RAS Quantification in Patients With Aliskiren or Candesartan

NCT01827202 | Completed Phase 4 DMC

• 1 other identifier: EK-Nr. 011/2012
• Study Type: interventional
• Target: 24
• Locations: 1 country
• Sites: 1

Brief Summary

Forced blockade of the renin-angiotensin-system (RAS) by using direct renin inhibition (DRI) has long been propagated to effectuate beneficial outcomes. However, recent large clinical trials have outlined harmful effects for DRI in combination with other forms of RAS blockade. To date, information regarding DRI as RAS-blocking monotherapy is very limited. Furthermore, it remains to be elucidated how DRI and angiotensin receptor blockers affect the so-called 'classical' and 'alternative' RAS molecularly. As components of the 'alternative' RAS (e.g. Ang 1-7) have moved into research focus, it would be of importance to determine angiotensin regulation with medical RAS blockade. In this prospective, single-center randomized trial over 10 weeks, 24 patients with chronic kidney disease (CKD) stage III-IV (eGFR 15-59 ml/min) will be randomized to take either aliskiren (up to 300 mg per day) or candesartan (up to 16 mg per day) after a two week run-in phase where all RAS-blockers are eliminated. The investigators will then employ a novel mass spectrometry-based quantification method (after run-in and 10 weeks) to capture the concentrations of ten different angiotensin peptides (including angiotensin I and II, angiotensin 1-7 and angiotensin 1-5). The investigators hypothesize that significant differences exist between angiotensin levels in CKD patients with DRI compared to angiotensin receptor blockers. Specifically, the investigators expect to determine the regulation of the alternative RAS represented by angiotensin 1-7 with proximal versus distal blockade of the system. Our data might contribute to a more profound understanding of results from registries and clinical trials beyond the clinical effects of RAS blockade. Further, the study's results might help to individualize and optimize RAS-blocking therapy strategies in CKD patients.

Conditions

Hypertension; Chronic Kidney Disease; Proteinuria

Keywords

renin-angiotensin-system; RAS blockade

Outcome Measures

Primary Outcomes (1)

• Mass spectrometry RAS peptide quantification

  Quantitative RAS peptide changes determined by mass spectrometry after a 2-month treatment with aliskiren or candesartan

  2 months

Secondary Outcomes (2)

• Blood pressure

  2 months

• Proteinuria

  2 months

Study Arms (2)

Aliskiren

ACTIVE COMPARATOR

After a two-week phase where all RAS blockade is eliminated, patients in this arm will commence taking aliskiren 150 mg once daily for 4 weeks. Thereafter, the dose will be increased to 300 mg once daily for another 4 weeks.

Other: RAS blockade discontinuation; Drug: Aliskiren

Candesartan

ACTIVE COMPARATOR

After a two-week phase where all RAS blockade is eliminated, patients in this arm will commence taking candesartan 8 mg once daily for 4 weeks. Thereafter, the dose will be increased to 16 mg once daily for another 4 weeks.

Other: RAS blockade discontinuation; Drug: Candesartan

Interventions

RAS blockade discontinuation OTHER

In the initial two weeks of the study, all RAS blockade will be eliminated from the subjects' antihypertensive regimen

Aliskiren; Candesartan

Aliskiren DRUG

Also known as: Rasilez

Aliskiren

Candesartan DRUG

Also known as: Atacand

Candesartan

Eligibility Criteria

• Age: 18 Years - 99 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Chronic kidney disease stages III-IV (defined by modification of diet in renal disease (MDRD) formula)
• Urinary albumin to creatinine ratio (UACR) \>300mg/g, UACR \>200mg/g if already receiving RAS blockade
• Arterial hypertension

You may not qualify if:

• Age \<18 years
• Diabetes mellitus type 2 (defined by WHO criteria)
• Chronic kidney disease stage V (end-stage renal disease)
• UACR \>3500mg/g
• Severe hypertension (systolic blood pressure \>180mmHg)
• Pregnancy

Sponsors & Collaborators

• Medical University of Vienna: lead

Study Sites (1)

Medical University of Vienna, Department of Internal Medicine III, Division of Nephrology and Dialysis

Vienna, Vienna, 1090, Austria

Location

MeSH Terms

Conditions

Hypertension; Renal Insufficiency, Chronic; Proteinuria

Interventions

aliskiren; candesartan; candesartan cilexetil

Condition Hierarchy (Ancestors)

Vascular Diseases; Cardiovascular Diseases; Renal Insufficiency; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Urination Disorders; Urological Manifestations; Signs and Symptoms

Study Officials

• Marcus D Saemann, MD

  Medical University of Vienna

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SCREENING
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assoc. Prof. Priv.-Doz. Dr.med.univ.

Study Record Dates

• First Submitted: April 4, 2013
• First Posted: April 9, 2013
• Study Start: December 1, 2012
• Primary Completion: February 1, 2016
• Study Completion: February 1, 2016
• Last Updated: March 16, 2016

Record last verified: 2016-03

Locations

AU (1)