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Trial registered on ANZCTR
Registration number
ACTRN12610000044022
Ethics application status
Approved
Date submitted
14/01/2010
Date registered
14/11/2005
Date last updated
10/07/2012
Type of registration
Retrospectively registered
Titles & IDs
Public title
Intensive versus Conventional Renal Support in Acute Renal Failure
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Scientific title
In critically ill patients with acute renal failure does a strategy of intensive renal replacement therapy as compared to a strategy of less-intensive renal replacement therapy decrease all-cause mortality at 60 days
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Secondary ID [1]
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ClinicalTrials.gov NCT00076219
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Universal Trial Number (UTN)
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Trial acronym
ATN Study
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Acute Renal Failure
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Condition category
Condition code
Renal and Urogenital
256702
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0
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Kidney disease
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Intensive renal replacement therapy defined as: Daily (except Sunday) intermittent hemodialysis when hemodynamically stable and
Continuous venovenous hemodiafiltration at 35 mL/kg per hour or daily (except Sunday) sustained low-efficiency dialysis when hemodynamically unstable
Duration of intervention: Up to 28 days or until recovery of kidney function, withdrawal of life support, death or discharge from acute care
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Intervention code [1]
255809
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Treatment: Other
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Comparator / control treatment
Less-intensive renal replacement therapy defined as: Evenry-other day (except Sunday) intermittent hemodialysis when hemodynamically stable and
Continuous venovenous hemodiafiltration at 20 mL/kg per hour or every-other day (except Sunday) sustained low-efficiency dialysis when hemodynamically unstable
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Control group
Active
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Outcomes
Primary outcome [1]
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All-cause mortality as assessed from medical records
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Assessment method [1]
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Timepoint [1]
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60 days following randomization
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Secondary outcome [1]
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Recovery of renal function defined as a measured creatinine clearance of > 20 mL/min
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Assessment method [1]
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Timepoint [1]
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28 days after randomization
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Secondary outcome [2]
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All-cause in-hosptial mortality assessed from hospital medical records
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Assessment method [2]
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Timepoint [2]
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60 days following randomisation
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Secondary outcome [3]
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All-cause mortality assessed from follow-up telephone interview and/or vital status registry
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Assessment method [3]
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Timepoint [3]
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1 year following randomization
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Eligibility
Key inclusion criteria
1. Acute renal failure (ARF) clinically consistent with a diagnosis of acute tubular necrosis (ATN), defined as: clinical setting of acute ischemic or nephrotoxic injury; and oliguria (average urine output < 20 mL/hr) for > 24 hours or an increase in serum creatinine of at least 2.0 mg/dL (men)/1.5 mg/dL (women) over a period of no more than 4 days
2. Plan for renal replacement therapy
3. Receiving care in critical care unit
4. At least one non-renal organ failure (Sequential Organ Function Assessment organ system score of at least 2) or the presence of sepsis
5. Age of at least 18 years
6. Informed consent
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Baseline chronic kidney disease (CKD) defined by serum creatinine > 2 mg/dL (men) / 1.5 mg/dL (women)
2. Acute renal failure (ARF) due to an etiology other than acute tubular necrosis (ATN)
3. More than 72 hours since meeting BOTH of the following: Definition of ARF as specified in the inclusion criteria and a blood urea nitrogen (BUN) > 100 mg/dL
4. More than 1 hemodialysis treatment or more than 24 hours of continuous renal replacement therapy (CRRT)
5. History of kidney transplantation
6. Weight > 128.5 kg
7. Pregnancy
8. Prisoner
9. Non-candidacy for renal replacement therapy (RRT)
10. Not expected to survive 28-days due to underlying chronic medical condition
11. Moribund sate or comfert measures only (CMO) status
12. Participation in a concurrent interventional trial
13. Patient refusal
14. Physician refusal
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
3/11/2003
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
1164
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
1993
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United States of America
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State/province [1]
1993
0
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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US Department of Veterans Affairs
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Address [1]
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1722 I St., NW
Washington, DC 20006
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Country [1]
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United States of America
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Funding source category [2]
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Government body
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Name [2]
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National Institutes of Health
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Address [2]
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6707 Democracy Boulevard
Bethesda, MD 20892
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Country [2]
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United States of America
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Primary sponsor type
Government body
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Name
US Department of Veterans Affairs Cooperative Studies Program
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Address
1722 I St., NW
Washington, DC 20006
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Country
United States of America
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Secondary sponsor category [1]
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Government body
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Name [1]
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National Institutes of Health
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Address [1]
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6707 Democracy Boulevard
Bethesda, MD 20892
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Country [1]
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United States of America
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Cooperative Studies Program Human Rights Committee
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Ethics committee address [1]
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Cooperative Studies Program Coordinating Center VA Connecticut Healthcare System 950 Campbell Avenue West Haven, CT 06516
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Ethics committee country [1]
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United States of America
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Date submitted for ethics approval [1]
258386
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Approval date [1]
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16/07/2002
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Ethics approval number [1]
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Summary
Brief summary
The Acute Renal Failure Trial Network (ATN) Study is a clinical research study that is jointly sponsored by the Department of Veterans Affairs and the National Institutes of Health in order to determine if an increased dose of dialysis will decrease mortality rates in patients with acute renal failure (ARF). The ATN Study is being conducted using a network of VA and non-VA medical centers across the United States. The study is comparing two strategies for the management of renal replacement therapy in critically ill patients with ARF. Both treatment strategies employ both conventional intermittent hemodialysis in patients whose blood pressure is stable and either sustained low-efficiency dialysis (SLED) or continuous renal replacement therapy (CRRT) in patients who are hemodynamically unstable. In one strategy, intermittent hemodialysis and SLED are provided three-times per week and CRRT is dosed to provide a clearance of approximately 20 mL/kg/hour. In the other treatment arm, intermittent hemodialysis and SLED are provided six-times per week and CRRT is dosed to provide a clearance of approximately 35 mL/kg/hour. The ATN study began enrolling patients in November 2003 and closed after 44 months on July 2, 2007. The total enrollment was 1124 subjects. All-cause mortality was 53.6% with intensive therapy and 51.5% with less-intensive therapy (odds ratio, 1.09; 95% confidence interval, 0.86 to 1.40; P = 0.47). There was no significant difference between the two groups in the duration of renal replacement therapy or the rate of recovery of kidney function or nonrenal organ failure.
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Trial website
http://www.ATNStudy.org
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Trial related presentations / publications
1. Palevsky PM, O'Connor T, Zhang JH, Star RA, Smith MW for the VA/NIH Acute Renal Failure Trial Network. Design of the VA/NIH Acute Renal Failure Trial Network (ATN) study: Intensive versus conventional renal support in acute renal failure. Clinical Trials 2005; 2:423-435. 2. Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RMH, Smith MW, Swanson KM, Thompson BT, Vijayan A, Watnick S, Star RA, Peduzzi P for the VA/NIH Acute Renal Failure Trial Network. Intensity of renal support critically ill patients with acute kidney injury. New England Journal of Medicine 2008; 359:7-20. 3. Palevsky PM, O’Connor TZ, Chertow GM, Crowley ST, Zhang JH, Kellum JA for the VA/NIH Acute Renal Failure Trial Network. Intensity of renal replacement therapy in acute kidney injury: Prospective from within the Acute Renal Failure Trial Network Study. Critical Care 2009; 13:310.
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Dr, Paul Palevsky
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Address
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Chief, Renal Section, Medical Service, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA 15240, USA
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Country
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United States of America
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Phone
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+1 412 360-3932
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Dr. Paul Palevsky
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Address
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Chief, Renal Section, Medical Service, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA 15240, USA
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Country
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United States of America
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Phone
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+1 412 360-3932
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Fax
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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