DRAFFT Trial: Delayed Renal Allograft Function and Furosemide Treatment: A Randomized Prospective Double-blinded Placebo-controlled Clinical Pilot Trial
试验速览
- 阶段
- 2 期
- 状态
- 撤回
- 试验地点
- 1
- 主要终点
- The percent of participants receiving a deceased donor kidney that develop Delayed Graft Function (DGF), defined as the need to undergo Renal Replacement Therapy (RRT) within the first seven days after renal transplant.
研究概览
简要总结
This study will be a randomized prospective double-blind placebo-controlled clinical pilot trial. This will be a single center project that will take place at Loma Linda University Medical Center. All adult kidney recipients will be informed of the study prior to operation. The Nephrology fellows or attending physicians will attempt to obtain informed consent from all eligible patients, pre-transplant. Those patients who consent will be screened post operation for enrollment. Patients who do not meet all eligibility criteria and/or who meet some exclusion criteria will be deemed ineligible for the trial, and will be excluded. The Nephrology and Transplant teams will be blinded of patient assignment and only the pharmacy will know the patient's assignment.
详细描述
- Background/ Rationale Kidney Transplantation is a lifesaving modality in patients with end-stage renal disease (ESRD), and the numbers of transplants have been skyrocketing since the first successful trials. In 2013 alone, there were over 18,000 kidney transplants done in the United States of America. Of those, 11,161 were from a deceased donor (NKUDIC 2011, One Legacy 2014, USRDS 2013). One common complication of renal transplants is Delayed Graft Function (DGF). DGF is a serious complication, which is best defined as the need for renal replacement therapy, such as dialysis, within the first week after renal transplant (Mallon et al. 2013). DGF greatly increases the risk of acute and chronic transplant rejection, which decreases patient survival and quality of life, for those patients who do survive (Perico et al. 2004, Weber et al. 2014). Additionally, the rate of DGF is highest in patients who have received deceased donor transplants (One Legacy 2014). Therefore, it is crucial to the well-being of this large population to reduce the incidence of DGF. Our approach is to investigate current treatment modalities for patients post-deceased donor renal transplant, to understand how best to prevent DGF before it even starts. Currently, administration of loop diuretics such as furosemide is a common practice in order to prevent and treat oliguria in renal transplant patients. However, only animal models have been able to show a benefit in treating acute kidney injury (AKI), which occurs in the transplant kidney due to cold ischemia time, with furosemide. There is a lack of evidence that furosemide use leads to improved patient outcomes in patients with AKI (Nadeau-Fredette et al. 2013). Given that side effects of furosemide administration include ototoxicity, hypotension, electrolyte abnormalities, and hypersensitivity reactions, and the investigators hypothesize, may not significantly reduce the incidence of DGF from placebo, it is important to investigate if the benefits of furosemide administration truly outweigh the harms (Strom et al. 2003). The investigators intend to achieve this by way of a randomized, double-blinded, pilot clinical trial in adult oliguric patients, post-deceased donor renal transplant.
- Objectives
I.Primary Objective:
i.To test the hypothesis that DGF rate is the same in adult oliguric post-deceased donor renal transplant patients administered furosemide vs. placebo.
II.Secondary Objectives:
i.To compare the following within the two treatment groups:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Triple (Participant, Care Provider, Investigator)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age ≥ 18 years
- •Patient with ESRD who has been on RRT (Hemodialysis or Peritoneal dialysis)
- •Recipient of deceased donor kidney transplant
- •Urine output less than 0.5 mL/kg/h before transplant
- •Patient consents to the study
- •Patient is not allergic to furosemide or sulfa
- •English or Spanish speaking patient
- •Patient is oliguric (urine output less than 0.5mL/kg/h, as per AKIN criteria) or anuric (urine output less than 10 mL in 6 hours post-transplant or 2 mL/h) in the first 6 hours post kidney transplant
排除标准
- •Recipients of a living donor kidney transplant
- •Patients who do not consent for the study
- •Patients age <18 years
- •Patients who are allergic to furosemide or sulfa containing medications
- •Non-oliguric patients
- •Patients who require immediate dialysis within 6 hours of the transplant (before enrollment)
- •Patients with renal ischemia due to vascular compromise that has been confirmed with Doppler Ultrasound right after transplant as per standard of care
- •Patients who return to the operating room due to complications within 24 hours
- •Simultaneous multi-organ transplant recipients
- •Hypotensive patients with BP <90/60 or MAP <60 mmHg
- •Patients who are on vasopressors at any time during study period
- •Non-English or Spanish speaking patient
研究组 & 干预措施
Furosemide
Patients assigned to the furosemide infusion group will receive furosemide infusions, as outlined in figure 2. This has been adapted from Ostermann et al. (2007) and the SPARK study protocol (Bagshaw et al. 2010). Furosemide will be prepared in bags that contain 1000 mg of furosemide per 250 mL of saline reaching a concentration of 4 mg/mL. All medication and placebo bags will have no identifiers that show what type of drug is being administered, for blinding purposes. Medication and placebo bags will have randomly generated study identifier numbers. The protocol in figure 2 will be followed to achieve a total urine output of 1mL/kg/h. The furosemide infusion rate will not exceed 4mg/min IV as this is the maximum set by the manufacturer.
干预措施: Furosemide (Drug)
Saline
All patients assigned to the saline group will receive saline that is equal in volume as compared to the treatment group. The amount of saline given to the patients in the placebo arm is so small that its effect on these patients is negligible. All other aspects of care for the enrolled patient will be managed per primary team and any consultants.
干预措施: Placebo (Drug)
结局指标
主要结局
The percent of participants receiving a deceased donor kidney that develop Delayed Graft Function (DGF), defined as the need to undergo Renal Replacement Therapy (RRT) within the first seven days after renal transplant.
时间窗: 7 Days
次要结局
- 30-day, 90-day and 12-month creatinine levels and estimated Glomerular Filtration Rate (eGFR)(30 days, 90 days and 12 months post-transplant)
- The need for Renal Replacement Therapy (RRT) 30 days, 90 days and 12 months post-transplant(30 days, 90 days and 12 months post-transplant)
- The time from transplant to Delayed Graft Function (DGF) development(24 hours)
- The incidence of Delayed Graft Function (DGF)(24 Hours)
- Overall hospital length of stay(30 days)
- The incidence of primary graft non-function(12 months)
- The Kidney Profile Donor Index (KDPI) score in relation to primary graft non-function(12 months)