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Chronic Kidney Disease.Phase 3PENNYNCT01680198

Paricalcitol and Endothelial Function in Chronic Kidney Disease Patients (the PENNY Study)

A Phase 3 study testing Paracalcitol in people with Chronic Kidney Disease., run by Fondazione C.N.R./Regione Toscana "G. Monasterio", Pisa, Italy at 1 site in Italy.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The primary aim of this study was to test the hypothesis that Paricalcitol, an active form of vitamin D, improved endothelial function in stage 3-4 chronic kidney disease (CKD) patients. Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Chronic Kidney Disease.
What is being tested?
Paracalcitol
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
88 participants
Where
1 siteItaly
Study dates
Jun 2011to Aug 2012
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients with iPTH level > 65 pg/ml; Ca between 8.4- 10.00 mg/dL and P between 2.9-4.5
  • Negative serum pregnancy test for female subjects of childbering potential.
  • Informed consent.

Who cannot join

  • Use vitamin D supplements.
  • Altered liver function tests (bilirubin, aminotransferases and total alkaline phosphatase > 3 times the upper limit of normal ranges).
  • Sympthomatic cardiovascular disease on the basis of clinical history. Cancer.

Trial locations and contacts

1 site in 1 country.

Italy1 site
  • Nephrology, Dialysis and Transplantation Unit

    Reggio Calabria, Reggio Calabria, 89124

Other trials in Italy

About this study

Official title: Effect of Paricalcitol on Endothelial Function in Chronic Kidney Disease (CKD) Patients (the PENNY Study)

The primary aim of this study was to test the hypothesis that Paricalcitol, an active form of vitamin D, improved endothelial function in stage 3-4 chronic kidney disease (CKD) patients. A secondary aim of this trial was to study the relationship between endothelial function and plasma/serum and genetic biomarkers of bone mineral disorders in CKD (BMD-CKD) and renin angiotensin-aldosteron system (RAS) (angiotensin II and plasma renin activity).

Read the detailed description

Primary objective: Test the hypothesis that Paricalcitol, an active form of vitamin D improves endothelial function in stage 3-4 chronic kidney disease (CKD) patients.

Secondary analysis: Study the relationship between endothelial function and plasma/serum and genetic biomarkers of bone mineral disorders in CKD (BMD-CKD) and renin angiotensin-aldosteron system (RAS) (angiotensin II and plasma renin activity).

Background:

Endothelial function is altered in patients with CKD. Factors responsible for disturbed endothelium-dependent vasodilatation in CKD include reduced bioactivity of the nitric oxide (NO) pathway with decreased endothelial NO synthase (NOS) activity or inhibition via accumulation of endogenous inhibitors. In patients with CKD and in those on dialysis serum 25(OH)D3 and 1,25(OH)2D3 levels are associated with FMD. Vitamin D receptors and 1 -hydroxylase activity are present in endothelial and vascular smooth muscle cells and 1,25(OH)2D3 stimulates vascular endothelial growth factor and prostacyclin production by vascular smooth muscle cells. These biological observations may have clinical implications because paricalcitol treatment predicts longer survival in ESRD patients and very recent data link vitamin D to progression to ESRD in patients with stage 3-5 CKD. Furthermore, a previous study by us has shown that the BMSI polymorphism of the vitamin D receptor gene is associated with LVH and LVH progression in ESRD patients.

Study population: Patients with stage 3-4 CKD of both sexes in the age range 18-80 years. Patients taking vitamin D supplements, with abnormal liver function tests, symptomatic cardiovascular disease, diabetes or cancer and those whose medications changed during the study were excluded.

Design and Methods: The study was a double-blind, randomized, parallel groups trial. After baseline measurements, patients with iPTH level > 65 pg/ml; Ca between 8.4- 10.00 mg/dL and P between 2.9-4.5 were randomized to receive 2 micrograms Paricalcitol capsules (or matching placebo) daily, for 12 weeks. This doses was adjusted based on clinical laboratory parameters and the maximum dose was 2 micrograms daily.

During the study if a subject experienced over suppression of serum iPTH (defined as a serum iPTH <15 pg/mL), or hypercalcemia (defined as Ca > 11.0 mg/dL), the subject continued to take study drug at reduced dosage 1 mcg any other day and returned in 2 weeks for an unscheduled visit. If the values from the unscheduled visit serum iPTH and/or Ca did not returned to > 15 pg/mL and/or <11.0 mg/dL, respectively, the drug was discontinued.

Flow mediated vasodilatation was measured according to a validated protocol developed at the coordinating center of a national (Italian)working group of vascular function testing.

Primary end-point: Change in Flow Mediated Dilatation (FMD) induced by Paricalcitol in comparison to Placebo.

Study power: To detect a 2% difference (standard deviation: ± 3.0%) in the change in FMD between Paracalcitol treated and untreated patients with a power of 80 %, a confidence level using a two-tailed test of 5% and a potential attrition rate of 15%, at least 44 patients per group were required (88 patients in total).

Statistical analysis: Data will be summarized as mean ± standard deviation (normally distributed data), median and inter-quartile range (non normally distributed data) or as percent frequency, and comparison between groups will be made by independent T-Test, Mann-Whitney Test, or Chi Square test, as appropriate. Within patients comparisons will be done by statistical tests for paired observations. Data analysis of the primary outcome will be performed by comparing the changes in FMD in Paracalcitol treated and untreated patients by using the T-Test for independent observations. Possible differences in risk factors at baseline not controlled by randomization (i.e. differences due to chance) will be accounted for by using multivariate regression analyses.

Being tested
Paracalcitol, placebo
Keywords
Vitamin D, Paracalcitol, Chronic kidney disease, Endothelial dysfunction, Flow mediated vasodilation
Medical subject headings
Renal Insufficiency, Chronic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ParacalcitolDrug

    Also called Active form of Vitamin D.

    Patients in the experimental arm received 2 micrograms Paricalcitol capsules daily, for 12 weeks. This dose was adjusted based on clinical laboratory parameters and the maximum dose was 2 micrograms daily.

  • placeboDrug

Study groups in NCT01680198
Study groupRoleWhat they receive
PlaceboPlacebo comparatorPlacebo capsules daily for 12 weeks.
Receives: Drug: placebo
ParacalcitolExperimentalsee "Intervention description" for details.
Receives: Drug: Paracalcitol

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Endothelial function measurement

    Endothelial-dependent and independent vasodilation was assessed by a Toshiba Nemia XG Echo-Doppler applying a 7.5 MHz transducer that was fixed by an adjustable stereotactic clamp to warrant image stability. After baseline recording (1 min) a standard sphygmomanometer was placed on the right forearm 2 cm below the elbow and the cuff was inflated to 250 mmHg for 5 min. Recordings were performed during the 4 min following cuff deflation to estimate endothelium-dependent FMD. In studies of endothelium-independent vasodilatation recording times were 1 min for the baseline assessment and 5 min for changes in arterial diameter brought about by GTN. An interval of at least 1h was set between the last FMD assessment and GTN administration. All scans were recorded, stored and analyzed off-line. FMD and GTN were computed as the maximal % increase in diameter over baseline by an automatic edge detection system.

    Measured: 12 weeks from baseline

Secondary outcomes (1)
  1. Endothelial function and plasma/serum and genetic biomarkers of bone mineral disorders in CKD (BMD-CKD) and renin angiotensin-aldosteron system (RAS).

    The investigators will analyze the relationship between endothelial function and plasma/serum and genetic biomarkers of bone mineral disorders in CKD (BMD-CKD) and renin angiotensin-aldosteron system (RAS) (angiotensin II and plasma renin activity).

    Measured: 12 weeks from baseline

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Sep 2012 (estimated)
  2. Study startJun 2011
  3. Primary completionAug 2012
  4. Study completionAug 2012

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Investigator, Outcomes assessor
Enrolment
88 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01680198
Sponsor's protocol ID
Oct2010PENNYStudy
Acronym
PENNY
Status last verified
Oct 2012
First submitted
30 Aug 2012
Last updated
2 Oct 2012
Results posted
No
Data monitoring committee
Yes

Publications

  • Yilmaz MI, Sonmez A, Saglam M, Yaman H, Kilic S, Demirkaya E, Eyileten T, Caglar K, Oguz Y, Vural A, Yenicesu M, Zoccali C. FGF-23 and vascular dysfunction in patients with stage 3 and 4 chronic kidney disease. Kidney Int. 2010 Oct;78(7):679-85. doi: 10.1038/ki.2010.194. Epub 2010 Jul 7.

    PubMed 20613714
  • London GM, Guerin AP, Verbeke FH, Pannier B, Boutouyrie P, Marchais SJ, Metivier F. Mineral metabolism and arterial functions in end-stage renal disease: potential role of 25-hydroxyvitamin D deficiency. J Am Soc Nephrol. 2007 Feb;18(2):613-20. doi: 10.1681/ASN.2006060573. Epub 2007 Jan 3.

    PubMed 17202417
  • Yamamoto T, Kozawa O, Tanabe K, Akamatsu S, Matsuno H, Dohi S, Hirose H, Uematsu T. 1,25-dihydroxyvitamin D3 stimulates vascular endothelial growth factor release in aortic smooth muscle cells: role of p38 mitogen-activated protein kinase. Arch Biochem Biophys. 2002 Feb 1;398(1):1-6. doi: 10.1006/abbi.2001.2632.

