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End Stage Renal DiseasePhase 2CLEARTOXNCT06595680

Development of an Innovative Hemodialysis Method to Improve Dialytic Clearance of Protein-bound Uremic Toxins

A Phase 2 study testing Medialipide 20% perfusion, NaCl 0,9% and Blood sample in people with End Stage Renal Disease and Chronic Hemolysis, run by Hospices Civils de Lyon at 1 site in France.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
Search all trials

Trial summary

Current hemodialysis techniques fail to efficiently remove protein-bound uremic toxins (such as p-cresyl sulfate (p-CS) or indoxyl sulfate (IS)) due to their strong binding to serum albumin. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
End Stage Renal Disease, Chronic Hemolysis
What is being tested?
Medialipide 20% perfusion, NaCl 0,9% and Blood sample
Could I receive a placebo?
No, everyone receives an active treatment
How many people
12 participants
Where
1 siteFrance
Study dates
1 Jan 2025to 22 Jan 2027
Phase
Phase 2
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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥18 years
  • On haemodialysis at a frequency of 3 sessions of 4 hours per week, for at least 3 months.
  • For patients of childbearing age, effective contraception (sexual abstinence, hormonal contraception, intrauterine device or hormone-releasing system, cap, diaphragm or sponge with spermicide, condom) for the entire duration of treatment is required. A blood pregnancy test (beta-human chorionic gonadotropin (HCG)) will be carried out at inclusion.
  • Patient affiliated to a social security scheme
  • Free, informed and written consent signed by the patient

Who cannot join

  • Residual diuresis > 100 mL per day
  • Pregnant or breast-feeding
  • Uncontrolled hypertension > 180/115 millimetre of mercury (mmHg)
  • Perdialytic hypotension requiring vascular filling > 100 mL during the last 3 sessions
  • Patients already on parenteral nutrition
  • Patients already on Vitamin K antagonists (VKA) (or prescribed less than one month before inclusion)
Show all 24Show fewer
  • Patients with allergy to heparin or requiring haemodialysis without anticoagulant (recent haemorrhage)
  • Criteria relating to products/procedures: Patient with
  • an allergy to egg, soya or peanut proteins or to one of the active ingredients or one of the excipients (glycerol, egg phospholipids for injection, a-tocopherol, sodium oleate (to adjust the pH), water for injection) of Médialipide
  • Severe hyperlipidaemia or severe lipid metabolism disorder characterised by hypertriglyceridaemia > 3 mmol/l
  • Sepsis < 1 month
  • Severe liver failure or cholestasis
  • Known severe coagulopathy
  • Acute thrombo-embolic events
  • Fat embolism
  • Aggravating bleeding diathesis,
  • Uncompensated metabolic acidosis.
  • Unstable circulatory state threatening the vital prognosis (collapse and shock),
  • Unstable metabolic conditions (e.g. severe post-traumatic syndrome, coma of unknown origin),
  • Acute phase of myocardial infarction or stroke,
  • Uncorrected disturbances of fluid and electrolyte balance, such as hypokalaemia and hypotonic dehydration.
  • Decompensated heart failure,
  • Acute pulmonary oedema.
  • Subject participating in another interventional study involving a drug with an exclusion period still in progress at inclusion.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

France1 site
  • Hopital Edouard Herriot

    Lyon, 69003

    Fitsum GUEBRE-EGZIABHER, PU,PH, 0472110260 ext. +33, fitsum.guebre-egziabher@chu-lyon.fr

    Laure-Anne RAILLON, 0633345131 ext. +33, laure-anne.raillon@chu-lyon.fr

Other trials in France

About this study

Current hemodialysis techniques fail to efficiently remove protein-bound uremic toxins (such as p-cresyl sulfate (p-CS) or indoxyl sulfate (IS)) due to their strong binding to serum albumin. The accumulation of these toxins in end-stage renal failure patients on hemodialysis is strongly suspected to contribute to the significant morbidity and mortality observed in this population.

