Cardio-renal SyndromeUF-CARENCT02846337
Ultrafiltration Versus Medical Therapies in the Management of the Cardio Renal Syndrome
A study testing ULTRAFILTRATION and ENHANCED MEDICAL TREATMENT in people with Cardio-renal Syndrome, run by Hospices Civils de Lyon at 1 site in France.
Trial summary
Type 2 cardio renal syndrome is defined by the occurrence or the exacerbation of a kidney failure induced by a chronic heart failure. Sodium overload is one of the main causes leading to the occurrence or the exacerbation of this syndrome. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Cardio-renal Syndrome
- What is being tested?
- ULTRAFILTRATION and ENHANCED MEDICAL TREATMENT
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 108 participants
- Where
- 1 siteFrance
- Study dates
- 31 Mar 2017to 28 Oct 2021
- Phase
- Interventional
- 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 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Severe heart failure with recurring congestive symptoms and at least one the following criteria :
- At least 2 hospitalization > 24 hours for congestive symptoms among the 12 months before the inclusion, whose latest one was in the 6 months before the inclusion
- Persistent congestive symptoms throughout 30 days (case history) before the randomization: dyspnea NYHA III or IV, lower limbs edema and/or ascites.
- Diuretic treatment with at least 250mg furosemide per day (or 6mg bumetanide)during at least 1 month
- Cardiac medical treatment enhanced by the European cardiology society guidance (except intolerance, and/or contraindication) and according to patient cardiologist.
- Non terminal kidney disease or failure : estimated glomerular filtration rate (GFR) (CKD-Epi formula) between 20 and 90 mL/min/1.73m² (or GFR estimated between 60 and 90 mL/min/1.73m² with proteinuria and/or hematuria) and urea rate under 50mmol/L
Who cannot join
- Cardiogenic shock or situations that contraindicate the ultrafiltration technique elsewhere than shock room
- Patient who already had long course ultrafiltration for more than 3 months, or not available because of end-stage renal failure
- Biventricular pacemaker implementation, single or dual chamber pacemaker implementation, or defibrillator implementation up to 15 days before the inclusion
- Vasoactive drugs ambulatory treatment (dobutamine, dopamine, adrenalin, noradrenalin)
- General condition incompatible with any ultrafiltration techniques
- Age under 18
Show all 11Show fewer
- Pregnant or lactating women
- Law-protected patients
- Patients that can't submit to the follow-up for geographical, social or mental reasons
- Unwillingness to be treated by ultrafiltration techniques
- Patients who don't belong to the national social security system, or similar system.
Trial locations and contacts
1 site in 1 country.
France1 site
Hospices Civils de Lyon, Hôpital E Herriot, Service de néphrologie, 5 place d'Arsonval
Lyon, Rhones Alpes, 69003
About this study
Type 2 cardio renal syndrome is defined by the occurrence or the exacerbation of a kidney failure induced by a chronic heart failure. Sodium overload is one of the main causes leading to the occurrence or the exacerbation of this syndrome. Some patients have a massive sodium retention on which medications are not effective enough. These patients have no further therapeutic options because of the refractory congestion and a 3-months mortality rate around 15%, frequent rehospitalization (3-months rehospitalization rate at 71%) and an excessively impaired quality of life.
For those refractory heart failure with cardio renal syndrome, nephrology departments resort to non-medication sodium extraction (hemodialysis, peritoneal dialysis, isolated ultrafiltration). Between 2002 and 2008, 927 French patients would have start dialysis in this situation. In 2013, 174 patients start dialysis in 97 dialysis centers. French National Authority of Health recently published new Good Practice Guidance thereupon, strengthened by the increasing number of publications and the widespread use of this technique. There is therefore a consensus among professionals about the benefits of such a technique in those indications. However, bibliographical data are not strong enough to support a strong level of evidence. None of foresight strategies have been compared to others in a proper randomized controlled trial, and there is no clue about any suspected superiority from one strategy to another.
Read more
So far, the investigators propound invasive, expensive and not validated techniques to patients with functional and vital prognosis altered. The investigators think it's essential to prove the efficacy of such an approach. They wish to quantify those techniques impact on rehospitalization, with a consideration for the potential survival impact.
It seems unethical to evaluate separated techniques, taking in account that patients with severe heart failure will switch from one technique to another among their care. It is therefore crucial to validate benefits from an invasive procedure (hemodialysis, peritoneal dialysis, isolated ultrafiltration) compared to a medication-restricted care.
- Conditions
- Cardio-renal Syndrome
- Being tested
- ULTRAFILTRATION, ENHANCED MEDICAL TREATMENT
- Keywords
- cardio-renal syndrome, hemodialysis, peritoneal dialysis, hemofiltration, composite endpoint
- Medical subject headings
- Cardio-Renal Syndrome
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
ULTRAFILTRATIONProcedure or surgery
Peritoneal dialysis: at least one daily contact, 5 days a week minimum, with a hypertonic solution. Le number of contact et the stasis duration will be decided by the practitioner.
Hemodialysis: at least one hemodialysis per week, one hemofiltration and/or hemodiafiltration per week, and at least 2 liter of ultrafiltrate extraction per week. In case of serious interdialytic weight gain, and/or hemodynamic unsteadiness, sessions can be up to 6 per weeks. Sessions duration will be adjusted to the needful ultrafiltrate and hemodynamic tolerance.
Isolated ultrafiltration: at least once a week, and includes an extraction of minimum 2 liter ultrafiltrate in less than 4 hours. It could be done, according to routines and department capacity, on a hemodialysis generator, plasmatic exchange generator, or mobile ultrafiltration device.
ENHANCED MEDICAL TREATMENTProcedure or surgery
- Close cardiologic and nephrologic follow-up, minimum 4 times a year, This incidence matches the heart failure, and chronic kidney failure care guidance for our sample
- Medical care adjustment in order to apply European and American guidance for chronic heart failure care
- Hydric, caloric, peptic and sodium input evaluation by a dietician, and adjustment if needed
- Physical rehabilitation suggestions by a physiologist
- Evaluation of an interventional approach requirement, and implementation if needed (pacemaker, defibrillator, cardiac resynchronization, diagnosis and therapeutic coronary angiography, ventricular stimulator) according to European and American guidance.
| Study group | Role | What they receive |
|---|---|---|
| ULTRAFILTRATION | Experimental | The ultrafiltration sodium-overload extraction will be chosen by the patient nephrologist and the patient himself (according to his comorbidities) among the following one: peritoneal dialysis (at least a daily contact), hemodialysis (>1 session per week) or isolated ultrafiltration (>1 session per week). Ultrafiltration technique could change throughout the care Receives: Procedure: ULTRAFILTRATION |
| ENHANCED MEDICAL TREATMENT | Other | The control group called "enhanced medical treatment" will not benefit of ultrafiltration (except refractory pulmonary edema, or terminal kidney failure requiring extra renal depuration). These situations will not be considered as protocol violation, because they are scientifically indicated for extra renal depuration. Receives: Procedure: ENHANCED MEDICAL TREATMENT |
What is being measured
The primary outcome is the main question the study is designed to answer.
death and/or unscheduled hospitalization
The primary outcome measure is a combined measure including death whatever the cause, and/or unscheduled hospitalization for acute decompensated heart failure. For each groups, deaths, cause and time of deaths will be recorded. Hospitalization date, duration, location, and reason will be recorded. The "hospitalization" setting and the "acute decompensated heart failure" setting will be endorsed by an event validation committee.
Measured: up to 12 months post-randomization
Secondary outcomes (22)
Survival
number of days spent alive and not hospitalized
Measured: 12 months
Survival
Intervention effect on one-year overall survival
Measured: 12 months
Hospitalization for acute decompensated heart failure
Intervention effect on :
- Period before first unscheduled hospitalization for acute decompensated heart failure
- Number and duration of hospitalizations for acute heart failure (scheduled or not) throughout the year
- Number and duration of unscheduled hospitalization for acute heart failure throughout the year.
Measured: up to 12 months post- randomization
Change in NYHA classification
New York Health Association - Measurement scale to classify heart failure in 4 stages (stage 1 ; no symptoms)
Measured: randomization day and 12 months post randomization.
Change in 6MWT - Six-Minute Walk Test
Six-minute walk test with an experimented physiologist. The distance in meters is retained.
Measured: randomization day and 12 months post randomization.
Change in MLwHF form
Minnesota Living with Heart Failure - Quality of life self-administered survey focusing on heart failure symptoms (21 items with 1 : slightly to 5 : al lot) Safety issue? 0 Yes 1 No
Measured: randomization day and 12 months post randomization.
Change in SF36 form
Short Form 36 : Quality of life self-administered survey with 36 items about 8 dimensions including a physical and mental score.
Measured: randomization day and 12 months post randomization.
Death occurrence attributable to ultrafiltration technique
Safety: Death occurrence attributable to ultrafiltration technique, validated by an independent supervisory board, and any adverse event.
Measured: up to 12 months post- randomization
Change in Brain Natriuretic Peptide and/or NT-Probating Natriuretic Peptide rate
Following biological features variation : Brain Natriuretic Peptide (BNP) and/or NT-ProBNP
Measured: randomization day and 12 months post randomization
Change in total bilirubin rate
Following biological features variation : total bilirubin
Measured: randomization day, then 3, 6 and 12 months post randomization
Change high-sensitivity T troponin rate
Following biological features variation : high-sensitivity T troponin
Measured: randomization day and 12 months post randomization
Change in hemoglobin rate
Following biological features variation : hemoglobin
Measured: randomization day and 12 months post randomization
Change in Left ventricular ejection fraction (LVEF)
Following echocardiographic parameters features : left systolic function (LVEF)
Measured: randomization day and 12 months post randomization
Change in Tricuspid annular plane systolic excursion (TAPSE)
Following echocardiographic parameters features :right systolic function (TAPSE)
Measured: randomization day and 12 months post randomization
Change in tricuspid annular velocity
Following echocardiographic parameters features : right systolic function assessed by tricuspid annular velocity measured with Pulsed Doppler tissue imaging
Measured: randomization day and 12 months post randomization
Change in transmitral patterns classification
Following echocardiographic parameters features : left diastolic function assessed by transmitral patterns classification
Measured: randomization day and 12 months post randomization
Change in E/E' ratio
Following echocardiographic parameters features : E/E'
Measured: randomization day and 12 months post randomization
Change in pulmonary artery systolic pressure (PASP)
Following echocardiographic parameters features : pulmonary artery systolic pressure (PASP)
Measured: randomization day and 12 months post randomization
Change in Surface of the Left Atrium
Following echocardiographic parameters features : Surface of the Left Atrium
Measured: randomization day and 12 months post randomization
Change in right atrial pressure
Following echocardiographic parameters features : Impact on right ventricular function assessed by right atrial pressure
Measured: randomization day and 12 months post randomization
Change in cardiac index
Following echocardiographic parameters features : cardiac index
Measured: randomization day and 12 months post randomization
Change in cardiac flow
Following echocardiographic parameters features : cardiac flow
Measured: randomization day and 12 months post randomization
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted27 Jul 2016 (estimated)
- Study start31 Mar 2017
- Primary completion28 Oct 2021
- Study completion28 Oct 2021
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Cardio-renal SyndromeStudies of the same condition, open and under way.
- More trials run by Hospices Civils de LyonThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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 N/A
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 108 participants (actual)
Sponsor and investigators
- Lead sponsor
- Hospices Civils de Lyon
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Laurent JUILLARD, Principal investigator, Hospices Civils de Lyon, 69002 LYON France
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02846337
- Sponsor's protocol ID
- 69HCL15_0077
- Other IDs
- 2016-A00518-43
- Acronym
- UF-CARE
- Status last verified
- Oct 2026
- First submitted
- 22 Jul 2016
- Last updated
- 14 Oct 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Schleef M, Sens F, Magaud L, Haesebaert J, Langlois-Jacques C, Juillard L, Bonnefoy E, Baudry G; UF-CARE Study Group. Renal replacement therapy in type 2 severe cardiorenal syndrome: a randomized controlled trial. ESC Heart Fail. 2026 May 9:xvag133. doi: 10.1093/eschf/xvag133. Online ahead of print.
PubMed 42105307
Study at a glance
From the registry record, last updated by the sponsor on 14 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Ultrafiltration Versus Medical Therapies in the Management of the Cardio Renal Syndrome
- ClinicalTrials.gov ID
- NCT02846337
- Acronym / sponsor ID
- UF-CARE / 69HCL15_0077
- Conditions
- Cardio-renal Syndrome
- Keywords
- cardio-renal syndrome, hemodialysis, peritoneal dialysis, hemofiltration, composite endpoint
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 108 participants (actual)
- Lead sponsor
- Hospices Civils de LyonUniversity, hospital or other
- Study start
- 31 Mar 2017 (actual)
- Primary completion
- 28 Oct 2021 (actual)
- Study completion
- 28 Oct 2021 (actual)
- First posted
- 27 Jul 2016 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Type 2 cardio renal syndrome is defined by the occurrence or the exacerbation of a kidney failure induced by a chronic heart failure. Sodium overload is one of the main causes leading to the occurrence or the exacerbation of this syndrome. Some patients have a massive sodium retention on which medications are not effective enough. These patients have no further therapeutic options because of the refractory congestion and a 3-months mortality rate around 15%, frequent rehospitalization (3-months rehospitalization rate at 71%) and an excessively impaired quality of life.
For those refractory heart failure with cardio renal syndrome, nephrology departments resort to non-medication sodium extraction (hemodialysis, peritoneal dialysis, isolated ultrafiltration). Between 2002 and 2008, 927 French patients would have start dialysis in this situation. In 2013, 174 patients start dialysis in 97 dialysis centers. French National Authority of Health recently published new Good Practice Guidance thereupon, strengthened by the increasing number of publications and the widespread use of this technique. There is therefore a consensus among professionals about the benefits of such a technique in those indications. However, bibliographical data are not strong enough to support a strong level of evidence. None of foresight strategies have been compared to others in a proper randomized controlled trial, and there is no clue about any suspected superiority from one strategy to another.
So far, the investigators propound invasive, expensive and not validated techniques to patients with functional and vital prognosis altered. The investigators think it's essential to prove the efficacy of such an approach. They wish to quantify those techniques impact on rehospitalization, with a consideration for the potential survival impact.
It seems unethical to evaluate separated techniques, taking in account that patients with severe heart failure will switch from one technique to another among their care. It is therefore crucial to validate benefits from an invasive procedure (hemodialysis, peritoneal dialysis, isolated ultrafiltration) compared to a medication-restricted care.
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| ULTRAFILTRATION | Experimental | Procedure: ULTRAFILTRATIONThe ultrafiltration sodium-overload extraction will be chosen by the patient nephrologist and the patient himself (according to his comorbidities) among the following one: peritoneal dialysis (at least a daily contact), hemodialysis (>1 session per week) or isolated ultrafiltration (>1 session per week). Ultrafiltration technique could change throughout the care |
| ENHANCED MEDICAL TREATMENT | Other | Procedure: ENHANCED MEDICAL TREATMENTThe control group called "enhanced medical treatment" will not benefit of ultrafiltration (except refractory pulmonary edema, or terminal kidney failure requiring extra renal depuration). These situations will not be considered as protocol violation, because they are scientifically indicated for extra renal depuration. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (6 listed)
- Severe heart failure with recurring congestive symptoms and at least one the following criteria :
- Diuretic treatment with at least 250mg furosemide per day (or 6mg bumetanide)during at least 1 month
- Cardiac medical treatment enhanced by the European cardiology society guidance (except intolerance, and/or contraindication) and according to patient cardiologist.
- Non terminal kidney disease or failure : estimated glomerular filtration rate (GFR) (CKD-Epi formula) between 20 and 90 mL/min/1.73m² (or GFR estimated between 60 and 90 mL/min/1.73m² with proteinuria and/or hematuria) and urea rate under 50mmol/L
Key exclusion criteria (11 listed)
- Cardiogenic shock or situations that contraindicate the ultrafiltration technique elsewhere than shock room
- Patient who already had long course ultrafiltration for more than 3 months, or not available because of end-stage renal failure
- Biventricular pacemaker implementation, single or dual chamber pacemaker implementation, or defibrillator implementation up to 15 days before the inclusion
- Vasoactive drugs ambulatory treatment (dobutamine, dopamine, adrenalin, noradrenalin)
- General condition incompatible with any ultrafiltration techniques
