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Renal DiseaseNCT03084666

Remote Ischemic Preconditioning Living Donor Renal Transplant Protocol

A study testing Zimmer ATS tourniquet system in people with Renal Disease, run by University of Alabama at Birmingham at 1 site in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

In this study, patients undergoing live donor kidney transplantation will be allocated to the control group or remote ischemic preconditioning group (RIPC). RIPC is the utilization of short periods of ischemia to provide protection of the myocardium or other organ (i.e. kidney) from a subsequent ischemic event. Read more about this study

Who is it for?
Ages 19 years and olderHealthy volunteers can take part
Conditions the study is for
Renal Disease
What is being tested?
Zimmer ATS tourniquet system
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
40 participants
Where
1 siteUnited States
Study dates
2 Jul 2014to 20 May 2021
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

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 19 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • > OR = 19 years of age receiving a living donor renal transplant (treatment control group) and their donors (control group donors)

Who cannot join

  • < 19 years of age
  • No safe extremity to place tourniquet
  • Patients with previous muscle, vascular, or nerve injury to an extremity,
  • Patients with only one available extremity that has an arteriovenous fistula
  • Patients who are hemodialysis dependent who have not received hemodialysis in the past 4 days
  • Paraplegic/quadriplegic patients
Show all 9Show fewer
  • Active pathologic cutaneous lesions on extremities
  • Patients with a history of tourniquet pain or complex regional pain syndrome (CRPS)
  • Pregnant patients

Trial locations and contacts

1 site in 1 country.

United States1 site
  • UAB Department of Anesthesiology and Perioperative Medicine

    Birmingham, Alabama, 35249

Other trials in United States

About this study

In this study, patients undergoing live donor kidney transplantation will be allocated to the control group or remote ischemic preconditioning group (RIPC). RIPC is the utilization of short periods of ischemia to provide protection of the myocardium or other organ (i.e. kidney) from a subsequent ischemic event. Before allograft implantation, RIPC will be accomplished in the treatment group donor and control group donor by inducing intermittent extremity ischemia through intermittent inflation of an extremity tourniquet three times for five-minute intervals with five minutes of deflation between inflation periods. The monitored clinical end points will include total urine output following kidney reperfusion over five days, plasma creatinine declination over five days, initiation of dialysis, and development of graft injury. Magnitude of graft injury is the primary endpoint and will be measured using biochemical markers, such as, plasma and urinary concentration of neutrophil gelatinase associated lipocalin (NGAL), interleukin-18 (IL-18), and kidney injury molecule-1 (KIM-1). The sample size calculation is based on a projected difference of NGAL levels between the two study arms. Hall et al reported a mean NGAL level of 49 mg/mL (SD = 37 mg/mL) for a group of patients that had immediate graph function and a mean NGAL level of 248 mg/mL in a group of patients with slow graft function. (which Hall reference is this) Based on these data, a conservative estimate of a mean difference between study groups will be considered 35 mg/mL NGAL. Using these assumptions, an alpha level of 0.05 and 80% power, a sample size of n= 19 per study group will be calculated. By rejecting our null hypothesis, RIPC may serve as a safe, cost-effective protective strategy to prevent allograft injury in the clinical setting of live donor kidney transplantation.

