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Diabetes InsipidusCARGOxNCT03572166

Use of Copeptin Measurement After Arginine Infusion for the Differential Diagnosis of Diabetes Insipidus - the CARGOx Study

A study testing Arginine infusion and Hypertonic saline infusion in people with Diabetes Insipidus and Polydipsia, Primary, run by University Hospital, Basel, Switzerland at 7 sites in 6 countries.

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 differential diagnosis of central diabetes insipidus (cDI) is difficult and the current test with the highest diagnostic accuracy is copeptin measurement after hypertonic saline infusion (HIS). Read more about this study

Who is it for?
Ages 18 to 95 years
Conditions the study is for
Diabetes Insipidus, Polydipsia, Primary
What is being tested?
Arginine infusion and Hypertonic saline infusion
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
177 participants
Where
7 sitesin 6 countries
Study dates
3 Sep 2018to 31 Dec 2022
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 to 95 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥ 18 years
  • Hypotonic polyuria / polydipsia syndrome defined as: polyuria >50ml/kg body weight/24h and polydipsia >3l /24h or known diabetes insipidus under treatment with DDAVP
  • Urine-Osmolality <800mOsm/L

Who cannot join

  • Polyuria / polydipsia secondary to diabetes mellitus, hypercalcemia or hypokalemia
  • Nephrogenic diabetes insipidus (defined as baseline copeptin level >21.4pmol/L)
  • Evidence of any acute illness
  • Epilepsy requiring treatment
  • Uncontrolled arterial hypertension (blood pressure >160/100mmHg at baseline)
  • Cardiac failure (NYHA III-IV)
Show all 11Show fewer
  • Liver cirrhosis (Child B-C)
  • Uncorrected adrenal or thyroidal deficiency
  • Patients refusing or unable to give written informed consent
  • Pregnancy or breast feeding
  • End of life care

Trial locations and contacts

7 sites in 6 countries.

7 sites in 6 countries

Switzerland2 sites
  • University Hospital Basel, Department of Endocrinology

    Basel, Canton of Basel-City, 4031

  • University Hospital Zurich

    Zurich

Other trials in Switzerland

Brazil1 site
  • Hospital das clinicas Minas Gerais

    Belo Horizonte

Other trials in Brazil

Germany1 site
  • University Hospital Würzburg

    Würzburg

Other trials in Germany

Italy1 site
  • Granda Ospedale Maggiore Policlinico Milan

    Milan

Other trials in Italy

Netherlands1 site
  • Erasmus MC

    Rotterdam

Other trials in Netherlands

United Kingdom1 site
  • Cambridge University Hospital

    Cambridge

Other trials in United Kingdom

About this study

The differential diagnosis of central diabetes insipidus (cDI) is difficult and the current test with the highest diagnostic accuracy is copeptin measurement after hypertonic saline infusion (HIS). Although the HIS improved diagnostic accuracy compared to the standard water deprivation test used for decades before, it still comprises great discomfort for patients due to the rise in serum sodium levels above 149mmol/l and requires the presence of medical staff at all times to guarantee safety of the test.

The arginine stimulation test is routinely used to stimulate growth hormone. Own data in 52 patients with polyuria / polydipsia syndrome showed that arginine infusion is a potent stimulator of the neurohypophysis and provides a new diagnostic tool in the differential diagnosis of cDI. Copeptin measurements upon arginine stimulation (CAS) discriminated patients with diabetes insipidus vs. patients with primary polydipsia with a high diagnostic accuracy of 94%.

To validate these results and to compare them against the HIS a large multicenter trial is needed, where the diagnostic accuracy of the CAS is compared to the HIS.

Being tested
Arginine infusion, Hypertonic saline infusion
Keywords
Copeptin
Medical subject headings
Diabetes Insipidus, Polydipsia, Psychogenic

What participants receive

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

  • Arginine infusionDiagnostic test

    Intravenous Infusion of Arginine is given, copeptin measurement will be collected before and 60minutes after start of infusion

  • Hypertonic saline infusionDiagnostic test

    Intravenous Infusion of hypertonic Saline is given, copeptin measurement will be collected before and once Plasma sodium rises above 149mmol/l

Study groups in NCT03572166
Study groupRoleWhat they receive
Arginine InfusionExperimentalArginine Stimulation Test
Receives: Diagnostic Test: Arginine infusion
Hypertonic saline infusionActive comparatorHypertonic Saline Infusion Test
Receives: Diagnostic Test: Hypertonic saline infusion

What is being measured

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

  1. The primary outcome is the overall diagnostic accuracy - defined as the proportion of correct diagnoses - of each diagnostic procedure in differentiating patients with central diabetes insipidus from patients with primary polydipsia.

