Wearable Cardioverter Defibrillator in Hemodialysis Patients (WED-HED) Study

Not Applicable

Terminated

• Conditions: Sudden Cardiac Death; Sudden Cardiac Arrest
• Interventions: Device: Wearable Cardioverter Defibrillator

• Registration Number: NCT02481206
• Lead Sponsor: Zoll Medical Corporation

Brief Summary

A multi-center, prospective, randomized controlled clinical trial with 1:1 assignment of treatment and control. This study will evaluate the impact of wearable cardioverter defibrillator use on sudden cardiac death in incident hemodialysis patients. The study will enroll up to 2,600 subjects. A maximum of 200 sites in the USA will be used for enrollment.

Detailed Description

Objective:

To study the impact of wearable cardioverter defibrillator (WCD) use on sudden cardiac death in hemodialysis patients.

Study Population:

Participants will be patients beginning hemodialysis (\<2 months from initiation) who are ≥ 50 years old.

Intervention:

A WCD will be used for protection against sudden cardiac death (SCD).

Study Design:

The study will be a multi-center, prospective, randomized controlled trial with 1:1 assignment of treatment and control.

Study Size:

The study will enroll up to 2,600 subjects. A maximum of 200 sites will be used for enrollment.

Study Timeline

• Study Start: 2015-06
• Study First Submitted: 2015-06-08
• Study First Submitted QC: 2015-06-22
• Study First Posted: 2015-06-25
• Primary Completion: 2017-12
• Study Completion: 2017-12
• Results First Submitted: 2019-09-18
• Status Verified: 2020-12
• Results First Submitted QC: 2020-12-23
• Last Update Submitted: 2020-12-23
• Results First Posted: 2021-01-19
• Last Update Posted: 2021-01-19

Recruitment & Eligibility

• Status: TERMINATED
• Sex: All
• Target Recruitment: 66

Inclusion Criteria

• End stage renal disease (ESRD) requiring hemodialysis
• On hemodialysis for ≤ 2 calendar months or scheduled to begin hemodialysis within 1 calendar month
• ≥50 years of age
• Documented Ejection Fraction > 35% within the previous calendar year
• • If the patient has been hospitalized for a myocardial infarction or heart failure decompensation, the Ejection Fraction measurement must have occurred during the last hospitalization or after discharge

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Exclusion Criteria

• Is receiving or will receive hemodialysis due to acute kidney injury and is not expected to receive subsequent chronic hemodialysis therapy
• Patient has an active ICD
• Patient has a unipolar pacemaker
• Patient has physical or mental conditions preventing him/her from interacting with or wearing a Wearable Cardioverter Defibrillator
• Patient has a chest circumference at the level of the xiphoid of < 24 inches
• Patient has a chest circumference at the level of the xiphoid of > 56 inches
• Patient has an advance directive prohibiting resuscitation
• Patient has cancer or other terminal disease (excluding ESRD) with expected survival less than 6 months
• Patient is medically unstable for reasons not specifically related to kidney disease
• Patient is scheduled for live-donor kidney transplantation within 6 calendar months
• Patient is unable to consent

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Wearable Cardioverter Defibrillator	Wearable Cardioverter Defibrillator	End Stage Renal Disease (ESRD) patients beginning hemodialysis will use a Wearable Cardioverter Defibrillator for six months

Primary Outcome Measures

Name	Time	Method
Number of Participants Experiencing Sudden Cardiac Death (SCD) Mortality as Assessed by Intention-to-Treat Analysis	6 months	This is an intention to treat analysis of SCD, with subjects analyzed by randomization assignment regardless of treatment crossovers or noncompliance. For witnessed deaths, SCD will be defined as an unexpected, non-traumatic, non-self-inflicted fatality in otherwise stable subjects who die within one hour of the onset of the terminal symptoms (dialysis noncompliance or withdrawal subjects excluded). Subjects dying more than one hour after a sudden cardiac arrest from a ventricular arrhythmia will be designated as non-sudden death due to ventricular arrhythmia. For unwitnessed deaths, if the subject is found dead within 24 hours of being well the death will be designated as SCD. If more than 24 hours has passed the death will be designated as indeterminate.

Secondary Outcome Measures

Name	Time	Method
Kidney Disease Quality of Life 36-item Short Form Survey (KDQOL-36) As Assessed by As-treated Analysis at 2 Months	2 months	A self completed questionnaire, the KDQOL-36 has five scales scored from 0 to 100, with higher numbers considered better (i.e., better health related quality of life). For reporting the total score, the 5 scales were averaged for each subject, creating a 0 to 100 range with higher scores considered better.
Kidney Disease Quality of Life 36-item Short Form Survey (KDQOL-36) As Assessed by As-treated Analysis at 6 Months	6 months	A self completed questionnaire, the KDQOL-36 has five scales scored from 0 to 100, with higher numbers considered better (i.e., better health related quality of life). For reporting the total score, the 5 scales were averaged for each subject, creating a 0 to 100 range with higher scores considered better.
Total Mortality	6 months	All cause mortality
Sudden Cardiac Death (SCD) Mortality Assessed by As-treated Analysis	6 months	This is an as-treated analysis of SCD. For witnessed deaths, SCD will be defined as an unexpected, non-traumatic, non-self-inflicted fatality in otherwise stable subjects who die within one hour of the onset of the terminal symptoms (dialysis noncompliance or withdrawal subjects excluded). Subjects dying more than one hour after a sudden cardiac arrest from a ventricular arrhythmia will be designated as non-sudden death due to ventricular arrhythmia. For unwitnessed deaths, if the subject is found dead within 24 hours of being well the death will be designated as SCD. If more than 24 hours has passed the death will be designated as indeterminate.
Clinical Status of Sudden Cardiac Arrest (SCA) Survivors	48 hours after SCA	This is an intention to treat analysis of the clinical status of participants who experience an SCA and survive at least 48 hours, as determined by the Glasgow Coma Scale (numeric scale is 3 to 14, higher is better).
Incidence of Potentially Life Threatening Arrhythmias	6 months	In the Wearable Cardioverter Defibrillator arm, determine the incidence of potentially life-threatening arrhythmias while the device was worn. Life-threatening arrhythmias are defined as ventricular tachycardia over 150 beats per minute and ventricular fibrillation (VTVF).
Risk of Inappropriate Therapy	6 months	Device reported inappropriate shocks/treatments during patient wear time in experimental device wearing arm
Compliance With Wearable Cardioverter Defibrillator Therapy	6 months	In the group randomized to receive a Wearable Cardioverter Defibrillator, the device recorded time of use will be used to determine compliance measured as a % of time available for use.