Pre-clinical studies conducted previously showed that medium-chain fatty acids (such as sodium octanoate and decanoate), which are natural ligands of albumin, can effectively displace the binding of uremic toxins on serum albumin and thus promote their elimination during a hemodialysis session.

Read more

Medialipide® 20% (Braun) is an emulsion of medium chain triglycerides (MCT) (6 to 12 carbons) used in parenteral nutrition. Medialipide® constitutes a relevant clinical formulation for the administration of octanoate and decanoate because it contains 94% of sodium octanoate and decanoate.

In this study, a proof of concept intervention will be carried out to study the effect on the clearance uremic toxins clearance of the perfusion of Medialipide® emulsion (as a sodium octanoate and decanoate donor) in patients during their hemodialysis session compared to a control situation Sodium chloride (NaCl) 0,9%).

Being tested
Medialipide 20% perfusion, NaCl 0,9%, Blood sample
Keywords
End stage renal disease, Hemodialysis, Protein Bound Uremic Toxins, p-Cresyl Sulfate, Indoxyl Sulfate, Medium Chain fatty acids, Medium chain triglycerides, Octanoate, Decanoate, Medialipide
Medical subject headings
Kidney Failure, Chronic

What participants receive

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

  • Medialipide 20% perfusionDrug

    Each patient will receive during a 4 hours hemodialysis session a perfusion of Medialipide 20% at a rate of 0,11 g/kg/h. Medialipide will be perfused using the venous line connected to the hemodialysis machine.

  • NaCl 0,9%Drug

    Each patient will receive during a 4 hours hemodialysis session a perfusion of NACL 0,9% with a volume corresponding to the one of Medialipide 20%. NaCl 0,9% will be perfused using the venous line connected to the hemodialysis machine.

  • Blood sampleBiological

    Serial biological sampling for the measurement of different blood concentrations : electrolytes, serum protein , albumin, renal function (urea, creatinine), hemoglobin, hematocrit, liver test, lipid test, ketone bodies, 6 uremic toxins (including IS and p-CS), sodium octanoate and decanoate.

Study groups in NCT06595680
Study groupRoleWhat they receive
Medialipide 20% - NaCl 0,9%ExperimentalGroup 1 will receive during the first interventional hemodialysis session a perfusion of Medialipide 20% perfused at a rate of 0,11 gram/kilogram/hour (g/kg/h) during 4 hours. One week late, they will receive during the second interventional hemodialysis session a perfusion of NaCl 0,9% with a volume corresponding to the one of Medialipide also during 4 hours.
Receives: Drug: Medialipide 20% perfusion; Drug: NaCl 0,9%; Biological: Blood sample
NaCl 0,9% - Medialipide 20%ExperimentalGroup 2 will receive during the first interventional hemodialysis session a perfusion of NaCl 0,9% with a volume corresponding to the one of Medialipide during 4 hours. One week late, they will receive during the second interventional hemodialysis session a perfusion of Medialipide 20% perfused at a rate of 0,11 gram/kilogram/hour (g/kg/h) also during 4 hours.
Receives: Drug: Medialipide 20% perfusion; Drug: NaCl 0,9%; Biological: Blood sample

What is being measured

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

  1. Dialytic clearance of p-CS

    Dialysis clearance of p-CS (millilitre/minute) is defined as follows:

    Clearance = Qd X (C dialysate/C arterial) with Qd corresponding to the dialysate flow rate, C dialysate the concentration of p-CS in the dialysate, C arterial the concentration of p-CS in the blood sampled at the arterial port of the dialyser.

    Measured: until 240 minutes after haemodialysis session

Secondary outcomes (19)
  1. Reduction fraction (RF) of p-CS

    Reduction fraction will be measured in percentage Reduction fraction will be compared between the medialipide perfusion situation and the NACL 0,9% perfusion situation.

