Chronic Kidney DiseasePhase 4NCT03982160
L-arginine to Reduce Sympathetic Nerve Activity in CKD Patients
A Phase 4 study testing L-Arginine in people with Chronic Kidney Disease, run by The University of Texas at Arlington at 2 sites in United States.
Trial summary
Chronic kidney disease (CKD) is associated with a higher risk of cardiovascular disease and death. An overactive sympathetic nervous system in CKD patients is one of the major mechanisms increasing the cardiovascular risks in this patient population. Read more about this study
- Who is it for?
- Ages 35 to 75 years
- Conditions the study is for
- Chronic Kidney Disease
- What is being tested?
- L-Arginine
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 15 participants
- Where
- 2 sitesUnited States
- Study dates
- 1 Feb 2018to 31 Dec 2026
- Phase
- Phase 4
- Are there results?
- Not yet: the study is under way
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 35 to 75 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- CKD patients classified as Stage 3 and 4 of National Kidney Foundation Classification with estimated glomerular filtration rate (GFR) between 15 and 59 mL/min/1.73 m2 according to the Modification of Diet in Renal Disease (MDRD) formula based on serum creatinine, age, gender, and race.
- Men and women 35 to 75 years of age
Who cannot join
- myocardial infarction
- heart failure
- anemia (hemoglobin <8 g/dl)
- cancer with current treatment
- previous organ transplantation
- immunosuppressant therapy
Show all 13Show fewer
- human immunodeficiency virus infection
- pregnancy and/or lactating
- current tobacco use
- taking menopausal drugs (estradiol)
- treatment for diabetic neuropathy
- resting heart rate ≥ 100 bpm and
- systolic blood pressure ≤ 90 mmHg
Trial locations and contacts
2 sites in 1 country.
United States2 sites
UT Southwestern
Dallas, Texas, 75390
University of Delaware
Newark, Delaware, 19716
About this study
Official title: Role of Decreased Nitric Oxide in the Tonic Elevation of Resting Sympathetic Nerve Activity in Chronic Kidney Disease Patients
Chronic kidney disease (CKD) is associated with a higher risk of cardiovascular disease and death. An overactive sympathetic nervous system in CKD patients is one of the major mechanisms increasing the cardiovascular risks in this patient population. A potential signal driving sympathetic nerve activity (SNA) involves accumulation of the endogenous nitric oxide synthase (NOS) inhibitor asymmetric dimethylarginine (ADMA). ADMA is elevated in CKD and is a strong, independent predictor of future cardiovascular events in these patients. .
The goal of this study is to determine whether overcoming the accumulation of endogenous ADMA with acute L-arginine infusion reduces SNA in CKD patients.
Read the detailed description
The central hypothesis is that accumulation of ADMA constitutes a major mechanism for the sympathetic overactivity and hypertension in patients with CKD. In this study, the investigators will determine if restoration of NO production with the infusion of L-arginine reduces SNA and blood pressure. On the experimental day, CKD patients will arrive at the laboratory fasted with no morning meds, will refrain from caffeine for 12 hours, and alcohol and physical activity for 24 hours. The collaborating physician Dr. Ashfaq Siddiqui will review subject medications and advise regarding any withholding of medications. If Dr. Siddiqui deems that a medication should not be withheld the investigators will proceed with the patient taking the medication. Prior to any screening/testing, all experimental measurements and procedures will be explained in detail and subjects will provide written, informed consent. A medical health history questionnaire will be filled out. Women of child-bearing age will provide a urine sample for a pregnancy testing prior to any study procedures. The research nurse will place an intravenous catheter in antecubital or hand vein. Subjects will be familiarized with the experimental measures and procedures prior to actual testing. Following this, the subjects will be instrumented with ECG leads, an arterial blood pressure (BP) finger-cuff (Finometer), an arterial BP upper-arm cuff for intermittent absolute BP values, and a strain gauge pneumobelt placed around the abdomen to monitor respiratory excursions. After measuring blood pressure and pulse wave velocity using applanation tonometry, a Doppler ultrasound probe will then be positioned for beat-to-beat measurements of blood velocity and artery diameter and flow-mediated dilation (FMD) will be performed. After this, continuous recording of muscle sympathetic nerve activity (MSNA) will be obtained from the peroneal nerve of the leg, as described below. Following all instrumentation, 25 minutes of resting baseline data (continuous heart rate, MSNA, BP, respiration, and blood flow) will be collected. A blood sample will then be obtained from the intravenous catheter. Next, systemic intravenous infusion of L-arginine, at a dose of 250-350 mg/kg, or saline will be performed for 30 minutes in a randomized order. During each infusion, cardiovascular measurements (heart rate, BP and MSNA) will be recorded continuously and an FMD and cold pressor test performed. The blood draw will be repeated after L-arginine infusion. A 15-minute recovery period will be provided between infusions. Thus, for this study, patients will visit the lab once and the visit will take approximately 5 hours.
