Effect of the SGLT2 inhibitor empagliflozin in patients with euvolemic and hypervolemic hyponatremia – a multicentric randomized double-blind placebo-controlled trial (the EMPOWER Study)
试验速览
- 阶段
- 2 期
- 状态
- 招募中
- 发起方
- 入组人数
- 60
- 试验地点
- 2
- 主要终点
- The short-term outcome is the change in average daily area under the curve (AUC) for plasma sodium concentration from baseline (day 0) to day 4.
研究概览
简要总结
To investigate whether a treament with empagliflozin (Jardiance)® 25mg once daily results in a stronger average daily increase in plasma sodium concentration from baseline (day 0) to day 4 and from baseline (day 0) to day 30 in patients with euvolemic or hypervolemic hyponatremia compared to placebo.
入排标准
- 年龄范围
- 18 years 至 65+ years(18-64 Years, 65+ Years)
- 接受健康志愿者
- 否
入选标准
- •Adult patients, aged ≥18 years
- •Chronic eu- OR hypervolemic non hyperosmolar (<300 mOsm/kg) hyponatremia (heparin plasma sodium <130mmol/L on day of inclusion)
排除标准
- •Known hypersensitivity or allergy to class of drugs or the investigational product
- •Contraindication for lowering blood pressure
- •Diabetes mellitus type 1 or pancreatic diabetes mellitus
- •Treatment with SGLT2 inhibitors, lithium chloride, vaptans, demeclocycline or urea on inclusion day
- •Severe immunosuppression (leucocytes <2 G/l)
- •Peripheral arterial disease stage III-IV of the Fontaine Classification
- •Fasting or other reasons preventing medication intake
- •Participation in another intervention study
- •Pregnancy, breastfeeding, intention to become pregnant during the course of the study or lack of safe contraception
- •End of life care
- •Severe symptomatic hyponatremia in need of treatment with 3% NaCl-solution or in need of intensive/intermediate care treatment at time of inclusion
- •Clinical hypovolemia
- •Severe reduction of eGFR <20 mL/min/1,73 m2 (KDIGO G4 and G5) or end stage renal disease
- •Chronic liver insufficiency with Child Pugh Score ≥10 or decompensated liver cirrhosis (jaundice, hepatorenal syndrome, encephalopathy, bleeding, …)
- •Hepatic impairment defined as aspartate transaminase (AST) or alanine transaminase (ALT) >3x the upper limit of normal (ULN); or total bilirubin >2x ULN at time of enrolment
- •Uncontrolled hypothyroidism
- •Uncontrolled adrenal insufficiency
- •Systolic blood pressure <90mmHg
结局指标
主要结局
The short-term outcome is the change in average daily area under the curve (AUC) for plasma sodium concentration from baseline (day 0) to day 4.
The short-term outcome is the change in average daily area under the curve (AUC) for plasma sodium concentration from baseline (day 0) to day 4.
The long-term outcomes is the change in plasma sodium concentration from baseline to day 30
The long-term outcomes is the change in plasma sodium concentration from baseline to day 30
次要结局
- Short (day 1, day 2, day 3, day of discharge term course of plasma sodium level
- Urine sodium, eGFR, serum and urine -osmolality, -potassium, -creatinine, -urea, -uric acid, -glucose, -CRP at baseline, on day 4, and day 30
- Blood and urine aliquots on day 0, day 1, day 4 and day 30, including predefined analysis: markers of salt-water balance (MR-proANP, NT-proBNP, copeptin, aldosteron, renin) and markers of bone metabolism (procollagen type I N propeptide (P1NP) and serum C telopeptide (CTX)
- Daily fluid intake (mL) from baseline (day 0) to day 4
- Change in body weight (including AUC 24h – 4 days), blood pressure and heart rate twice a day at baseline (day 0) and on day 1 and then once a day on day 2, day 3, day 4, and day 30
- Course of thirst and symptoms of hyponatremia assessed on a yes or no basis: headache, vertigo and nausea at baseline (day 0), on day 4 and day 30
- Course of general well-being rated by patients on a visual analogue scale (VAS) reaching from 0 (no well-being) to 10 (excellent well-being) at baseline (day 0), on day 4 and day 30
- Change in quality of life assessed by the EQ-5D-5L questionnaire at baseline (day 0), on day 4 and day 30
- Change in neurocognitive functions assessed by the MoCA Test and the Trail Making Test A and B at baseline (day 0), on day 4 and day 30
- Change in gait stability assessed by the Timed Up and Go Test at baseline (day 0), on day 4 and day 30
- Fall as admission (co)-diagnosis at baseline or as re-admission (co)-diagnosis during treatment period (Day 0 – Day 30)
- Incidence of fractures during the twelve months prior to treatment start, fractures as admission (co)-diagnosis at baseline or as re-admission (co)-diagnosis during treatment period (Day 0 – Day 30)
- Grip strength measured with a hand dynamometer at baseline (day0), on day 4 and day 30
- Percentage of patients with plasma sodium concentration that has normalized after 4, on day of discharge) and after 30 days of treatment
- Duration (days) until normonatremia has been reached
- Recurrence-rate of hyponatremia during treatment period (Day 0 – Day 30)
- Recurrence of hyponatremia after treatment completion according to plasma sodium measurement at follow up (day 37 +21/- 3 days)
- Need for additional hyponatremia treatment and treatment escalation (e.g. administration of 3% NaCl infusion) during treatment period (Day 0 – Day 30)
- Rate of ICU-admissions during treatment period (Day 0 – Day 30)
- Length of hospital stay (days)
- Rate of readmission due to hyponatremia and other causes during treatment period (Day 0 – Day 30)
- Baseline characteristics including age, gender, medical history, medication, date of hospitalisation and admission diagnosis.
研究者
Prof. Mirjam Christ-Crain
Scientific
Universitaetsspital Basel