    RF (%) = (Concentration of p-CS at T0 - Concentration of p-CS at T240)/Concentration of p-CS at T0

    Measured: At 240 minutes after haemodialysis session

  2. Dialytic clearance of Indoxyl sulfate

    Dialysis clearance of Indoxyl sulfate (millilitre/minute) is defined as follows:

    Clearance = Qd X (C dialysate/C arterial) with Qd corresponding to the dialysate flow rate, C dialysate the concentration of Indoxyl sulfate in the dialysate, C arterial the concentration of Indoxyl sulfate in the blood sampled at the arterial port of the dialyser.

    Measured: until 240 minutes after haemodialysis session

  3. Reduction fraction (RF) of Indoxyl sulfate

    Reduction fraction will be measured in percentage Reduction fraction will be compared between the medialipide perfusion situation and the NACL 0,9% perfusion situation.

    RF (%) = (Concentration of Indoxyl sulfate at T0 - Concentration of Indoxyl sulfate at T240)/Concentration of Indoxyl sulfate at T0

    Measured: At 240 minutes after haemodialysis session

  4. Dialytic clearance of hippuric acid

    Dialysis clearance of hippuric acid (millilitre/minute) is defined as follows:

    Clearance = Qd X (C dialysate/C arterial) with Qd corresponding to the dialysate flow rate, C dialysate the concentration of hippuric acid in the dialysate, C arterial the concentration of hippuric acid in the blood sampled at the arterial port of the dialyser.

    Measured: until 240 minutes after haemodialysis session

  5. Reduction fraction (RF) of hippuric acid

    Reduction fraction will be measured in percentage Reduction fraction will be compared between the medialipide perfusion situation and the NACL 0,9% perfusion situation.

    RF (%) = (Concentration of hippuric acid at T0 - Concentration of hippuric acid at T240)/Concentration of hippuric acid at T0

    Measured: At 240 minutes after haemodialysis session

  6. Dialytic clearance of p-cresyl glucuronide

    Dialysis clearance of p-cresyl glucuronide (millilitre/minute) is defined as follows:

    Clearance = Qd X (C dialysate/C arterial) with Qd corresponding to the dialysate flow rate, C dialysate the concentration of p-cresyl glucuronide in the dialysate, C arterial the concentration of p-cresyl glucuronide in the blood sampled at the arterial port of the dialyser.

    Measured: until 240 minutes after haemodialysis session

  7. Reduction fraction (RF) of p-cresyl glucuronide

    Reduction fraction will be measured in percentage Reduction fraction will be compared between the medialipide perfusion situation and the NACL 0,9% perfusion situation.

    RF (%) = (Concentration of p-cresyl glucuronide at T0 - Concentration of p-cresyl glucuronide at T240)/Concentration of p-cresyl glucuronide at T0

    Measured: At 240 minutes after haemodialysis session

  8. Dialytic clearance of indol acetic acid

    Dialysis clearance of indol acetic acid (millilitre/minute) is defined as follows:

    Clearance = Qd X (C dialysate/C arterial) with Qd corresponding to the dialysate flow rate, C dialysate the concentration of indol acetic acid in the dialysate, C arterial the concentration of indol acetic acid in the blood sampled at the arterial port of the dialyser.

    Measured: until 240 minutes after haemodialysis session

  9. Reduction fraction (RF) of indol acetic acid

    Reduction fraction will be measured in percentage Reduction fraction will be compared between the medialipide perfusion situation and the NACL 0,9% perfusion situation.

    RF (%) = (Concentration of indol acetic acid at T0 - Concentration of indol acetic acid at T240)/Concentration of indol acetic acid at T0

    Measured: At 240 minutes after haemodialysis session

  10. Dialytic clearance of uric acid

    Dialysis clearance of indol acetic acid (millilitre/minute) is defined as follows:

    Clearance = Qd X (C dialysate/C arterial) with Qd corresponding to the dialysate flow rate, C dialysate the concentration of uric acid in the dialysate, C arterial the concentration of uric acid in the blood sampled at the arterial port of the dialyser.