Read the detailed description

All female patients of childbearing age that qualify for this study will receive a urinary pregnancy test prior to enrollment. Application of a tourniquet will occur after induction of anesthesia and intubation with minimal possibility of causing discomfort as the patient will be anesthetized. The tourniquet will be applied preferably to a leg but an arm will be used if a leg is unavailable. The tourniquet will be inflated for three 5 minute intervals over a 30 minute period of time using the Zimmer A.T.S. 2000 Tourniquet System. Patients will be randomly allocated to one of two groups. The treatment group donor will have the tourniquet inflated on the leg or arm to 200 mmHg. The control group donor will have the tourniquet inflated on the leg or arm to only 20 mmHg. An audible timer will be used to help alert investigators that the tourniquet is in need of deflation after each 5-minute interval. The tourniquet will be removed after the needed 30 minutes of inflation/deflation to prevent inadvertent inflation of the tourniquet. Blood and Urine specimens will be labeled with patient name and medical record number. Urine samples will be taken in the operating room and at 6,12,24,48 hours postoperatively to test for urinary biomarkers at the O'Brien Clinical Research Center. Blood samples for calculation of serum blood urea nitrogen and creatinine will be collected/processed/distributed/stored according to current University of Alabama at Birmingham (UAB) main laboratory guidelines as this test is routinely ordered on renal transplant patients. Urinary biomarker laboratory testing samples will be obtained by a bedside nurse placed in a routine urine sample container and a co-investigator will then bring samples to the laboratory where the samples will be tested for NGAL, KIM-1, and IL-18. Blood samples will be taken daily for the first 5 days. A blood sample will be taken from the patient at 1 month to determine the serum blood urea nitrogen level and the creatinine level. The degree of allograft injury will be assessed by the levels of urinary biomarkers NGAL, IL-18, and KIM-1. Incidence of allograft or transplanted kidney primary malfunction will be based on urine output during the first three days after transplantation, the one month serum creatinine concentration, one month estimated glomerular filtration rate calculated according to diet modification. Additional secondary endpoints include 90-day mortality, length of ICU stay, and length of hospital stay. There is a low probability of tourniquet postoperative pain secondary to time of tourniquet inflation being both intermittent and for a short period of time. Inconvenience includes phone discussions with researchers/coordinators and preoperative discussions addressing risks and benefits of the study. Tourniquets will not be placed on extremities with preexisting arteriovenous fistulas or grafts utilized for hemodialysis. In addition, tourniquets will be placed after oscillometric blood pressure cuff placement for intraoperative anesthesia/surgical monitoring to provide adequate patient blood pressure assessment. The tourniquet will not be placed on the same extremity as the oscillometric blood pressure cuff. The primary investigator or a co-investigator will be present during times of tourniquet inflation. The patient will be assessed for complications immediately after tourniquet removal, in the Post- Anesthesia Care Unit (PACU) , and in the ICU/or step down unit. Finally, patient complication assessment will occur on the transplant floor after effects of anesthesia have completely resolved within 24 hours of tourniquet application. The extremity will also be assessed for injury at the 1-month follow up visit.

Conditions
Renal Disease
Being tested
Zimmer ATS tourniquet system
Medical subject headings
Kidney Diseases

What participants receive

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

  • Zimmer ATS tourniquet systemDevice

    The tourniquet is the same kind that is used in orthopedic surgeries to limit blood loss in arm or leg surgery. It can be inflated to a set pressure for a set amount of time.

Study groups in NCT03084666
Study groupRoleWhat they receive
Treatment GroupExperimentalThe treatment will receive 200 mmHg of pressure from a Zimmer automatic tourniquet system (ATS) for three 5 minute intervals.
Receives: Device: Zimmer ATS tourniquet system
Control GroupExperimentalOur control group will receive 20 mmHg of pressure from a Zimmer automatic tourniquet system (ATS) for three 5 minute intervals.
Receives: Device: Zimmer ATS tourniquet system

What is being measured

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

  1. Biomarkers Measured to Indicate the Magnitude of Graft Injury

    Remote ischemic preconditioning (RIPC) will be accomplished in the treatment group donor and control group donor by inducing intermittent extremity ischemia through intermittent inflation of an extremity tourniquet three times for five-minute intervals with five minutes of deflation between inflation periods. The monitored clinical end points will include total urine output following kidney reperfusion. Magnitude of graft injury is the primary endpoint and will be measured using biochemical markers, such as, plasma and urinary concentration of neutrophil gelatinase associated lipocalin (NGAL), interleukin-18 (IL-18), and kidney injury molecule-1 (KIM-1). The sample size calculation is based on a projected difference of NGAL levels between the two study arms.

    Measured: Baseline

  2. Biomarkers Measured to Indicate the Magnitude of Graft Injury

    RIPC will be accomplished in the treatment group donor and control group donor by inducing intermittent extremity ischemia through intermittent inflation of an extremity tourniquet three times for five-minute intervals with five minutes of deflation between inflation periods. The monitored clinical end points will include total urine output following kidney reperfusion. Magnitude of graft injury is the primary endpoint and will be measured using biochemical markers, such as, plasma and urinary concentration of neutrophil gelatinase associated lipocalin (NGAL), IL-18, and KIM-1. The sample size calculation is based on a projected difference of NGAL levels between the two study arms.

    Measured: 6 hours post-operatively

  3. Biomarkers Measured to Indicate the Magnitude of Graft Injury

    RIPC will be accomplished in the treatment group donor and control group donor by inducing intermittent extremity ischemia through intermittent inflation of an extremity tourniquet three times for five-minute intervals with five minutes of deflation between inflation periods. The monitored clinical end points will include total urine output following kidney reperfusion. Magnitude of graft injury is the primary endpoint and will be measured using biochemical markers, such as, plasma and urinary concentration of neutrophil gelatinase associated lipocalin (NGAL), IL-18, and KIM-1. The sample size calculation is based on a projected difference of NGAL levels between the two study arms.

    Measured: 12 hours post-operatively

  4. Biomarkers Measured to Indicate the Magnitude of Graft Injury

    RIPC will be accomplished in the treatment group donor and control group donor by inducing intermittent extremity ischemia through intermittent inflation of an extremity tourniquet three times for five-minute intervals with five minutes of deflation between inflation periods. The monitored clinical end points will include total urine output following kidney reperfusion. Magnitude of graft injury is the primary endpoint and will be measured using biochemical markers, such as, plasma and urinary concentration of neutrophil gelatinase associated lipocalin (NGAL), IL-18, and KIM-1. The sample size calculation is based on a projected difference of NGAL levels between the two study arms.

    Measured: 24 hours post-operatively

  5. Biomarkers Measured to Indicate the Magnitude of Graft Injury

    RIPC will be accomplished in the treatment group donor and control group donor by inducing intermittent extremity ischemia through intermittent inflation of an extremity tourniquet three times for five-minute intervals with five minutes of deflation between inflation periods. The monitored clinical end points will include total urine output following kidney reperfusion. Magnitude of graft injury is the primary endpoint and will be measured using biochemical markers, such as, plasma and urinary concentration of neutrophil gelatinase associated lipocalin (NGAL), IL-18, and KIM-1. The sample size calculation is based on a projected difference of NGAL levels between the two study arms.

    Measured: 48 hours post-operatively

Secondary outcomes (3)
  1. Number of Participants That Experienced a Mortality Event

    This measure will be a review of those participants that didn't survive this procedure.

    Measured: From baseline through 90 days

  2. Length of ICU Stay

    The number of days will be counted for their ICU stay

    Measured: from baseline through 90 days

  3. Overall Length of Hospital Stay

    The entire length of hospital stay will be counted in days

    Measured: from baseline through 90 days

Timeline

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

  1. First posted21 Mar 2017
  2. Study start2 Jul 2014
  3. Primary completion20 May 2021
  4. Study completion20 May 2021

Why it stopped: Recruitment difficulties

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 N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
In this study, patients undergoing live donor kidney transplantation will be allocated to the control group or remote ischemic preconditioning group (RIPC). RIPC is the utilization of short periods of ischemia to provide protection of the myocardium or other organ (i.e. kidney) from a subsequent ischemic event.
Masking
Single blind
Who is masked
Participant
Enrolment
40 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03084666
Sponsor's protocol ID
F130312023
Status last verified
Apr 2022
First submitted
14 Mar 2017
Last updated
12 May 2022
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A study testing Zimmer ATS tourniquet system in people with Renal Disease, run by University of Alabama at Birmingham at 1 site in United States.

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 1 inclusion and 9 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: stopped early, as of the sponsor's last update on 12 May 2022. 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 United States. 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?

Yes. Results are posted in the registry (first posted 12 May 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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?

Biomarkers Measured to Indicate the Magnitude of Graft Injury (time frame: Baseline). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 12 May 2022.

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