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Kidney DiseasesPhase 4PREFERRED-1NCT05096195

PRevEnting FracturEs in REnal Disease - 1

A Phase 4 study testing Denosumab 60 mg/ml, Calcium and vitamin D prophylaxis and Monitoring of post-injection calcium and phosphate in people with Kidney Diseases and Dialysis; Complications, run by Western University, Canada at 6 sites in Canada.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

PREFERRED-1 is a pilot study designed to determine the feasibility of a large randomized, pragmatic, open-label, comparative-effectiveness trial of denosumab for the prevention of fragility fractures in people receiving hemodialysis. Read more about this study

Who is it for?
Ages 40 years and older
What is being tested?
Denosumab 60 mg/ml, Calcium and vitamin D prophylaxis and Monitoring of post-injection calcium and phosphate
Could I receive a placebo?
No, everyone receives an active treatment
How many people
60 participants
Where
6 sitesCanada
Study dates
11 Jun 2022to Dec 2025
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 40 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Treating nephrologist/nurse practitioner in the dialysis unit deems that a prescription for study drug (denosumab) will be safe/reasonable in the potential participant.
  • Age ≥40 years
  • Access to denosumab through provincial drug benefits (i.e. evidence of receiving outpatient prescription medications through the Ontario Drug Benefits Program, Ontario Disability Support Program)
  • Baseline albumin-corrected serum calcium ≥2.15 mmol/L, PTH ≥15 pmol/L (or 2-9x the upper limit of normal for the local laboratory).
  • High risk of fragility fracture defined by: a) ≥15% 10-year risk of major osteoporotic fracture or >3% 10-year risk of hip fracture (using the World Health Organization's Fracture Risk Assessment Tool which is validated in hemodialysis),OR b) a prior history of hip or vertebral fracture (where the later could have been asymptomatic and only observed radiographically), OR c) two or more fragility fractures of the humerus, wrist, and/or pelvis (e.g. 2 humerus fractures, humerus and wrist fracture).43

Who cannot join

  • Expected to recover kidney function, stop hemodialysis, pursue palliative care, or transfer to home or peritoneal dialysis within 12 months (as assessed by a health professional).
  • Expected to start IV bisphosphonates (i.e. pamidronate or zoledronic acid).
  • Current use of cinacalcet (Sensipar).
  • Current use of an osteoporosis medication including:
  • Denosumab
  • Bisphosphonates
Show all 20Show fewer
  • Alendronate (Fosavance or Fosamax)
  • Risedronate (Actonel or Actonel DR)
  • Zoledronic acid (Aclasta) or Pamidronate
  • Raloxifene (Evista)
  • Oral or conjugated estrogen
  • Topical, oral or injectable testosterone (Androgel, Testim, Fortesta, Androderm, testosterone enanthate and testosterone cypionate)
  • Teriperatide (Forteo)
  • Romosozumab (Evenity)
  • Calcitonin (Calcimar)
  • Of childbearing status
  • History of femur fracture attributed to osteoporosis medication use (i.e. midshaft femoral fracture or atypical femoral fracture)
  • Major dental surgery planned within the next 6 months (e.g. root canal).
  • Known allergy or intolerance to denosumab.
  • Expected to receive a parathyroidectomy for hyperparathyroidism in the next 12 months

Trial locations and contacts

6 sites in 1 country.

6 sites in 1 country

Canada6 sites
  • Kingston Health Sciences Centre

    Kingston, Ontario, K7L 2V7

  • London Health Sciences Centre

    London, Ontario

  • The Ottawa Hospital

    Ottawa, Ontario, K1Y 4E9

  • Huron Perth Healthcare Alliance - Stratford General Hospital

    Stratford, Ontario, N5A 2Y6

  • St. Michaels Hospital

    Toronto, Ontario, M5B 1W8

  • Woodstock Hospital

    Woodstock, Ontario, N4V 0A4

Other trials in Canada

About this study

Official title: Denosumab for the Prevention of Fragility Fractures in Hemodialysis: a Pilot Study for an Innovative, Randomized-controlled Trial, Embedded in Routine Care

PREFERRED-1 is a pilot study designed to determine the feasibility of a large randomized, pragmatic, open-label, comparative-effectiveness trial of denosumab for the prevention of fragility fractures in people receiving hemodialysis. The pilot study will enroll at least 60 patients from across at least 6 different hemodialysis centres in Ontario, Canada. Patients on outpatient maintenance hemodialysis at high risk of fragility fracture, will be randomized 1:1 to a denosumab care pathway vs. usual care.

