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出境医 / 临床实验 / Albumin for Management of Hypervolemic Hyponatremia (AlbuCAT) (AlbuCAT)

Albumin for Management of Hypervolemic Hyponatremia (AlbuCAT) (AlbuCAT)

Study Description
Brief Summary:
resolution of hyponatremia, defined as an increase in serum sodium of more than 5 mEq/L with a final value > 130 mEq/L, maintained for at least 48 consecutive hours during the 10-day treatment period

Condition or disease Intervention/treatment Phase
Hyponatremia With Excess Extracellular Fluid Volume Cirrhosis, Liver Drug: Albumin treatment Phase 2

Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 52 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Albumin for Management of Hypervolemic Hyponatremia in Patients With Decompensated Cirrhosis. A Proof of Concept Study.
Estimated Study Start Date : July 2020
Estimated Primary Completion Date : July 2022
Estimated Study Completion Date : November 2022
Arms and Interventions
Arm Intervention/treatment
No Intervention: No treatment
No treatment.
Experimental: Albumin treatment
one dose per day of a 40g albumin g/l gram(s)/litre for 10 days.
Drug: Albumin treatment
one dose per day of a 40g albumin g/l gram(s)/litre for 10 days. resolution of hyponatremia, defined as an increase in serum sodium of more than 5 mEq/L with a final value > 130 mEq/L, maintained for at least 48 consecutive hours during the 10-day treatment period
Other Name: Human Albumin Grifols 200 g/l, solution for infusion

Outcome Measures
Primary Outcome Measures :
  1. Resolution of hyponatremia [ Time Frame: for at least 48 consecutive hours during the 10-day treatment ]
    defined as an increase in serum sodium of more than 5 mEq/L with a final value > 130 mEq/L


Secondary Outcome Measures :
  1. partial resolution of hyponatremia [ Time Frame: maintained for at least 48 consecutive hours during the 10-day treatment period. ]
    defined as an increase in serum sodium of more than 5meq/L with a final value below 130meq/L,

  2. Evaluation of systemic hemodynamics [ Time Frame: levels at day 0, at day 5 and at day 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days) of the study period. ]
    mean arterial pressure

  3. kidney function [ Time Frame: levels at day 0, 5 and 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days). ]
    measurement of creatinine levels

  4. Effects on the inflammatory profile [ Time Frame: levels at day 0, and 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days). ]
    evaluation of PCR of plasma cytokines by using a multiplex kit including plasmatic cytokines related to immune response. This multiplex test will be performed at day 0 and day 10 of the study period (or at the end of study in case of early termination).

  5. Effects on neurocognitive function and quality [ Time Frame: levels at day 0, and 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days). ]
    PHES questionnaire

  6. Effects on brain water content [ Time Frame: levels at day 0, and 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days). ]
    performance of aMagnetic Resonance Spectroscopy (MRS)

  7. Effects of albumin administration on liver phagocytic capacity [ Time Frame: levels at day 0, and 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days). ]
    Effects of albumin administration on liver phagocytic capacity as assessed by performance of hepatic SPECT with 99mTc-phytate at day 0 and 10 (or at the end of study in case of early termination).

  8. Effects on phagocytic capacity and inflammatory response of peripheral monocytes [ Time Frame: levels at day 0, and 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days). ]
    Effects on phagocytic capacity and inflammatory response of peripheral monocytes will be assessed by performance specific tests (Phagotest and Phagoburst) evaluating the in vitro phagocytic capacity and burst response. Monocytes will be isolated and analysed at day 0 and at day 10 of the study period (or at the end of study in case of early termination).

  9. Effects of albumin administration of microbiome composition [ Time Frame: levels at day 0, and 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days). ]
    Effects of albumin administration of microbiome composition as assessed by analysis of microbiome composition at day 0 and 10 of the study period (or at the end of study in case of early termination).

  10. Effects of albumin administration on development of infections, development of complications of cirrhosis and survival. [ Time Frame: levels at day 0, and 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days). ]
    Effects of albumin administration on development of infections, development of complications of cirrhosis and survival.

  11. Effects of albumin administration on serum albumin levels [ Time Frame: levels at day 0, 5, 10, 28 and 90 of study period. ]
    Effects of albumin administration on serum albumin levels assessed by measurement of mEq/L serum albumin levels at day 0, 5, 10, 28 and 90 of study period.