- Conditions
- Chronic Kidney Disease
- Being tested
- L-Arginine, Placebo
- Keywords
- L-arginine, blood pressure, ADMA
- 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.
L-ArginineDrug
Arginine Hydrochloride 60% concentration injection 15 g in 25 mL, contains arginine hydrochloride 600 mg/mL in water for injections to 25 mL.
PlaceboOther
Saline
| Study group | Role | What they receive |
|---|---|---|
| L-arginine | Experimental | Intravenous infusion of L-arginine (250-350 mg/kg) will be performed for 30 minutes. Receives: Drug: L-Arginine |
| Saline | Placebo comparator | Saline will be infused for 30 minutes Receives: Other: Placebo |
What is being measured
The primary outcome is the main question the study is designed to answer.
Muscle sympathetic nerve activity (MSNA) will be reduced after L-arginine infusion
Multiunit postganglionic MSNA will be recorded using standard microneurographic techniques. Briefly, a unipolar tungsten microelectrode will be inserted into muscle fascicles of the peroneal nerve near the fibular head of the right leg. Neural signals will be amplified, filtered (bandwidth, 700-2,000 Hz), rectified, and integrated (time constant, 0.1 s) to obtain mean voltage neurograms (University of Iowa Bioengineering, Iowa City, IA).
Measured: 30 minutes
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 Jun 2019
- Study start1 Feb 2018
- Primary completion31 Dec 2026 (estimated)
- Study completion31 Dec 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Chronic Kidney DiseaseStudies of the same condition, open and under way.
- 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 4
- Primary purpose
- Basic science
- Allocation
- Randomised
- Intervention model
- Crossover
- Model description
- This will be a randomize, saline-controlled crossover design study
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 15 participants (estimated)
Sponsor and investigators
- Lead sponsor
- The University of Texas at Arlington
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Paul Fadel, The University of Texas at Arlington
- Investigators
- Paul J Fadel, PhD, Principal investigator, University of Texas at Arlington
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03982160
- Sponsor's protocol ID
- CKD-IRB-2016-0069
- Status last verified
- Jun 2026
- First submitted
- 6 Jun 2019
- Last updated
- 18 Jun 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 18 Jun 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Role of Decreased Nitric Oxide in the Tonic Elevation of Resting Sympathetic Nerve Activity in Chronic Kidney Disease Patients
- ClinicalTrials.gov ID
- NCT03982160
- Acronym / sponsor ID
- CKD-IRB-2016-0069
- Conditions
- Chronic Kidney Disease
- Keywords
- L-arginine, blood pressure, ADMA
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 15 participants (estimated)
- Lead sponsor
- The University of Texas at ArlingtonUniversity, hospital or other
- Study start
- 1 Feb 2018 (actual)
- Primary completion
- 31 Dec 2026 (estimated)
- Study completion
- 31 Dec 2026 (estimated)
- First posted
- 11 Jun 2019 (actual)
- 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.
Chronic kidney disease (CKD) is associated with a higher risk of cardiovascular disease and death. An overactive sympathetic nervous system in CKD patients is one of the major mechanisms increasing the cardiovascular risks in this patient population. A potential signal driving sympathetic nerve activity (SNA) involves accumulation of the endogenous nitric oxide synthase (NOS) inhibitor asymmetric dimethylarginine (ADMA). ADMA is elevated in CKD and is a strong, independent predictor of future cardiovascular events in these patients. .
The goal of this study is to determine whether overcoming the accumulation of endogenous ADMA with acute L-arginine infusion reduces SNA in CKD patients.