Primary outcomes include recruitment feasibility and treatment adherence. Secondary outcomes include safety and participant satisfaction with our protocol and processes.

Read the detailed description

Despite a fragility fracture risk that is >5-fold higher than those without chronic kidney disease (CKD), there is a lack of evidence on how to prevent fracture in patients on hemodialysis. Medications known to prevent fragility fracture in other populations, are either contraindicated in dialysis, or associated with severe side effects.

Denosumab (Prolia) is one of the only Health Canada approved medications for fragility fracture prevention across the CKD stages. While small clinical trials inclusive of hemodialysis patients have noted that denosumab improves bone mineral density and reduces bone turnover, whether this treatment effectively and safely prevents fragility fracture in this population still remains unclear.

Instead of conducting an expensive traditional RCT where results might fail to apply to the "real-world", the study will embed a trial of denosumab into routine care. The intervention will be delivered by healthcare staff. Participants will be closely followed at the dialysis unit where the participant has dialysis treatments. Baseline characteristics and outcomes will be captured using routine care data including administrative health data.

The overarching aim of the PREFERRED Program is to determine whether a denosumab care pathway vs. usual care (i.e., non-use of denosumab) alters the risk of fragility fracture in patients receiving in-centre hemodialysis. PREFERRED-1 is a pilot study that will inform the feasibility of conducting a large-scale, efficiently run, randomized-controlled trial in Canada to test whether denosumab reduces the risk of fragility fracture in patients receiving hemodialysis. The goal is to understand if individual level recruitment is feasible and timely, and if the intervention is acceptable to patients.

The objectives of PREFERRED-1 are to:

  1. Examine whether streamlined methods of enrollment can facilitate recruitment across multiple centres in a timely way;
  2. Demonstrate good adherence with the trial protocol and examine whether well-received by participants;
  3. Ensure that participants are adherent with treatment assignment (i.e., intervention group to denosumab, minimal cross-over to denosumab in usual group);
  4. Confirm there are no 'signals' of unmanageable harm (i.e. hypocalcemia) that would prevent testing of our intervention on a larger scale.

PREFERRED-1 will be deemed a success if:

  • The study can randomly allocate at least 60 patients from at least 6 hemodialysis centres within 6-months of the trial being activated at each centre.
  • Demonstrate that patients randomly allocated to denosumab receive over 90% of the scheduled injections at 0, 6 and 12 months
  • Patients randomly allocated to no denosumab (i.e. usual care) do not receive a prescription for denosumab.

This "high-risk" innovative pragmatically approached trial focused on better treatments for fracture prevention in those with kidney disease will

  1. inform transformational change in the care of real-world patients;
  2. produce essential knowledge to safely prevent fracture in patients with kidney disease, and the associated costs to the healthcare system;
  3. foster the conduct of collaborative, multidisciplinary care for those with complex kidney disease.
Being tested
Denosumab 60 mg/ml, Calcium and vitamin D prophylaxis, Monitoring of post-injection calcium and phosphate
Keywords
Pilot Study, Fracture, denosumab, hemodialysis
Medical subject headings
Kidney Diseases, Chronic Kidney Disease-Mineral and Bone Disorder, Fractures, Bone

What participants receive

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

  • Denosumab 60 mg/mlDrug

    Also called Prolia

    Details described in intervention arm/group description section.

  • Calcium and vitamin D prophylaxisOther

    Details described in intervention arm/group description section.

  • Monitoring of post-injection calcium and phosphateDiagnostic test

    Details described in intervention arm/group description section.

Study groups in NCT05096195
Study groupRoleWhat they receive
InterventionExperimental60 mg of denosumab (Prolia) will be administered every 6 months over a 15 - month period. Monitoring of serum calcium and phosphate will occur and bloodwork will be drawn for 7 weeks following each denosumab injection. Correction of vitamin D deficiency (if required), the adjustment of calcium dialysate and the provision of intravenous (IV) or oral (po) calcitriol/calcidiol will be administered as needed following each denosumab injection as described in the Beside Protocol. Once the study monitoring period is over, serum calcium monitoring and management will occur as per routine care in the dialysis centre. All intervention activities will occur during regularly scheduled hemodyalisis sessions.
Receives: Drug: Denosumab 60 mg/ml; Other: Calcium and vitamin D prophylaxis; Diagnostic Test: Monitoring of post-injection calcium and phosphate
Usual careNo interventionUsual care participants will continue to receive the typical standard of care in their dialysis unit which includes their routine dialysis monitoring and bloodwork. They will not receive denosumab, calcium and vitamin prophylaxis. There will be no extra monitoring or bloodwork.