  12. evaluate treatment-related serious adverse events [ Time Frame: visit day 1,2,3,4,5,6,7,8,9,28 and 90 ]
    To evaluate treatment-related serious adverse events during the treatment period


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients included into the study must meet all the following criteria:

This study will include patients with liver cirrhosis and hypervolemic hyponatremia (serum sodium<130 mEq/L) admitted to hospital for any decompensation of the disease. Patients will be enrolled if hyponatremia persists after 3 days of diuretic withdrawal and fluid restriction. Women of child-bearing potential must have a negative pregnancy test in serum before the inclusion in the study and agree to use highly effective contraceptive methods, including intrauterine device, bilateral tubal occlusion or a vasectomized partner. Hormonal contraceptive methods will be avoided due to the risk of adverse events and impairment of liver function.

Exclusion Criteria:

  1. Patients with Acute kidney injury 1B or higher;
  2. Chronic kidney disease grade 3a or higher, defined as glomerular filtration rate <60ml/min for three months and markers of kidney damage (one or more): Albuminuria (Albumin excretion rate > 30 mg/24h; Albumin-to-creatinine ratio > 30 mg/g), Urine sediment abnormalities, Electrolyte and other abnormalities due to tubular disorders, Electrolyte and other abnormalities due to tubular disorders, Abnormalities detected by histology or Structural abnormalities detected by imaging.
  3. Previous kidney or liver transplant;
  4. Active infection apart from spontaneous bacterial peritonytis based on positive culture (blood, urine, sputum or other samples) or by the following criteria:

    1. Urinary infections: signs of systemic inflammation and more than 10 leukocytes per high-power field in urine;
    2. Pneumonia: compatible symptoms (cough, purulent sputum, chest pain, shortness of breath) and presence of new infiltrates on chest x-ray;
    3. Skin/soft tissue infection: physical exam findings of swelling, erythema, heat and tenderness in the skin;
    4. Acute cholangitis: signs of systemic inflammation1, compatible symptoms (right upper quadrant pain and jaundice) and radiological data of biliary obstruction, analytical data of cholestasis;
    5. Suspected bacterial infection: signs of systemic inflammation1 but no identifiable origin of this infection (polymorphonuclear cells in ascitic and pleural fluid < 250/mm3, normal urine sediment and chest Xray) After 48 hours of appropriate antibiotic treatment patients can be enrolled.
  5. Spontaneous bacterial peritonitis.
  6. Hypo or hyperthyroidism not controlled under adequate treatment.
  7. Associated heart failure, defined as a New York Heart Association (NYHA) classification III or IV or heart failure with reduced ejection fraction (LVEF<40%). Previously known structural cardiomyopathy including ischemic cardiomyopathy, restrictive cardiomyopathy or valvular cardiomyopathy.
  8. Hepatocellular carcinoma beyond Milan criteria.
  9. Severe alcoholic hepatitis defined by Maddrey score ≥32 and/or MELD score ≥ 20
  10. ACLF with two or more organ failures
  11. Treatment with diuretics (furosemide or spironolactone), albumin infusion, somatostatin or terlipresin in the previous 3 days.
  12. Symptomatic hyponatremia (manifested by cardio-respiratory distress, abnormal and deep somnolence, seizures or coma) with serum sodium below 120 mEq/L.
  13. Previous known hypersensitivity to human albumin
  14. Refuse to give informed consent
Contacts and Locations

Contacts
Layout table for location contacts
Contact: Anna Cruceta 0034 93 2279838 acruceta@clinic.ub.es