    Measured: until 240 minutes after haemodialysis session

  11. Reduction fraction (RF) of uric acid

    Reduction fraction will be measured in percentage Reduction fraction will be compared between the medialipide perfusion situation and the NACL 0,9% perfusion situation.

    RF (%) = (Concentration of uric acid at T0 - Concentration of uric acid at T240)/Concentration of uric acid at T0

    Measured: At 240 minutes after haemodialysis session

  12. Dialytic clearance of 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid

    Dialysis clearance of indol acetic acid (millilitre/minute) is defined as follows:

    Clearance = Qd X (C dialysate/C arterial) with Qd corresponding to the dialysate flow rate, C dialysate the concentration of 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid in the dialysate, C arterial the concentration of 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid in the blood sampled at the arterial port of the dialyser.

    Measured: until 240 minutes after haemodialysis session

  13. Reduction fraction (RF) of 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid

    Reduction fraction will be measured in percentage Reduction fraction will be compared between the medialipide perfusion situation and the NACL 0,9% perfusion situation.

    RF (%) = (Concentration of 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid at T0 - Concentration of 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid at T240)/Concentration of 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid at T0

    Measured: At 240 minutes after haemodialysis session

  14. Tolerance of medialipide perfusion (%)

    Percentage of patients with the occurrence of at least one symptom including: nausea, emesis, headaches during the hemodialysis session

    Measured: until 240 minutes after haemodialysis session

  15. Safety of medialipide perfusion

    % of patients who presented one of the following event : hypertriglyceridemia > 4 gram/liter, alteration of liver test (cytolysis > 2 times the normal value, cholestasis > 2 times the normal value), or hemolysis.

    Measured: until 7 days after the last haemodialysis session

  16. octanoate blood concentration

    Measured: until 240 minutes after haemodialysis session

  17. decanoate blood concentration

    Measured: until 240 minutes after haemodialysis session

  18. clearance of octanoate

    Dialysis clearance of Indoxyl sulfate (millilitre/minute) is defined as follows:

    Clearance = Qd X (C dialysate/C arterial) with Qd corresponding to the dialysate flow rate, C dialysate the concentration of octanoate in the dialysate, C arterial the concentration of octanoate in the blood sampled at the arterial port of the dialyser.

    Measured: until 240 minutes after haemodialysis session

  19. clearance of decanoate

    Dialysis clearance of Indoxyl sulfate (millilitre/minute) is defined as follows:

    Clearance = Qd X (C dialysate/C arterial) with Qd corresponding to the dialysate flow rate, C dialysate the concentration of decanoate in the dialysate, C arterial the concentration of decanoate in the blood sampled at the arterial port of the dialyser.

    Measured: until 240 minutes after haemodialysis session

Timeline

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

  1. First posted19 Sep 2024
  2. Study start1 Jan 2025 (estimated)
  3. Primary completion22 Jan 2027 (estimated)
  4. Study completion22 Jan 2027 (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 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Crossover
Model description
Each patient will sequentially receive during two 4 hours hemodialysis session separated by one week a perfusion of Medialipide and a perfusion of NaCl 0,9%. The order of intervention will be determined by randomization.
Masking
None (open label)
Enrolment
12 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06595680
Sponsor's protocol ID
69HCL23_0031
Other IDs
2023-510406-41-00, 2023
Acronym
CLEARTOX
Status last verified
Sep 2024
First submitted
6 Sep 2024
Last updated
19 Sep 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Medialipide 20% perfusion, NaCl 0,9% and Blood sample in people with End Stage Renal Disease and Chronic Hemolysis, 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 5 inclusion and 24 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: opening soon, as of the sponsor's last update on 19 Sep 2024. 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.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

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?

Contact Fitsum GUEBRE EGZIABHER, PU,PH (0472110260 ext. +33, fitsum.guebre-egziabher@chu-lyon.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Dialytic clearance of p-CS (time frame: until 240 minutes after haemodialysis session). 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 19 Sep 2024.

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