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Trial registered on ANZCTR
Registration number
ACTRN12608000337370
Ethics application status
Approved
Date submitted
11/07/2008
Date registered
17/07/2008
Date last updated
17/07/2008
Type of registration
Retrospectively registered
Titles & IDs
Public title
Landmark Study III - A randomised controlled trial comparing the impact of aggressive risk factor and lifestyle modification utilising nurse led co-ordinated care with standard care to limit the progression of cardiovascular disease in patients with chronic kidney disease.
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Scientific title
Landmark Study III - A randomised controlled trial comparing the impact of aggressive risk factor and lifestyle modification utilising nurse led co-ordinated care with standard care to limit the progression of cardiovascular disease in patients with chronic kidney disease.
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Universal Trial Number (UTN)
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Trial acronym
Landmark III
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Cardiovascular disease
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Condition category
Condition code
Renal and Urogenital
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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
Aggressive cardivascular risk factor and lifestyle modification utilising nurse led co-ordinated care. The trial clinic will be additional to the patients' usual medical care. The trial clinic will use a co-ordinated care approach to achieving cardiovascular risk factor modification and include a significant lifestyle and diet modification component customized to the patients' health care needs. There will be focus on patient self-management and motivation for sustainable behavior change. Patients will be followed for up to 3 years. For patients in the Nurse coordinated care arm, they will be seen for an initial assessment (approximately 1 hour) about 2 weeks after enrollment. Then out to monthly or further apart follow up (half hour session) depending on their needs and stage of chronic kidney disease (CKD). These visits with the nurses alternate with visits to Nephrology outpatients department (shared care). This for the duration of the trial which is 3 years.
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Intervention code [1]
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Lifestyle
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Comparator / control treatment
Standard care with Nephrologist in renal outpatients at Princess Alexandra Hospital. Standard care is the Outpatient visits to nephrology and necessary referrals where needed. Standard care patients will be followed for 3 years.
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Control group
Active
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Outcomes
Primary outcome [1]
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Carotid intima media thickness (ultrasound of vascular structure)
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Assessment method [1]
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Timepoint [1]
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At baseline 12 months, 24 months and 36 months
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Secondary outcome [1]
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Exercise stress echocardiography (development of new areas of poor heart blood flow)
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Assessment method [1]
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Timepoint [1]
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At baseline 12 months, 24 months and 36 months
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Secondary outcome [2]
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Brachial Artery Reactivity (ultrasound of vascular function)
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Assessment method [2]
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Timepoint [2]
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At baseline 12 months, 24 months and 36 months
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Eligibility
Key inclusion criteria
Patients with stage 3 or 4 chronic kidney disease (eGFR - estimated Glomerular Filtration Rate <60ml/min and >25 ml/min); Must have one of the following risk factors – Blood pressure not at target; Overweight (BMI - Body Mass Index >25) ; Poor diabetic control; or Lipids not at target
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Minimum age
18
Years
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Maximum age
75
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
Patients from areas in Queensland where follow-up vascular studies can not be carried out for logistic reasons; Unable or unwilling to give informed consent; estimated Glomerular Filtration Rate (eGFR) < 25ml/min; Pregnant; Life expectancy less than 6 months; Current involvement in other research study; Organ transplant
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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
Recruiting
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Date of first participant enrolment
Anticipated
18/03/2008
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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
200
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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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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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National Health and Medical Research Council (NHMRC) (CCRE - Centres of Clinical Research Excellence)
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Address [1]
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The University of Queensland
Brisbane QLD 4072 Australia
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Country [1]
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Australia
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Primary sponsor type
University
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Name
CCRE - Centres of Clinical Research Excellence
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Address
The University of Queensland
Brisbane QLD 4072 Australia
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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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Princess Alexandra Hospital, Nephrology Department
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Address [1]
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Ipswich Road, Woolloongabba Qld 4102
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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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Princess Alexandra Hospital
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Ethics committee address [1]
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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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Approval date [1]
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Ethics approval number [1]
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2007/190
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Summary
Brief summary
Chronic kidney disease (CKD) is associated with a twenty-fold increase in the death from heart and blood vessel disease (cardiovascular disease -CVD). Patients with CKD have multiple risk factors for CVD and include high cholesterol, hypertension, anaemia, abnormalities of blood chemistry, diabetes, obesity and sedentary lifestyle. Intervention may decrease the progression of CVD and treatment guidelines have been developed. However, patients with CKD have complex health issues and audit data suggests that within the current model of care, many do not reach treatment targets. Co-ordinated care clinics utilizing a nurse led, case management approach and a multidisciplinary team have been demonstrated to optimize CKD care and decrease progression of kidney dysfunction. However, the impact on progression of CVD has not been studied. The hypothesis of this proposal is therefore: Nurse led co-ordinated care approach to cardiovascular risk factor and lifestyle modification will reduce the progression of CVD when compared with standard care, in patients with CKD. Additional hypotheses are: The nurse led clinic improves service quality and patient satisfaction AND This model of care will be cost effective.
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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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Dr Nicole Isbel
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Address
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Nephrology department, Princess Alexandra Hospital, Ipswich Road, Woolloongabba Qld 4102
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Country
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Australia
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Phone
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07 3240 5080
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Fax
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07 3240 5480
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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 Nicole Isbel
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Address
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Nephrology department, Princess Alexandra Hospital, Ipswich Road, Woolloongabba Qld 4102
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Country
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Australia
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Phone
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07 3240 5080
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Fax
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07 3240 5480
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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
Source
Title
Year of Publication
DOI
Dimensions AI
Multimodality vascular imaging in CKD: divergence of risk between measured parameters
2011
https://doi.org/10.1093/ndt/gfr397
Embase
Left ventricular global longitudinal strain is associated with cardiovascular risk factors and arterial stiffness in chronic kidney disease.
2015
https://dx.doi.org/10.1186/s12882-015-0098-1
Embase
Oxidative stress is associated with decreased heart rate variability in patients with chronic kidney disease.
2017
https://dx.doi.org/10.1080/13510002.2016.1173326
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Agreement between cystatin-C and creatinine based eGFR estimates after a 12-month exercise intervention in patients with chronic kidney disease.
2018
https://dx.doi.org/10.1186/s12882-018-1146-4
Embase
Effect of a 3-Year Lifestyle Intervention in Patients with Chronic Kidney Disease: A Randomized Clinical Trial.
2022
https://dx.doi.org/10.1681/ASN.2021050668
N.B. These documents automatically identified may not have been verified by the study sponsor.
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