RED DESERT: Alfapump Direct Sodium Removal (DSR) Feasibility Study
Study Details
Study Description
Brief Summary
First in Human feasibility and sfafety study of the alfapump DSR system in the treatment of Heart failure subects resistant to diuretic therapy. Up to 10 subjects will be enrolled in up to 3 centres in Belgium and Georgia and will be iplanted with the alfapump DSR system. Subjects will undergo DSR titration during a 2 week hospitalisation period, and will continue titrated DSR therapy as outpatients for 4 more weeks.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Up to 10 subjects diagnosed with stable chronic heart failure (CHF) on high oral diuretic dose and an MDRD eGFR > 30ml/min/1.73m2 will undergo subcutaneous implantation of the alfapump DSR system (Day-13) and portacath system and participate in a 6 week interventional study. Prior to an inpatient study period, the subject will undergo a 40mg IV furosemide (or 1 mg IV bumetanide) diuretic challenge with timed biospecimen collection. On day 14 post-implant (Day 0), the subject will be admitted for a 14-day period in which diuretics will be withheld and subjects will be on a strict low-sodium (3g/day) diet with strict intake/output and all urine collected and samples saved for analysis. During the first 7 days (Day 0 - 6) subjects will be treated with 1000ml of DSR Infusate Monday, Wednesday, Friday administered to the peritoneal cavity through the subcutaneous peritoneal catheter. The infusate will remain in the peritoneal cavity for a 2 hour dwell time, then all fluid will be removed from the peritoneal cavity to the urinary bladder using the alfapump DSR system over the subsequent 8 hours. On day 7, subjects will be transitioned to a moderate to high salt diet given as the same low-sodium (3g/day) diet with supplementation with sodium chloride tablets (2g/day) (5g/day total sodium), as this will likely represent their typical home sodium intake. During this time, the optimal treatment protocol (frequency of administration and volume of DSR infusate administered) for individual subjects based on daily sodium balance, weight changes, and blood pressure will be created and tested over the next seven days in hospital (Day 7 - 13). Following the inpatient period, a second diuretic challenge will be conducted. Over the subsequent 28 days, diuretics will continue to be withheld with preferential maintenance of euvolemia through DSR and subjects will come into the clinic based on their tailored therapy schedule and undergo supervised DSR infusate administration. Addition of diuretic treatment will only be allowed if maximal DSR therapy has been instituted (DSR 7 days per week (i.e., including weekends) at 1.5L per session with dwell time of 4 hours) and/or holding diuretics until additional DSR can be utilized would represent a risk to the subject, as described in the CIP diuretic algorithm.
After the completion of the study period, the alfapump DSR therapy is halted and the subject undergoes a third diuretic challenge to quantify diuretic response. At this point oral diuretic therapy will be resumed. At the end of the study the alfapump can remain implanted and set to 'dormant' state after discussion and agreement between subject and investigator, and if there are no clinical, ethical or other reasons indicating explanation of the alfapump. Alternatively, the subject may elect to enroll into a low intensity follow-on study.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: DSR Up to 10 subjects will be treated with alfapump DSR system for a total treatment period of 59 days post-implantation |
Device: alfapump DSR system
Infusion of sodium free Dextrose 10% into peritoneal cavity to remove sodium and fluid using principles of peritoneal dialysis, sodium and ultrafiltrate will be evacuated to the bladder by the alfapump
|
Outcome Measures
Primary Outcome Measures
- Safety in-hospital - Device related [Through Day 14 of treatment period]
Rate of device related serious adverse events
- Safety in-hospital - therapy related [Through Day 14 of treatment period]
Rate of therapy related serious adverse events
- Safety in-hospital - procedure related [Through Day 14 of treatment period]
Rate of procedure related serious adverse events
- Safety during treatment period - device related [through Day 42 of treatment period]
Rate of device related serious adverse events
- Safety during treatment period - procedure related [through Day 42 of treatment period]
Rate of procedure serious adverse events
- Safety during treatment period - therapy related [through Day 42 of treatment period]
Rate of therapy related serious adverse events
Secondary Outcome Measures
- Feasibiity endpoint sodium balance in-hospital [through Day 14 of DSR therapy]
Number of patients with neutral sodium balance (sodium intake equal to sodium output) in the absence of diuretic therapy during hospitalization period
- Feasibility endpoint sodium balance during treatment period [Through Day 42 of DSR Therapy]
Number of patients with neutral sodium balance (sodium intake equal to sodium output) in the absence of diuretic therapy in a titrated schedule during treatment period
Other Outcome Measures
- Bioimpedance [At baseline, day 7, 14, and 42]
Change in bioimpedance from baseline through treatment
- Hemoconcentration markers [At baseline, day 7, 14, and 42]
Change in hemoglobin versus hematocrit ratio from baseline through treatment
- N-Terminal Prohormone of Brain Natriuretic Peptide (nt-ProBNP) [At baseline, day 7, 14, and 42]
Change in nt-proBNP from basline through treatment
- Weight [At baseline, day 7, 14, and 42]
Change in Weight from baseline through treatment
- Glycolated Hemoglobine (HbA1c) [At baseline, day 7, 14, and 42]
Changes in HBA1c from baseline through treatment
- Sodium balance [Up to day 42]
Daily sodium balance
- Fluid balance [Up to day 42]
Daily fluid balance
- 6-hour diuretic response [At baseline, day 14, day 42]
Change in response to 6 hour diuretic challenge from baseline through treatment
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Subjects > 18 years of age
-
eGFR > 30ml/min/14.73m2
-
Diagnosis of heart failure with one of the following: a. nt-proBNP > 400 pg/ml (or BNP
100 pg/mp) and oral diuretic dose ≥ 80mg furosemide (or 20mg torsemide or 1mg bumetanide) OR b. Oral diuretic dose ≥ 120mg furosemide (or 30 mg torsemide or 1.5 mg bumetanide)
-
Stable diuretic dose for 30 days
-
Systolic blood pressure ≥ 100 mmHg
-
Determined by treating provider to be at optimal volume status
Exclusion Criteria:
Candidates for participation will be ineligible for the study if any of the following exclusion criteria apply:
-
Proteinuria > 1g/day
-
BMI > 40
-
History of abdominal surgery or peritonitis
-
Anemia with hemoglobin < 8g/dL
-
Serum sodium < 135 mEq/L
-
Severe hyperkalemia or baseline plasma potassium > 4.5 mEq/L
-
Significant other organ disease or comorbidities
-
Hospitalization within 90 days
-
Cirrhosis
-
Hemodynamically significant stenotic valvular disease
-
Active or recurrent urinary tract infection or history of renal transplant
-
History of significant bladder dysfunction expected to interfere with ability of subject to tolerate DSR pumping into bladder
-
Uncontrolled diabetes with frequent hyperglycemia or Type 1 diabetes
-
Subject is currently participating in another clinical trial
-
Subject is unable to comply with all required study follow-up procedures
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | OLV Ziekenhuis | Aalst | Belgium | 9300 | |
| 2 | Tbilisi Heart & Vascular Clinic | Tbilisi | Georgia |
Sponsors and Collaborators
- Sequana Medical N.V.
- Yale University
Investigators
- Principal Investigator: Jozef Bartunek, MD, Onze Lieve Vrouw Hospital Aalst, Belgium
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 2019-CHF-005