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| ULTRAFILTRATIONPeritoneal dialysis: at least one daily contact, 5 days a week minimum, with a hypertonic solution. Le number of contact et the stasis duration will be decided by the practitioner. Hemodialysis: at least one hemodialysis per week, one hemofiltration and/or hemodiafiltration per week, and at least 2 liter of ultrafiltrate extraction per week. In case of serious interdialytic weight gain, and/or hemodynamic unsteadiness, sessions can be up to 6 per weeks. Sessions duration will be adjusted to the needful ultrafiltrate and hemodynamic tolerance. Isolated ultrafiltration: at least once a week, and includes an extraction of minimum 2 liter ultrafiltrate in less than 4 hours. It could be done, according to routines and department capacity, on a hemodialysis generator, plasmatic exchange generator, or mobile ultrafiltration device. | Procedure or surgery | ULTRAFILTRATION |
| ENHANCED MEDICAL TREATMENT* Close cardiologic and nephrologic follow-up, minimum 4 times a year, This incidence matches the heart failure, and chronic kidney failure care guidance for our sample * Medical care adjustment in order to apply European and American guidance for chronic heart failure care * Hydric, caloric, peptic and sodium input evaluation by a dietician, and adjustment if needed * Physical rehabilitation suggestions by a physiologist * Evaluation of an interventional approach requirement, and implementation if needed (pacemaker, defibrillator, cardiac resynchronization, diagnosis and therapeutic coronary angiography, ventricular stimulator) according to European and American guidance. | Procedure or surgery | ENHANCED MEDICAL TREATMENT |
Primary outcome
death and/or unscheduled hospitalization
Time frame: up to 12 months post-randomization
The primary outcome measure is a combined measure including death whatever the cause, and/or unscheduled hospitalization for acute decompensated heart failure. For each groups, deaths, cause and time of deaths will be recorded. Hospitalization date, duration, location, and reason will be recorded. The "hospitalization" setting and the "acute decompensated heart failure" setting will be endorsed by an event validation committee.
22 secondary outcomes
Survival
Time frame: 12 months
Survival
Time frame: 12 months
Hospitalization for acute decompensated heart failure
Time frame: up to 12 months post- randomization
Change in NYHA classification
Time frame: randomization day and 12 months post randomization.
Change in 6MWT - Six-Minute Walk Test
Time frame: randomization day and 12 months post randomization.
Change in MLwHF form
Time frame: randomization day and 12 months post randomization.
Change in SF36 form
Time frame: randomization day and 12 months post randomization.
Death occurrence attributable to ultrafiltration technique
Time frame: up to 12 months post- randomization
Change in Brain Natriuretic Peptide and/or NT-Probating Natriuretic Peptide rate
Time frame: randomization day and 12 months post randomization
Change in total bilirubin rate
Time frame: randomization day, then 3, 6 and 12 months post randomization
Change high-sensitivity T troponin rate
Time frame: randomization day and 12 months post randomization
Change in hemoglobin rate
Time frame: randomization day and 12 months post randomization
Change in Left ventricular ejection fraction (LVEF)
Time frame: randomization day and 12 months post randomization
Change in Tricuspid annular plane systolic excursion (TAPSE)
Time frame: randomization day and 12 months post randomization
Change in tricuspid annular velocity
Time frame: randomization day and 12 months post randomization
Change in transmitral patterns classification
Time frame: randomization day and 12 months post randomization
Change in E/E' ratio
Time frame: randomization day and 12 months post randomization
Change in pulmonary artery systolic pressure (PASP)
Time frame: randomization day and 12 months post randomization
Change in Surface of the Left Atrium
Time frame: randomization day and 12 months post randomization
Change in right atrial pressure
Time frame: randomization day and 12 months post randomization
Change in cardiac index
Time frame: randomization day and 12 months post randomization
Change in cardiac flow
Time frame: randomization day and 12 months post randomization
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 14 Oct 2026.
- Results publication: PubMed 42105307Schleef M, Sens F, Magaud L, Haesebaert J, Langlois-Jacques C, Juillard L, Bonnefoy E, Baudry G; UF-CARE Study Group. Renal replacement therapy in type 2 severe cardiorenal syndrome: a randomized controlled trial. ESC Heart Fail. 2026 May 9:xvag133. doi: 10.1093/eschf/xvag133. Online ahead of print.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Laurent JUILLARD principal investigator
Hospices Civils de Lyon, 69002 LYON France
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing ULTRAFILTRATION and ENHANCED MEDICAL TREATMENT in people with Cardio-renal Syndrome, run by Hospices Civils de Lyon at 1 site in France.
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 6 inclusion and 11 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 14 Oct 2026. 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 France. 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. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
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?
death and/or unscheduled hospitalization (time frame: up to 12 months post-randomization). 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 NCT02846337, which also lists 1 linked publication.
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 14 Oct 2026.