What is being measured

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

  1. Recruitment rate

    Number or N (%) of participants randomly allocated within 26 weeks of trial initiation at each centre.

    Measured: 26 weeks

  2. Adherence to study intervention

    Number (%) of participants randomized to the intervention who received >90% of their scheduled treatments to study end.

    Measured: 15 months

  3. Adherence to usual care

    Number (%) of participants randomized to usual care who received no prescription for denosumab to study end.

    Measured: 15 months

Secondary outcomes (8)
  1. Treatment-related hypocalcemia as assessed by CTCAE v4.0

    N (%) with hypocalcemia and symptomatic hypocalcemia [graded according to common terminology criteria for adverse events v 4.0 criteria (Grade 2, albumin-corrected serum calcium 1.75 to 1.99 mmol/L, Grade 3, 1.5 to 1.74 mmol/L, Grade 4, serum calcium <1.5 mmol/L)] within 7 weeks of denosumab. Symptomatic hypocalcemia will be defined by a calcium <2.00 mmol/L in the presence of new muscle cramps or paresthesia.

    Measured: within 7 weeks following denosumab injection

  2. Mean change in serum calcium

    Mean change in serum calcium from baseline to 7 weeks post injection

    Measured: 7 weeks following denosumab injection

  3. Median change in serum calcium

    Median change in serum calcium from baseline to 7 weeks post injection

    Measured: 7 weeks following denosumab injection

  4. Mean change in parathyroid hormone

    Mean change in parathyroid hormone from baseline to 7 weeks post injection

    Measured: 7 weeks following denosumab injection

  5. Median change in parathyroid hormone

    Median change in parathyroid hormone from baseline to 7 weeks post injection

    Measured: 7 weeks following denosumab injection

  6. Fragility fracture

    N (%) with hospital encounter for fragility fracture of the hip, vertebrae, humerus, wrist, or pelvis at 15 months

    Measured: 15 months

  7. Satisfaction with E-Platform and E-Consent Process

    Patient satisfaction with e-platform, and e-consent process. (Likert Scale with 1=not satisfied to 5=very satisfied)

    Measured: 15 months

  8. Satisfaction with intervention

    Patient satisfaction with intervention (Likert Scale with 1=not satisfied, 5=very satisfied)

    Measured: 15 months

Timeline

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

  1. First posted27 Oct 2021
  2. Study start11 Jun 2022
  3. Primary completionDec 2025 (estimated)
  4. Study completionDec 2025 (estimated)

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 4
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Investigator, Outcomes assessor
Enrolment
60 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05096195
Sponsor's protocol ID
3638
Acronym
PREFERRED-1
Status last verified
May 2025
First submitted
21 Sep 2021
Last updated
31 May 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Clemens KK, Cowan A, Dixon S, Naylor K, Weir MA, Thain J, Khan T, Silver S, Molnar AO, Sultan N, Holden RM, Hiremath S, Wald R, Kitchlu A, Arnold J, Field B, Garg AX. PRevEnting FracturEs in REnal Disease-1 (PREFERRED-1): protocol for a pilot study of a pragmatic, randomised controlled trial of denosumab for the prevention of fragility fractures in haemodialysis. BMJ Open. 2025 Sep 10;15(9):e097195. doi: 10.1136/bmjopen-2024-097195.

    PubMed 40935429

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Denosumab 60 mg/ml, Calcium and vitamin D prophylaxis and Monitoring of post-injection calcium and phosphate in people with Kidney Diseases and Dialysis; Complications, run by Western University, Canada at 6 sites in Canada.

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 5 inclusion and 20 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 31 May 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in Canada. 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.

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?

Recruitment rate (time frame: 26 weeks). The study lists 3 primary outcomes in all. 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 NCT05096195, 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 31 May 2025.

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