46 Participants Needed

Diuretics for Early Chronic Kidney Disease

(DOCK Trial)

LP
LP
Overseen ByLucile P Gregg, MD MS
Age: 18+
Sex: Any
Trial Phase: Phase 4
Sponsor: VA Office of Research and Development
Must be taking: Diuretics
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Prior Safety DataThis treatment has passed at least one previous human trial
Approved in 5 JurisdictionsThis treatment is already approved in other countries

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of diuretics for early chronic kidney disease?

The research indicates that in chronic kidney disease patients, there was an increase in the prescription of diuretics when patients were followed up in renal protection clinics, suggesting that these drugs are considered beneficial in managing the condition.12345

Are diuretics safe for people with chronic kidney disease?

Diuretics, including thiazide and loop types, have been used for many years and are generally safe, but they can have side effects like low sodium or potassium levels, especially in people with kidney issues. Potassium-sparing diuretics are considered safer in some cases, but all types should be used with caution and under medical supervision, particularly in those with advanced kidney disease.678910

How is the drug Diuretic Augmentation unique for treating early chronic kidney disease?

Diuretic Augmentation, which includes thiazide and loop diuretics, is unique because it combines different types of diuretics to potentially enhance their effectiveness in managing early chronic kidney disease, despite concerns about their efficacy in advanced stages. This combination may offer renoprotective benefits and better blood pressure control, especially in patients with conditions like type 2 diabetic kidney disease.68111213

What is the purpose of this trial?

This trial is testing whether medications that help remove extra fluid from the body can improve heart health in Veterans with early-stage kidney disease and high blood pressure. By reducing fluid volume, these medications may lower blood pressure and decrease heart strain. These medications have been used to manage extra fluid buildup and control blood pressure in various conditions, including heart failure and high blood pressure, for many years.

Research Team

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Lucile P Gregg, MD

Principal Investigator

Michael E. DeBakey VA Medical Center, Houston, TX

Eligibility Criteria

This trial is for Veterans with early-stage chronic kidney disease (CKD stages 1-3) who have high blood pressure. Participants must be at least 18 years old, able to give informed consent, and not on dialysis or a recipient of a kidney transplant. Those with severe heart issues, liver cirrhosis, major limb amputation, pregnancy, or certain devices like pacemakers are excluded.

Inclusion Criteria

Your blood pressure was too high at your last two doctor visits.
I have been diagnosed with mild to moderate kidney disease for at least 3 months.
Able to understand and sign informed consent after the nature of the study has been fully explained.

Exclusion Criteria

I am able to understand and give informed consent.
My kidney function is very low (stage 4-5 CKD).
I have been diagnosed with liver cirrhosis.
See 8 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Initiation or increase of diuretic treatment to assess changes in natriuretic peptides, symptoms, and cardiovascular parameters

4 weeks
2 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

  • Diuretic Augmentation
Trial Overview The study tests whether diuretics (like hydrochlorothiazide or furosemide) can reduce fluid overload in the body and improve cardiovascular health in people with early CKD. It compares two methods of measuring fluid overload and observes changes in symptoms and short-term heart function after treatment.
Participant Groups
1Treatment groups
Experimental Treatment
Group I: Diuretic augmentationExperimental Treatment1 Intervention
The participant's blood pressure medication regimen will be altered to initiate a thiazide-type or loop diuretic in those not already prescribed a diuretic, or to increase the dose if one is already prescribed.

Diuretic Augmentation is already approved in European Union, United States, Canada, Japan, China for the following indications:

🇪🇺
Approved in European Union as Diuretics for:
  • Hypertension
  • Edema
  • Heart failure
  • Chronic kidney disease
🇺🇸
Approved in United States as Diuretics for:
  • Hypertension
  • Edema
  • Heart failure
  • Chronic kidney disease
  • Nephrotic syndrome
🇨🇦
Approved in Canada as Diuretics for:
  • Hypertension
  • Edema
  • Heart failure
  • Chronic kidney disease
🇯🇵
Approved in Japan as Diuretics for:
  • Hypertension
  • Edema
  • Heart failure
🇨🇳
Approved in China as Diuretics for:
  • Hypertension
  • Edema
  • Heart failure
  • Chronic kidney disease

Find a Clinic Near You

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials
1,691
Recruited
3,759,000+

Findings from Research

Referral to renal protection clinics significantly increased the prescription rates of cardioprotective medications, such as ACE inhibitors and beta-blockers, among 259 patients with chronic kidney disease over a follow-up period of up to 1 year.
Despite the increase in prescriptions, adherence to these medications did not improve, indicating that while more patients were prescribed cardioprotective drugs, they were not necessarily taking them as directed.
The impact of renal protection clinics on prescription of and adherence to cardioprotective drug therapy in chronic kidney disease patients.Lepeytre, F., Cardinal, H., Fradette, L., et al.[2020]
This observational study of 100 dialysis patients in New Zealand aims to identify factors influencing medication adherence, using a comprehensive survey that assesses health literacy, medication knowledge, and beliefs about medications.
The findings will help develop targeted interventions to improve medication adherence in dialysis patients, which is crucial for enhancing their health outcomes.
Understanding barriers to optimal medication management for those requiring long-term dialysis: rationale and design for an observational study, and a quantitative description of study variables and data.Aspden, T., Wolley, MJ., Ma, TM., et al.[2022]
A randomized controlled trial with 120 hemodialysis patients showed that monthly educational sessions from a clinical pharmacist significantly improved adherence to treatment recommendations, with a total adherence score of 1170.6 in the intervention group compared to 665.8 in the control group (p < 0.001).
The intervention not only enhanced adherence but also led to better clinical outcomes, including improved quality of life, better laboratory values for key health indicators, and fewer hospitalizations (0.54 vs. 0.78 per patient, p < 0.001).
The role of clinical pharmacist in enhancing hemodialysis patients' adherence and clinical outcomes: a randomized-controlled study.Alshogran, OY., Hajjar, MH., Muflih, SM., et al.[2022]

References

The impact of renal protection clinics on prescription of and adherence to cardioprotective drug therapy in chronic kidney disease patients. [2020]
Understanding barriers to optimal medication management for those requiring long-term dialysis: rationale and design for an observational study, and a quantitative description of study variables and data. [2022]
The role of clinical pharmacist in enhancing hemodialysis patients' adherence and clinical outcomes: a randomized-controlled study. [2022]
Undiagnosed kidney disease in hospitalised patients: an opportunity for improvement. [2013]
Comparison of the effect of educational and self-management interventions on adherence to treatment in hemodialysis patients: A systematic review and meta-analysis of randomized controlled trials. [2021]
Revisiting diuretic choice in chronic kidney disease. [2023]
Hyponatraemia and hypokalaemia due to indapamide. [2020]
Thiazides in chronic kidney disease: "back to the future". [2023]
[Potassium-sparing diuretics (spironolactone, triamterene, amylorid)]. [2013]
The place of loop diuretics in the treatment of acute and chronic renal failure. [2010]
11.United Statespubmed.ncbi.nlm.nih.gov
The Use of Thiazide Diuretics for the Treatment of Hypertension in Patients With Advanced Chronic Kidney Disease. [2023]
Renoprotective effects of thiazides combined with loop diuretics in patients with type 2 diabetic kidney disease. [2021]
13.United Statespubmed.ncbi.nlm.nih.gov
Association of Continuation of Loop Diuretics at Hemodialysis Initiation with Clinical Outcomes. [2023]
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