    For Arginine stimulation the copeptin cut-off to differentiate between diabetes insipidus and primary polydipsia will be 3.8 pmol/l after 60 minutes, for hypertonic saline stimulation it will be the copeptin cut-off 4.9 pmol/l taken at the end of the test

    Measured: 2 days

Secondary outcomes (19)
  1. Sensitivity of both diagnostic procedures for each diagnosis (Primary polydipsia, partial and complete central Diabetes insipidus) according to recommended diagnostic test criteria and previously generated cutoff values

    Copeptin cut-offs used:

    Arginine stimulation:

    • Copeptin level at 60 minutes < 2.4 pmol/l = complete central diabetes insipidus
    • Copeptin level at 60 minutes 2.4 - 3.8 pmol/l = partial central diabetes insipidus
    • Copeptin level at 60 minutes > 3.8 pmol/l = primary polydipsia

    Hypertonic saline stimulation:

    • Copeptin level < 2.7 pmol/l = complete central diabetes insipidus
    • Copeptin level 2.7 - 4.9 pmol/l = partial central diabetes insipidus
    • Copeptin level > 4.9 pmol/l = primary polydipsia

    Measured: 2 days (1 day for each test, evaluation diagnostic accuracy at end of trial)

  2. Specificity of both diagnostic procedures for each diagnosis (Primary polydipsia, partial and complete central Diabetes insipidus) according to recommended diagnostic test criteria and previously generated cutoff values

    Copeptin cut-offs used:

    Arginine stimulation:

    • Copeptin level at 60 minutes < 2.4 pmol/l = complete central diabetes insipidus
    • Copeptin level at 60 minutes 2.4 - 3.8 pmol/l = partial central diabetes insipidus
    • Copeptin level at 60 minutes > 3.8 pmol/l = primary polydipsia

    Hypertonic saline stimulation:

    • Copeptin level < 2.7 pmol/l = complete central diabetes insipidus
    • Copeptin level 2.7 - 4.9 pmol/l = partial central diabetes insipidus
    • Copeptin level > 4.9 pmol/l = primary polydipsia

    Measured: 2 days (1 day for each test, evaluation diagnostic accuracy at end of trial)

  3. Positive predictive value of both diagnostic procedures for each diagnosis (Primary polydipsia, partial and complete central Diabetes insipidus) according to recommended diagnostic test criteria and previously generated cutoff values

    Copeptin cut-offs used:

    Arginine stimulation:

    • Copeptin level at 60 minutes < 2.4 pmol/l = complete central diabetes insipidus
    • Copeptin level at 60 minutes 2.4 - 3.8 pmol/l = partial central diabetes insipidus
    • Copeptin level at 60 minutes > 3.8 pmol/l = primary polydipsia

    Hypertonic saline stimulation:

    • Copeptin level < 2.7 pmol/l = complete central diabetes insipidus
    • Copeptin level 2.7 - 4.9 pmol/l = partial central diabetes insipidus
    • Copeptin level > 4.9 pmol/l = primary polydipsia

    Measured: 2 days (1 day for each test, evaluation diagnostic accuracy at end of trial)

  4. Negative predictive value of both diagnostic procedures for each diagnosis (Primary polydipsia, partial and complete central Diabetes insipidus) according to recommended diagnostic test criteria and previously generated cutoff values

    Copeptin cut-offs used:

    Arginine stimulation:

    • Copeptin level at 60 minutes < 2.4 pmol/l = complete central diabetes insipidus
    • Copeptin level at 60 minutes 2.4 - 3.8 pmol/l = partial central diabetes insipidus
    • Copeptin level at 60 minutes > 3.8 pmol/l = primary polydipsia

    Hypertonic saline stimulation:

    • Copeptin level < 2.7 pmol/l = complete central diabetes insipidus
    • Copeptin level 2.7 - 4.9 pmol/l = partial central diabetes insipidus
    • Copeptin level > 4.9 pmol/l = primary polydipsia

    Measured: 2 days (1 day for each test, evaluation diagnostic accuracy at end of trial)

  5. Best fit diagnostic copeptin cut-off values for differentiation between each diagnosis (Primary polydipsia, partial and complete central Diabetes insipidus) upon arginine stimulation and hypertonic saline infusion stimulation

    Measured: 2 days (1 day for each test, evaluation diagnostic accuracy at end of trial)

  6. Accuracy of the copeptin cut-off of 3.7 pmol/l after 60 minutes and 4.1 after 90 minutes for Arginine Stimulation test

    Measured: 2 days (1 day for each test, evaluation diagnostic accuracy at end of trial)

  7. Sensitivity of the copeptin cut-off of 3.7 pmol/l after 60 minutes and 4.1 after 90 minutes for Arginine Stimulation test

    Measured: 2 days (1 day for each test, evaluation diagnostic accuracy at end of trial)

  8. Specificity of the copeptin cut-off of 3.7 pmol/l after 60 minutes and 4.1 after 90 minutes for Arginine Stimulation test

    Measured: 2 days (1 day for each test, evaluation diagnostic accuracy at end of trial)

  9. Accuracy of the copeptin cut-off of 6.5 pmol/l for Hypertonic Saline Infusion test

    Measured: 2 days (1 day for each test, evaluation diagnostic accuracy at end of trial)

  10. Sensitivity of the copeptin cut-off of 6.5 pmol/l for Hypertonic Saline Infusion test

    Measured: 2 days (1 day for each test, evaluation diagnostic accuracy at end of trial)

  11. Specificity of the copeptin cut-off of 6.5 pmol/l for Hypertonic Saline Infusion test

    Measured: 2 days (1 day for each test, evaluation diagnostic accuracy at end of trial)

  12. Frequency and severity of thirst assessed by visual analogue scale during both tests

    assessed by visual analogue scale from 0 to 10, with 0 indicating no symptoms and 10 indicating severe symptoms.

    Measured: 2 days (1 for each test)

  13. Frequency and severity of headache assessed by visual analogue scale during both tests

    assessed by visual analogue scale from 0 to 10, with 0 indicating no symptoms and 10 indicating severe symptoms.

    Measured: 2 days (1 for each test)

  14. Frequency and severity of nausea assessed by visual analogue scale during both tests

    assessed by visual analogue scale from 0 to 10, with 0 indicating no symptoms and 10 indicating severe symptoms.

    Measured: 2 days (1 for each test)

  15. Frequency and severity of vertigo assessed by visual analogue scale during both tests

    assessed by visual analogue scale from 0 to 10, with 0 indicating no symptoms and 10 indicating severe symptoms.

    Measured: 2 days (1 for each test)

  16. Frequency and severity of general malaise assessed by visual analogue scale during both tests

    assessed by visual analogue scale from 0 to 10, with 0 indicating no symptoms and 10 indicating severe symptoms.

    Measured: 2 days (1 for each test)

  17. Subjective burden assessed by visual analogue scale of both tests

    assessed by visual analogue scale from 0 to 10, with 0 indicating no symptoms and 10 indicating severe symptoms.

    Measured: 2 days (1 for each test)

  18. Health care costs of both tests

    Measured: 2 days (1 for each test)

  19. Frequency of test preference at follow up visit

    Measured: 30 days

Timeline

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

  1. First posted28 Jun 2018
  2. Study start3 Sep 2018
  3. Primary completion30 Sep 2022
  4. Study completion31 Dec 2022

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
Diagnosis
Allocation
Randomised
Intervention model
Crossover
Model description
Observational randomized cross-over diagnostic international multicenter study
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
177 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03572166
Sponsor's protocol ID
CARGOx
Acronym
CARGOx
Status last verified
Jul 2023
First submitted
4 Jun 2018
Last updated
27 Jul 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Atila C, Chifu I, Drummond JB, Vogt DR, Nahum U, Fassnacht M, Winzeler B, Refardt J, Christ-Crain M. A novel diagnostic score for diagnosing arginine vasopressin deficiency (central diabetes insipidus) or primary polydipsia with basal laboratory and clinical parameters: results from two international multicentre prospective diagnostic studies. Lancet Diabetes Endocrinol. 2025 Jun;13(6):505-515. doi: 10.1016/S2213-8587(25)00053-1. Epub 2025 Apr 25.

    PubMed 40294614
  • Bizzozero CA, Monnerat S, Chapman FA, Dhaun N, Refardt J, Christ-Crain M. Apelin levels in patients with polyuria-polydipsia syndrome upon copeptin stimulation tests. Eur J Endocrinol. 2024 Oct 29;191(5):491-498. doi: 10.1093/ejendo/lvae138.

    PubMed 39425917
  • Refardt J, Atila C, Chifu I, Ferrante E, Erlic Z, Drummond JB, Indirli R, Drexhage RC, Sailer CO, Widmer A, Felder S, Powlson AS, Hutter N, Vogt DR, Gurnell M, Soares BS, Hofland J, Beuschlein F, Fassnacht M, Winzeler B, Christ-Crain M. Arginine or Hypertonic Saline-Stimulated Copeptin to Diagnose AVP Deficiency. N Engl J Med. 2023 Nov 16;389(20):1877-1887. doi: 10.1056/NEJMoa2306263.

    PubMed 37966286

Questions about this trial

What is this clinical trial studying?

A study testing Arginine infusion and Hypertonic saline infusion in people with Diabetes Insipidus and Polydipsia, Primary, run by University Hospital, Basel, Switzerland at 7 sites in 6 countries.

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 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 27 Jul 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 7 sites in Switzerland, Brazil, Germany, Italy, Netherlands and 1 more country. 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?

The primary outcome is the overall diagnostic accuracy - defined as the proportion of correct diagnoses - of each diagnostic procedure in differentiating patients with central diabetes insipidus from patients with primary polydipsia. (time frame: 2 days). 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 NCT03572166, which also lists 3 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 27 Jul 2023.

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