 months]
To compare the change in the total score and the domains of the questionnaire EuroQoL between the CPAP group and the control group
- Change from baseline in the daily physical activity of patients with diabetic nephropathy and OSA [12 months]
To compare the change in the total score of the International Physical Activity Questionnaire (iPAQ) between the CPAP group and the control group
- Change form baseline in the plasmatic levels of biomarkers of inflammation [12 months]
To compare the change in the plasmatic levels of interleukin (IL)-1beta, IL-6, IL-8 and tumor necrosis factor-alpha between the CPAP group and the control group
- Change form baseline in the plasmatic levels of 8-isoprostane [12 months]
To compare the change in the plasmatic levels of 8-isoprostane between the CPAP group and the control group
- Change form baseline in the plasmatic levels of endothelin [12 months]
To compare the change in the plasmatic levels of endothelin, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) between the CPAP group and the control group
- Change form baseline in the plasmatic levels of appetite-regulating hormones [12 months]
To compare the change in the plasmatic levels of leptin and adiponectin between the CPAP group and the control group
- To identify the CPAP-responder subgroup of OSA patients with diabetic nephropathy [12 months]
To identify the subgroup of OSA patients with diabetic nephropathy in those the CPAP treatment achieve an albuminuria reduction >20% from baseline.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Subjects aged 18 to 80 years old
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Overweight or obesity (BMI ≥25 kg/m2)
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Previous diagnosis of type 2 diabetes, fulfilling at least one of the following criteria: 1) current treatment with oral antidiabetic drugs and/or insulin; 2) a fasting glucose value above 126 mg/dl on at least 2 occasions; 3) blood glucose level at 2 hours after an oral glucose tolerance test is equal to or more than 200 mg/dl; or
- a glycated hemoglobin (HbA1c) level > 6.5 %
- Clinical diagnosis of diabetic nephropathy, with a urinary albumin/creatinine ratio
30 mg/g and an estimated glomerular filtration rate more than 20 ml/min per 1.73 m2.
- Treatment with stable doses of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers or anti-aldosterone agents in the last four weeks.
Exclusion Criteria:
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Non diabetic nephropathy (confirmed by biopsy).
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Dialysis for acute renal failure within the 6 previous months.
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Evidence in the clinic history of relevant bilateral stenosis of renal artery (> 75%)
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Urinary albumin/creatinine ratio higher than 3000 mg/g, at the baseline visit.
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Systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mm Hg at the baseline visit.
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Stroke, transient ischemic attack, acute coronary syndrome, or hospitalization for heart failure worsening, within the previous 30 days.
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Professional drivers, risk profession or respiratory failure.
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Severe daytime sleepiness (Epworth sleepiness scale >18)
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Concomitant treatment with high doses of acetylsalicylic acid (> 500 mg/day) or continuous treatment with non-steroidal anti-inflammatory drugs
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Previous treatment with CPAP
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Participation in another clinical trial within the 30 days prior to randomization.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Hospital Universitari Son Espases | Palma de Mallorca | Islas Baleares | Spain | 07120 |
2 | Hospital Universitario Infanta Sofía | San Sebastián de los Reyes | Madrid | Spain | 28703 |
3 | Hospital Universitario General de Guadalajara | Guadalajara | Spain | 19002 | |
4 | Hosptial Universitario La Paz, IdiPAZ | Madrid | Spain | 28034 | |
5 | Fundación Jiménez Díaz | Madrid | Spain | 28040 | |
6 | Hospital Universitario 12 de Octubre | Madrid | Spain | 28041 |
Sponsors and Collaborators
- Hospital Universitario La Paz
Investigators
- Study Chair: Francisco Garcia-Rio, MD, Hospital Universitario La Paz, IdiPAZ
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- HULP