Detailed description
The central hypothesis is that accumulation of ADMA constitutes a major mechanism for the sympathetic overactivity and hypertension in patients with CKD. In this study, the investigators will determine if restoration of NO production with the infusion of L-arginine reduces SNA and blood pressure. On the experimental day, CKD patients will arrive at the laboratory fasted with no morning meds, will refrain from caffeine for 12 hours, and alcohol and physical activity for 24 hours. The collaborating physician Dr. Ashfaq Siddiqui will review subject medications and advise regarding any withholding of medications. If Dr. Siddiqui deems that a medication should not be withheld the investigators will proceed with the patient taking the medication. Prior to any screening/testing, all experimental measurements and procedures will be explained in detail and subjects will provide written, informed consent. A medical health history questionnaire will be filled out. Women of child-bearing age will provide a urine sample for a pregnancy testing prior to any study procedures. The research nurse will place an intravenous catheter in antecubital or hand vein. Subjects will be familiarized with the experimental measures and procedures prior to actual testing. Following this, the subjects will be instrumented with ECG leads, an arterial blood pressure (BP) finger-cuff (Finometer), an arterial BP upper-arm cuff for intermittent absolute BP values, and a strain gauge pneumobelt placed around the abdomen to monitor respiratory excursions. After measuring blood pressure and pulse wave velocity using applanation tonometry, a Doppler ultrasound probe will then be positioned for beat-to-beat measurements of blood velocity and artery diameter and flow-mediated dilation (FMD) will be performed. After this, continuous recording of muscle sympathetic nerve activity (MSNA) will be obtained from the peroneal nerve of the leg, as described below. Following all instrumentation, 25 minutes of resting baseline data (continuous heart rate, MSNA, BP, respiration, and blood flow) will be collected. A blood sample will then be obtained from the intravenous catheter. Next, systemic intravenous infusion of L-arginine, at a dose of 250-350 mg/kg, or saline will be performed for 30 minutes in a randomized order. During each infusion, cardiovascular measurements (heart rate, BP and MSNA) will be recorded continuously and an FMD and cold pressor test performed. The blood draw will be repeated after L-arginine infusion. A 15-minute recovery period will be provided between infusions. Thus, for this study, patients will visit the lab once and the visit will take approximately 5 hours.
Study design
- Primary purpose
- Basic science
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Single blind (participant)
- Number of arms
- 2
- Model description
- This will be a randomize, saline-controlled crossover design study
| Arm | Type | Receives |
|---|---|---|
| L-arginine | Experimental | Drug: L-ArginineIntravenous infusion of L-arginine (250-350 mg/kg) will be performed for 30 minutes. |
| Saline | Placebo comparator | Other: PlaceboSaline will be infused for 30 minutes |
Who may qualify
- Ages
- 35 to 75 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (2 listed)
- CKD patients classified as Stage 3 and 4 of National Kidney Foundation Classification with estimated glomerular filtration rate (GFR) between 15 and 59 mL/min/1.73 m2 according to the Modification of Diet in Renal Disease (MDRD) formula based on serum creatinine, age, gender, and race.
- Men and women 35 to 75 years of age
Key exclusion criteria (13 listed)
- myocardial infarction
- heart failure
- anemia (hemoglobin <8 g/dl)
- cancer with current treatment
- previous organ transplantation
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 |
|---|---|---|
| L-ArginineArginine Hydrochloride 60% concentration injection 15 g in 25 mL, contains arginine hydrochloride 600 mg/mL in water for injections to 25 mL. | Drug | L-arginine |
| PlaceboSaline | Other | Saline |
Primary outcome
Muscle sympathetic nerve activity (MSNA) will be reduced after L-arginine infusion
Time frame: 30 minutes
Multiunit postganglionic MSNA will be recorded using standard microneurographic techniques. Briefly, a unipolar tungsten microelectrode will be inserted into muscle fascicles of the peroneal nerve near the fibular head of the right leg. Neural signals will be amplified, filtered (bandwidth, 700-2,000 Hz), rectified, and integrated (time constant, 0.1 s) to obtain mean voltage neurograms (University of Iowa Bioengineering, Iowa City, IA).
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 18 Jun 2026.
- Individual participant dataSharing planned: No
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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.
Paul J Fadel, PhD principal investigator
University of Texas at Arlington
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing L-Arginine in people with Chronic Kidney Disease, run by The University of Texas at Arlington at 2 sites 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 2 inclusion and 13 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: under way, not looking for participants, as of the sponsor's last update on 18 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites 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. 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 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
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?
Muscle sympathetic nerve activity (MSNA) will be reduced after L-arginine infusion (time frame: 30 minutes). 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 18 Jun 2026; AzTrials last refreshed its copy on 7 Nov 2026.