    PubMed 11811942
  • Wakasugi M, Noguchi T, Inoue M, Kazama Y, Tawata M, Kanemaru Y, Onaya T. Vitamin D3 stimulates the production of prostacyclin by vascular smooth muscle cells. Prostaglandins. 1991 Aug;42(2):127-36. doi: 10.1016/0090-6980(91)90072-n.

    PubMed 1775635
  • Teng M, Wolf M, Ofsthun MN, Lazarus JM, Hernan MA, Camargo CA Jr, Thadhani R. Activated injectable vitamin D and hemodialysis survival: a historical cohort study. J Am Soc Nephrol. 2005 Apr;16(4):1115-25. doi: 10.1681/ASN.2004070573. Epub 2005 Feb 23.

    PubMed 15728786
  • Teng M, Wolf M, Lowrie E, Ofsthun N, Lazarus JM, Thadhani R. Survival of patients undergoing hemodialysis with paricalcitol or calcitriol therapy. N Engl J Med. 2003 Jul 31;349(5):446-56. doi: 10.1056/NEJMoa022536.

    PubMed 12890843
  • Ravani P, Malberti F, Tripepi G, Pecchini P, Cutrupi S, Pizzini P, Mallamaci F, Zoccali C. Vitamin D levels and patient outcome in chronic kidney disease. Kidney Int. 2009 Jan;75(1):88-95. doi: 10.1038/ki.2008.501. Epub 2008 Oct 8.

    PubMed 18843258
  • Testa A, Mallamaci F, Benedetto FA, Pisano A, Tripepi G, Malatino L, Thadhani R, Zoccali C. Vitamin D receptor (VDR) gene polymorphism is associated with left ventricular (LV) mass and predicts left ventricular hypertrophy (LVH) progression in end-stage renal disease (ESRD) patients. J Bone Miner Res. 2010 Feb;25(2):313-9. doi: 10.1359/jbmr.090717.

    PubMed 20422622
  • Ghiadoni L, Faita F, Salvetti M, Cordiano C, Biggi A, Puato M, Di Monaco A, De Siati L, Volpe M, Ambrosio G, Gemignani V, Muiesan ML, Taddei S, Lanza GA, Cosentino F. Assessment of flow-mediated dilation reproducibility: a nationwide multicenter study. J Hypertens. 2012 Jul;30(7):1399-405. doi: 10.1097/HJH.0b013e328353f222.

    PubMed 22525207
  • D'arrigo G, Pizzini P, Cutrupi S, Tripepi R, Tripepi G, Mallamaci F, Zoccali C. Vitamin D receptor activation raises soluble thrombomodulin levels in chronic kidney disease patients: a double blind, randomized trial. Nephrol Dial Transplant. 2019 May 1;34(5):819-824. doi: 10.1093/ndt/gfy085.

    PubMed 29668990
  • Torino C, Pizzini P, Cutrupi S, Tripepi R, Vilasi A, Tripepi G, Mallamaci F, Zoccali C. Effect of Vitamin D Receptor Activation on the AGE/RAGE System and Myeloperoxidase in Chronic Kidney Disease Patients. Oxid Med Cell Longev. 2017;2017:2801324. doi: 10.1155/2017/2801324. Epub 2017 Dec 6.

    PubMed 29362665
  • Spoto B, Pizzini P, Tripepi G, Mallamaci F, Zoccali C. Circulating adiponectin modifies the FGF23 response to vitamin D receptor activation: a post hoc analysis of a double-blind, randomized clinical trial. Nephrol Dial Transplant. 2018 Oct 1;33(10):1764-1769. doi: 10.1093/ndt/gfx344.

    PubMed 29304245
  • Zoccali C, Curatola G, Panuccio V, Tripepi R, Pizzini P, Versace M, Bolignano D, Cutrupi S, Politi R, Tripepi G, Ghiadoni L, Thadhani R, Mallamaci F. Paricalcitol and endothelial function in chronic kidney disease trial. Hypertension. 2014 Nov;64(5):1005-11. doi: 10.1161/HYPERTENSIONAHA.114.03748. Epub 2014 Aug 4.

    PubMed 25259743

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Paracalcitol in people with Chronic Kidney Disease., run by Fondazione C.N.R./Regione Toscana "G. Monasterio", Pisa, Italy at 1 site in Italy.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 2 Oct 2012. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Endothelial function measurement (time frame: 12 weeks from baseline). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01680198, which also lists 13 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Oct 2012.

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