Inorganic Nitrate (NaNO3) Prevention of Contrast-Associated Acute Kidney Injury

Overview

This pilot study is designed to test the logistics and recruitment of a trial testing the benefit of sodium nitrate in the prevention of contrast-associated kidney injury in a group of patients at high-risk.

Detailed description

The timing of the follow-up blood test was changed from 48 hours (± 12 hours) to 72 hours (± 36 hours) after contrast exposure. This change allows participants more flexibility to complete their lab work at a convenient outpatient location without requiring a return visit within a narrow time window. The new timing still falls within the period when kidney function changes from contrast exposure would be expected to appear, so the study's ability to detect these changes is preserved and safety monitoring remains consistent.

Interventions

• Drug Sodium Nitrate
  The study drug is sodium nitrate capsule at a dose of 12mmol of nitrate. This medication will be given orally 1-8 hours before the planned contrast administration and then once per day for a total of four doses.
• Drug Placebo
  The placebo control medication will be a capsule filled with lactose that will be taken in the same manner and schedule as the sodium nitrate capsule

Primary outcome measures

• Percent of participants receiving the first dose of blinded study drug within 1-8 hours prior to contrast exposure [Time frame: Approximately 34 days]
• Percent of participants completing full course of 4 doses of blinded study drug [Time frame: Approximately 34 days]
• Percent of participants with 48-hour basic metabolic panel collected between 36-108 hours of contrast exposure [Time frame: Approximately 34 days]
• Percent of participants who had completion of clinical outcome monitoring at 30-day follow-up interview [Time frame: Approximately 34 days]
• Percent of participants recruited to the trial for undergoing coronary angiogram [Time frame: Approximately 34 days]
• Percent of participants recruited to the trial for undergoing a contrast-enhanced CT scan [Time frame: Approximately 34 days]

Secondary outcome measures (11)

• Number of participants who develop of Contrast-Associated Acute Kidney Injury (CA-AKI) [Time frame: Approximately 34 days]
• Number of participants who had initiation of renal replacement therapy within 30 days of planned contrast administration for patients that did not have active need for dialysis prior to study enrollment [Time frame: Approximately 34 days]
• Number of participants with all-cause mortality within 30 days of planned contrast administration as defined by cessation of life due to any cause [Time frame: Approximately 34 days]
• Number of participants with major adverse cardiovascular events (MACE) [Time frame: Approximately 34 days]
• Number of participants with cardiovascular death within 30 days of planned contrast administration as defined by cessation of life deemed secondary to cardiovascular cause [Time frame: Approximately 34 days]
• Number of participants with non-fatal myocardial infarction within 30 days of planned contrast administration [Time frame: Approximately 34 days]
• Number of participants with non-fatal stroke within 30 days of planned contrast administration [Time frame: Approximately 34 days]
• Number of participants with major adverse kidney events (MAKE) [Time frame: Approximately 34 days]
• Number of participants with persistent renal dysfunction at 30 days of planned contrast administration [Time frame: Approximately 34 days]
• Number of participants with new onset hypotension [Time frame: Approximately 34 days]
• Number of adverse events within 30 days of planned contrast administration [Time frame: Approximately 34 days]

Eligibility criteria

Inclusion criteria

• Planned coronary angiogram or contrast-enhanced CT scan.
• High-risk for contrast-associated acute kidney injury (AKI) with creatine/Glomerular filtration rate (GFR) within 90 days as defined as:

• Undergoing coronary angiogram with GFR <45 mL/min/1.73m2 OR
• Undergoing coronary angiogram with GFR <60 mL/min/1.73m2 and concurrent risk of AKI as defined by Hamilton et al. BMC2 risk prediction model ≥ 7%.

OR

• Undergoing contrast-enhanced CT scan with GFR<45 mL/min/1.73m2
• If subject is a woman of child-bearing potential, subject agrees to the use of highly effective contraception starting at screening and during study participation.
• Ability to take oral medication and be willing to adhere to the study intervention regimen.
• Ability to understand and willingness to agree to an informed consent

Exclusion criteria

• Already fulfilling definition of acute kidney injury prior to contrast exposure by kidney disease improving global outcomes (KDIGO) criteria (absolute increase in creatinine from baseline of 0.3mg/dL or more OR relative increase in creatine of 50% or more from baseline).
• Primary indication for Percutaneous Coronary Intervention (PCI) including acute ST-segment elevation myocardial infarction
• End-stage renal disease actively on dialysis.
• Received any intravenous or intraarterial contrast within five days from planned contrast administration.
• Cardiac arrest within 14 days of planned contrast administration.
• Systolic blood pressure < 100mmHg or diastolic blood pressure <60mmHg OR currently receiving inotropes or vasopressors for hemodynamic support.
• History of hypersensitivity or known allergy to any of the components of the investigational product or placebo including sodium nitrate, inorganic nitrate, beet root juice, or lactose. This does not include lactose intolerance.
• Pregnancy or nursing female
• Participation in other investigational trials within the past 30 days prior to enrollment.
• Use of tadalafil within 48 hours, sildenafil or vardenafil within 24 hours, and avanafil within 12 hours of initiation of trial medication. If participant is on continuous dosing of tadalafil, sildenafil, vardenafil, or avanafil, they will be excluded from the trial. If participant is on intermittent dosing of tadalafil, sildenafil, vardenafil, or avanafil, patient agrees to withhold use of medication for duration of medication treatment extending 48 hours after the final dose.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Quadruple blind

Primary purpose

Prevention

Study locations

United States · 1 center

• University of Michigan — Ann Arbor

Identifiers

NCT: NCT07016074 · HUM00263577

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