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Trial registered on ANZCTR
Registration number
ACTRN12608000057381
Ethics application status
Approved
Date submitted
24/01/2008
Date registered
30/01/2008
Date last updated
30/01/2008
Type of registration
Prospectively registered
Titles & IDs
Public title
Dialysate calcium study in alternate night nocturnal haemodialysis
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Scientific title
A randomised controlled trial of high versus low dialysate calcium concentrations to assess aortic calcification and changes in mineral metabolsim in alternate night nocturnal haemodialysis
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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:
Dialysis
2759
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Condition category
Condition code
Renal and Urogenital
2912
2912
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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
Low dialysate calcium bath (1.3mmol/L) administered during haemodialysis (alternate nightly) for 12 months
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Intervention code [1]
2498
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Treatment: Other
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Comparator / control treatment
High dialysate calcium bath (>1.6mmol/L) administered during haemodialysis (alternate nightly) for 12 months
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Control group
Dose comparison
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Outcomes
Primary outcome [1]
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Aortic vascular calcification measured by computed tomography (CT) scan
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Assessment method [1]
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Timepoint [1]
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12 months
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Secondary outcome [1]
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Changes in mineral metabolism (measured by serum calcium, phosphate, parathyroid hormone (PTH) and calcium-phosphate product (CaxP))
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Assessment method [1]
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Timepoint [1]
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12 months
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Eligibility
Key inclusion criteria
Subjects receiving renal replacement therapy in the form of haemodialysis at home, alternate night nocturnal haemoialysis (NHD) (3.5nights/week)
Subjects must be 18-80 years of age
Willingness to provide written informed consent
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Minimum age
18
Years
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Maximum age
80
Years
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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
Subjects unable to give informed consent or whom have an expected life-span of less than 3 months
Subjects already scheduled to have a kidney transplant from a known living donor
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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)
Recruitment will involve haemodialysis patients on NHD recruited from the respective institutions
Allocation will be by sealed envelopes
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Computer generated randomisation
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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
Phase 4
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
10/02/2008
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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
80
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Recruitment postcode(s) [1]
558
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3168
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Funding & Sponsors
Funding source category [1]
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Commercial sector/Industry
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Name [1]
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Roche Pharmaceuticals (Neorecormon Research Grant)
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Address [1]
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4-10 Inman Road
Dee Why NSW 2099
Australia
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Country [1]
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Australia
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Primary sponsor type
Hospital
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Name
Monash Medical Centre
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Address
Department of Nephrology
246 Clayton Road, Clayton 3168 Victoria
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Country
Australia
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Secondary sponsor category [1]
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Hospital
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Name [1]
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Royal Melbourne Hospital
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Address [1]
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Gratton Street
Parkville Victoria
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Country [1]
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Southern Health Research Ethics Committee
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Ethics committee address [1]
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Monash Medical Centre 246 Clayton Road, Clayton 3168 Victoria
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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01/01/2008
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Approval date [1]
4968
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Ethics approval number [1]
4968
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*07200C
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Summary
Brief summary
Elevated calcium phosphate product (Ca x P) is an independent risk factor for vascular calcification and cardiovascular death in the end-stage renal disease (ESRD) population (Block et al, 1998). Conventional haemodialysis (4hrs x 3) may not successfully correct the profound disturbances in calcium and phosphate metabolism of ESRD, characterised by hyperphosphatemia and abnormal serum calcium levels. In general a low calcium dialysate (1.3 mmol/L) is used for patients on conventional haemodialysis in North West Dialysis Service (NWDS), at Monash Medical Centre (MMC) and Geelong Hospital and throughout Australia. The calcium and phosphate balance achieved with Quotidian Nocturnal Haemodialysis (8 hours x 6 days) differs significantly from conventional haemodialysis and is associated with marked improvements in the reduction of elevated serum phosphate levels. An observational study by Lindsay et al demonstrated that patients on quotidian haemodialysis utilising 1.25 mmol/L dialysate calcium exhibited calcium depletion and hypocalcemia thus exacerbating secondary hyperparathyroidism (Lindsay et al, 2003). In the same study they demonstrated that an increase in dialysate calcium concentration was associated with a return of bone alkaline phosphatase levels to baseline and a gradual fall of parathyroid hormone (PTH) levels to target range. In association with the increase in dialysate calcium, the use of activated vitamin D compounds fell. Based on the results of this study, it has been common practice to dialyse all nocturnal haemodialysis patients, regardless of whether they dialyse for 8 hrs x 6 or 8 hrs x 3.5, on higher calcium baths (>1.6 mmol/L). It is not clear however, what should be the optimal calcium bath for patients on 8 x 3.5nights/week, particularly as serum phosphate levels are not as tightly controlled with quotidian haemodialysis, and unlike the 6 nights/week group, many patients still require the use of calcium based phosphate binders. Ideally the optimal calcium bath should be such that the overall Ca x P product is <4mmol2/l2 and the PTH 15-30pmol/l, however the concern is that the use of a higher calcium bath in the alternate night group will lead to relative hypercalcemia and an overall increase in Ca x P. Recent evidence also supports the importance of the pleiotropic effects of Vitamin D in addition to its well-recognised role in bone metabolism. It is conceivable that patients being dialysed with a higher calcium bath may not be able to tolerate the addition of Vitamin D due to the development of hypercalcemia. In order to establish the optimal calcium bath in patients on alternate night haemodialysis, we propose a prospective observational study comparing predefined outcomes using >1.6mmol/L and 1.3mmol/L dialysate calcium.
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Trial website
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Trial related presentations / publications
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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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Nigel Toussaint
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Address
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Department of Nephrology
Monash Medical Centre
246 Clayton Road, Clayton 3168 Victoria
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Country
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Australia
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Phone
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+61 3 9594 3072
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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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Nigel Toussaint
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Address
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Department of Nephrology
Monash Medical Centre
246 Clayton Road, Clayton 3168 Victoria
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Country
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Australia
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Phone
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+61 3 9594 3072
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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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