Locations
Layout table for location information
Spain
Hospital Clinic de Barcelona
Barcelona, Catalunya, Spain, 08036
Hospital Moises Broggi
Barcelona, Catalunya, Spain
Hospital Parc Taulí
Sabadell, Catalunya, Spain, 08208
Sponsors and Collaborators
Fundacion Clinic per a la Recerca Biomédica
Tracking Information
First Submitted Date  ICMJE March 28, 2019
First Posted Date  ICMJE May 8, 2019
Last Update Posted Date February 5, 2020
Estimated Study Start Date  ICMJE July 2020
Estimated Primary Completion Date July 2022   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: May 6, 2019)
Resolution of hyponatremia [ Time Frame: for at least 48 consecutive hours during the 10-day treatment ]
defined as an increase in serum sodium of more than 5 mEq/L with a final value > 130 mEq/L
Original Primary Outcome Measures  ICMJE Same as current
Change History
Current Secondary Outcome Measures  ICMJE
 (submitted: May 6, 2019)
  • partial resolution of hyponatremia [ Time Frame: maintained for at least 48 consecutive hours during the 10-day treatment period. ]
    defined as an increase in serum sodium of more than 5meq/L with a final value below 130meq/L,
  • Evaluation of systemic hemodynamics [ Time Frame: levels at day 0, at day 5 and at day 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days) of the study period. ]
    mean arterial pressure
  • kidney function [ Time Frame: levels at day 0, 5 and 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days). ]
    measurement of creatinine levels
  • Effects on the inflammatory profile [ Time Frame: levels at day 0, and 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days). ]
    evaluation of PCR of plasma cytokines by using a multiplex kit including plasmatic cytokines related to immune response. This multiplex test will be performed at day 0 and day 10 of the study period (or at the end of study in case of early termination).
  • Effects on neurocognitive function and quality [ Time Frame: levels at day 0, and 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days). ]
    PHES questionnaire
  • Effects on brain water content [ Time Frame: levels at day 0, and 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days). ]
    performance of aMagnetic Resonance Spectroscopy (MRS)
  • Effects of albumin administration on liver phagocytic capacity [ Time Frame: levels at day 0, and 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days). ]
    Effects of albumin administration on liver phagocytic capacity as assessed by performance of hepatic SPECT with 99mTc-phytate at day 0 and 10 (or at the end of study in case of early termination).
  • Effects on phagocytic capacity and inflammatory response of peripheral monocytes [ Time Frame: levels at day 0, and 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days). ]
    Effects on phagocytic capacity and inflammatory response of peripheral monocytes will be assessed by performance specific tests (Phagotest and Phagoburst) evaluating the in vitro phagocytic capacity and burst response. Monocytes will be isolated and analysed at day 0 and at day 10 of the study period (or at the end of study in case of early termination).
  • Effects of albumin administration of microbiome composition [ Time Frame: levels at day 0, and 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days). ]
    Effects of albumin administration of microbiome composition as assessed by analysis of microbiome composition at day 0 and 10 of the study period (or at the end of study in case of early termination).
  • Effects of albumin administration on development of infections, development of complications of cirrhosis and survival. [ Time Frame: levels at day 0, and 10 (or at the end of study in case of early termination due to primary endpoint reach from day 0 up to 10 days). ]
    Effects of albumin administration on development of infections, development of complications of cirrhosis and survival.
  • Effects of albumin administration on serum albumin levels [ Time Frame: levels at day 0, 5, 10, 28 and 90 of study period. ]
    Effects of albumin administration on serum albumin levels assessed by measurement of mEq/L serum albumin levels at day 0, 5, 10, 28 and 90 of study period.
  • evaluate treatment-related serious adverse events [ Time Frame: visit day 1,2,3,4,5,6,7,8,9,28 and 90 ]
    To evaluate treatment-related serious adverse events during the treatment period
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Albumin for Management of Hypervolemic Hyponatremia (AlbuCAT)
Official Title  ICMJE Albumin for Management of Hypervolemic Hyponatremia in Patients With Decompensated Cirrhosis. A Proof of Concept Study.
Brief Summary resolution of hyponatremia, defined as an increase in serum sodium of more than 5 mEq/L with a final value > 130 mEq/L, maintained for at least 48 consecutive hours during the 10-day treatment period
Detailed Description Not Provided
Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 2
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE
  • Hyponatremia With Excess Extracellular Fluid Volume
  • Cirrhosis, Liver
Intervention  ICMJE Drug: Albumin treatment
one dose per day of a 40g albumin g/l gram(s)/litre for 10 days. resolution of hyponatremia, defined as an increase in serum sodium of more than 5 mEq/L with a final value > 130 mEq/L, maintained for at least 48 consecutive hours during the 10-day treatment period
Other Name: Human Albumin Grifols 200 g/l, solution for infusion
Study Arms  ICMJE
  • No Intervention: No treatment
    No treatment.
  • Experimental: Albumin treatment
    one dose per day of a 40g albumin g/l gram(s)/litre for 10 days.
    Intervention: Drug: Albumin treatment
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Not yet recruiting
Estimated Enrollment  ICMJE
 (submitted: May 6, 2019)
52
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE November 2022
Estimated Primary Completion Date July 2022   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Patients included into the study must meet all the following criteria:

This study will include patients with liver cirrhosis and hypervolemic hyponatremia (serum sodium<130 mEq/L) admitted to hospital for any decompensation of the disease. Patients will be enrolled if hyponatremia persists after 3 days of diuretic withdrawal and fluid restriction. Women of child-bearing potential must have a negative pregnancy test in serum before the inclusion in the study and agree to use highly effective contraceptive methods, including intrauterine device, bilateral tubal occlusion or a vasectomized partner. Hormonal contraceptive methods will be avoided due to the risk of adverse events and impairment of liver function.

Exclusion Criteria:

  1. Patients with Acute kidney injury 1B or higher;
  2. Chronic kidney disease grade 3a or higher, defined as glomerular filtration rate <60ml/min for three months and markers of kidney damage (one or more): Albuminuria (Albumin excretion rate > 30 mg/24h; Albumin-to-creatinine ratio > 30 mg/g), Urine sediment abnormalities, Electrolyte and other abnormalities due to tubular disorders, Electrolyte and other abnormalities due to tubular disorders, Abnormalities detected by histology or Structural abnormalities detected by imaging.
  3. Previous kidney or liver transplant;
  4. Active infection apart from spontaneous bacterial peritonytis based on positive culture (blood, urine, sputum or other samples) or by the following criteria:

    1. Urinary infections: signs of systemic inflammation and more than 10 leukocytes per high-power field in urine;
    2. Pneumonia: compatible symptoms (cough, purulent sputum, chest pain, shortness of breath) and presence of new infiltrates on chest x-ray;
    3. Skin/soft tissue infection: physical exam findings of swelling, erythema, heat and tenderness in the skin;
    4. Acute cholangitis: signs of systemic inflammation1, compatible symptoms (right upper quadrant pain and jaundice) and radiological data of biliary obstruction, analytical data of cholestasis;
    5. Suspected bacterial infection: signs of systemic inflammation1 but no identifiable origin of this infection (polymorphonuclear cells in ascitic and pleural fluid < 250/mm3, normal urine sediment and chest Xray) After 48 hours of appropriate antibiotic treatment patients can be enrolled.
  5. Spontaneous bacterial peritonitis.
  6. Hypo or hyperthyroidism not controlled under adequate treatment.
  7. Associated heart failure, defined as a New York Heart Association (NYHA) classification III or IV or heart failure with reduced ejection fraction (LVEF<40%). Previously known structural cardiomyopathy including ischemic cardiomyopathy, restrictive cardiomyopathy or valvular cardiomyopathy.
  8. Hepatocellular carcinoma beyond Milan criteria.
  9. Severe alcoholic hepatitis defined by Maddrey score ≥32 and/or MELD score ≥ 20
  10. ACLF with two or more organ failures
  11. Treatment with diuretics (furosemide or spironolactone), albumin infusion, somatostatin or terlipresin in the previous 3 days.
  12. Symptomatic hyponatremia (manifested by cardio-respiratory distress, abnormal and deep somnolence, seizures or coma) with serum sodium below 120 mEq/L.
  13. Previous known hypersensitivity to human albumin
  14. Refuse to give informed consent
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Contact: Anna Cruceta 0034 93 2279838 acruceta@clinic.ub.es
Listed Location Countries  ICMJE Spain
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT03941405
Other Study ID Numbers  ICMJE 2019-000302-29
Has Data Monitoring Committee No
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
IPD Sharing Statement  ICMJE Not Provided
Responsible Party Anna Cruceta, Fundacion Clinic per a la Recerca Biomédica
Study Sponsor  ICMJE Fundacion Clinic per a la Recerca Biomédica
Collaborators  ICMJE Not Provided
Investigators  ICMJE Not Provided
PRS Account Fundacion Clinic per a la Recerca Biomédica
Verification Date February 2020

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP