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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT01737697
Registration number
NCT01737697
Ethics application status
Date submitted
19/11/2012
Date registered
29/11/2012
Date last updated
12/10/2018
Titles & IDs
Public title
Safety & Efficacy of Zirconium Silicate in Mild to Moderate Hyperkalemia
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Scientific title
Multicenter, Two-phase, Multi-dose, Prospective, Randomized, Double-blind, Placebo-Controlled Study of Safety and Efficacy of Microporous, Fractionated, Protonated Zirconium Silicate in Mild to Moderate Hyperkalemia
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Secondary ID [1]
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ZS-003
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Hyperkalemia
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Condition category
Condition code
Metabolic and Endocrine
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Other metabolic disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Zirconium silicate (acute phase)
Treatment: Drugs - Zirconium silicate (subacute phase)
Treatment: Drugs - Placebo (acute phase)
Treatment: Drugs - Placebo ( subacute phase)
Experimental: Zirconium silicate (acute phase) - Randomized oral doses (1.25g, 2.5g, 5g, and 10g) of microporous, fractionated, protonated zirconium silicate administered 3 times (tid) daily with meals for 48 hours.
Placebo comparator: Placebo (acute phase) - Placebo ( silicified microcrystalline cellulose) randomized to mimic doses of experimental drug administered 3 times (tid) daily with meals.
Experimental: Zirconium silicate (subacute phase) - Randomized oral doses (1.25g, 2.5g, 5g, and 10g) of microporous, fractionated, protonated zirconium silicate administered once a day prior to the morning meal for 12 days.
Placebo comparator: Placebo (subacute phase) - Placebo (silicified microcrystalline cellulose) randomized to mimic doses of experimental drug administered once a day (qd) prior to the morning meal for 12 days.
Treatment: Drugs: Zirconium silicate (acute phase)
Randomized oral doses (1.25g, 2.5g, 5g, and 10g) of microporous, fractionated, protonated zirconium silicate administered 3 times (tid) daily with meals for 48 hours.
Treatment: Drugs: Zirconium silicate (subacute phase)
Randomized oral doses (1.25g, 2.5g, 5g, and 10g) of microporous, fractionated, protonated zirconium silicate administered once a day prior to the morning meal for 12 days.
Treatment: Drugs: Placebo (acute phase)
Randomized to mimic doses of experimental drug administered 3 times (tid) daily with meals for 48 hours during the acute phase.
Treatment: Drugs: Placebo ( subacute phase)
Randomized to mimic doses of experimental drug administered once a day prior to the morning meal for 12 days during the subacute phase.
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Exponential Rate of Change in Serum Potassium (S-K) Levels During the Initial 48 Hours of Study Drug Treatment.
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Assessment method [1]
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Timepoint [1]
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Through 48 hours acute phase
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Primary outcome [2]
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Exponential Rate of Change in S-K Levels in the Subacute Phase.
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Assessment method [2]
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Timepoint [2]
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Through 12 days subacute phase (Day 3 through Day 15)
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Secondary outcome [1]
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Percentage of Subjects Who Achieve Normalization in S-K Levels After 48 Hours of Treatment
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Assessment method [1]
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Timepoint [1]
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Through 48 hours acute phase
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Secondary outcome [2]
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Mean Change From Baseline in S-K at All Time Points Acute Phase
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Assessment method [2]
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Mean change from baseline in S-K at all time points over initial 48 hours
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Timepoint [2]
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Through 48 hours acute phase. In particular, at Baseline; 1, 2, 4 hour Post 1st Dose on Study Day 1; 0 hour Pre-dose, 1, 4 hour Post 1st Dose on Study Day 2; and 0 hour Pre-dose on Study Day 3.
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Secondary outcome [3]
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Mean Percent Change From Baseline in S-K Change at All Time Points Acute Phase
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Assessment method [3]
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Mean percent change from baseline in S-K at all time points over initial 48 hours
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Timepoint [3]
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Through 48 hours acute phase. In particular, 1, 2, 4 hour Post 1st Dose on Study Day 1; 0 hour Pre-dose, 1, 4 hour Post 1st Dose on Study Day 2; and 0 hour Pre-dose on Study Day 3.
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Secondary outcome [4]
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Time Subjects Remain Normokalemic (Subacute Phase)
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Assessment method [4]
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Time (number of days) subjects remain normokalemic (3.5 - 5.0 mmol/l) subacute phase
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Timepoint [4]
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Through 18 days (12 days treatment, 6 days follow-up) of subacute phase
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Secondary outcome [5]
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Percentage of Subjects Within Each Treatment Group Who Retained Normal S-K Values at End of Subacute Phase
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Assessment method [5]
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Percentage of subjects within each treatment group who retained normal S-K values (values between 3.5-5.0 mmol/L) at end of subacute phase
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Timepoint [5]
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Through 18 days of subacute phase (12 days treatment, 6 days follow-up)
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Secondary outcome [6]
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Mean Change From Subacute Baseline in Serum Potassium at All Time Points.
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Assessment method [6]
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Mean change from subacute baseline in serum potassium at all time points during subacute phase
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Timepoint [6]
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Through 18 days of subacute phase (12 days treatment, 6 days follow-up)
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Secondary outcome [7]
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Mean Percent Change From Subacute Baseline in Serum Potassium at All Time Points.
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Assessment method [7]
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Mean percent change from subacute baseline in serum potassium at all time points during subacute phase
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Timepoint [7]
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Through 18 days of subacute phase (12 days treatment, 6 days follow-up)
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Eligibility
Key inclusion criteria
* Provision of written informed consent.
* Over 18 years of age.
* Mean i-STAT potassium values between 5.0 - 6.5 mmol/l inclusive, at screening (Study Day 0).
* Ability to have repeated blood draws or effective venous catheterization.
* Women of childbearing potential must be practicing a highly effective method of birth control.
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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
* Pseudohyperkalemia signs and symptoms, such as excessive fist clinching hemolyzed blood specimen, severe leukocytosis or thrombocytosis.
* Subjects treated with lactulose, xifaxan or other nonabsorbed antibiotics for hyperammonemia within the last 7 days.
* Subjects treated with resins (such as Sevelamer acetate or Sodium polystyrene sulfonate [SPS; e.g. Kayexalate®]), calcium acetate, calcium carbonate, or lanthanum carbonate, within the last 7 days.
* Subjects with a life expectancy of less than 3 months.
* Subjects who are HIV positive.
* Subjects who are severely physically or mentally incapacitated and who in the opinion of investigator are unable to perform the subjects' tasks associated with the protocol.
* Women who are pregnant, lactating, or planning to become pregnant.
* Subjects with Ketoacidosis/Acidemia.
* Presence of any condition which, in the opinion of the investigator, places the subject at undue risk or potentially jeopardizes the quality of the data to be generated.
* Known hypersensitivity or previous anaphylaxis to ZS or to components thereof.
* Previous treatment with ZS
* Treatment with a drug or device within the last 30 days that has not received regulatory approval at the time of study entry.
* Subjects with cardiac arrhythmias that require immediate treatment.
* Insulin-dependent diabetes mellitus
* Subjects on dialysis
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Study design
Purpose of the study
Other
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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
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
30/11/2012
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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
30/11/2013
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Sample size
Target
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Accrual to date
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Final
754
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Recruitment in Australia
Recruitment state(s)
NSW,VIC
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Recruitment hospital [1]
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Renal Research - Gosford
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Recruitment hospital [2]
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Melbourne Renal Research Group - Reservoir
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Recruitment postcode(s) [1]
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02250 - Gosford
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Recruitment postcode(s) [2]
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03073 - Reservoir
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Recruitment outside Australia
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United States of America
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Alabama
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Arizona
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California
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Colorado
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Connecticut
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Florida
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Illinois
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Kansas
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Pennsylvania
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South Carolina
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Texas
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United States of America
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State/province [17]
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Utah
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Funding & Sponsors
Primary sponsor type
Commercial sector/industry
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Name
ZS Pharma, Inc.
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Address
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Ethics approval
Ethics application status
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Summary
Brief summary
Acute Phase: It is hypothesized that ZS (zirconium silicate) is more effective than placebo control (alternative hypothesis) in lowering S-K levels in subjects with S-K between 5.0 - 6.5 mmol/l versus no difference between ZS and placebo control (null hypothesis). Subacute Phase (randomized withdrawal): It is hypothesized that ZS once daily is more effective than placebo control (alternative hypotheses) in maintaining normokalemic levels (3.5 - 4.9 mmol/l) among subjects completing the Acute Phase versus no difference between each ZS dose and respective placebo controls (null hypotheses).
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Trial website
https://clinicaltrials.gov/study/NCT01737697
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Trial related presentations / publications
Natale P, Palmer SC, Ruospo M, Saglimbene VM, Strippoli GF. Potassium binders for chronic hyperkalaemia in people with chronic kidney disease. Cochrane Database Syst Rev. 2020 Jun 26;6(6):CD013165. doi: 10.1002/14651858.CD013165.pub2. Amin AN, Menoyo J, Singh B, Kim CS. Efficacy and safety of sodium zirconium cyclosilicate in patients with baseline serum potassium level >/= 5.5 mmol/L: pooled analysis from two phase 3 trials. BMC Nephrol. 2019 Dec 2;20(1):440. doi: 10.1186/s12882-019-1611-8. Friedman PA, Scott CG, Bailey K, Baumann NA, Albert D, Attia ZI, Ladewig DJ, Yasin O, Dillon JJ, Singh B. Errors of Classification With Potassium Blood Testing: The Variability and Repeatability of Critical Clinical Tests. Mayo Clin Proc. 2018 May;93(5):566-572. doi: 10.1016/j.mayocp.2018.03.013. Packham DK, Rasmussen HS, Lavin PT, El-Shahawy MA, Roger SD, Block G, Qunibi W, Pergola P, Singh B. Sodium zirconium cyclosilicate in hyperkalemia. N Engl J Med. 2015 Jan 15;372(3):222-31. doi: 10.1056/NEJMoa1411487. Epub 2014 Nov 21.
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Public notes
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Contacts
Principal investigator
Name
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Henrik Rasmussen, MD
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Address
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ZS Pharma, Inc.
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Contact person for scientific queries
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
No documents have been uploaded by study researchers.
Results are available at
https://clinicaltrials.gov/study/NCT01737697
Download to PDF