Ignite Creation Date:
2024-05-06 @ 2:37 AM
Last Modification Date:
2024-10-26 @ 11:20 AM
Study NCT ID:
NCT02082483
Status:
COMPLETED
Last Update Posted:
2024-05-13
First Post:
2014-03-06
Brief Title:
Coronary Artery Disease Screening in Kidney Transplant Candidates
Sponsor:
University of British Columbia
Organization:
University of British Columbia
Study Overview
Official Title:
Pilot Study to Determine Feasibility of a Randomized Trial of Screening for Coronary Artery Disease in Kidney Transplant Candidates
Status:
COMPLETED
Status Verified Date:
2024-05
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
CADScreening
Brief Summary:
Kidney transplant candidates are at very high risk for coronary artery disease CAD The optimal strategy to monitor and maintain the cardiac fitness of patients awaiting kidney transplantation is unknown Currently patients undergo annual testing however screening for CAD may increase morbidity and mortality by
1 exposing patients to the risk of angiography and revascularization procedures
2 delaying or excluding patients from life saving transplantation
Before proceeding with a definitive study to determine whether screening is necessary feasibility will be determined in this pilot study
1 exposing patients to the risk of angiography and revascularization procedures
2 delaying or excluding patients from life saving transplantation
Before proceeding with a definitive study to determine whether screening is necessary feasibility will be determined in this pilot study
Detailed Description:
This pilot trial will determine the feasibility of a multi-center randomized parallel group definitive trial Asymptomatic wait-listed patients will be randomized to routine screening for coronary artery disease CAD ie Myocardial Perfusion Scintigraphy MPS or Dobutamine Stress Echo DSE as per the current standard of care versus selective screening based on symptoms Patients enrolled in the pilot will be included in the definitive trial analysis The pilot trial will include four Canadian centres The definitive trial will aim to determine if a strategy of selective use of screening tests ie Myocardial Perfusion Scintigraphy or Dobutamine Stress Echo only in the presence of symptoms ie chest pain dyspnea etc is non-inferior with respect to the composite endpoint of non-fatal MI and cardiac death compared to screening all asymptomatic wait-listed patients at regular intervals as described in transplant specific guidelines published by the National Kidney Foundation
Currently there is no strong evidence for or against using routine cardiac screening of asymptomatic transplant patients more evidence based randomized clinical trials are needed This need is further highlighted by a number of factors such as wait-listed patients are increasing in number and medical complexity longer wait times and changing donor characteristics can increase CAD risk wait-listed patients are at high risk for CAD but are commonly asymptomatic the standard of care is not evidence based and is expensive the current standard may be harmful The study will determine feasibility of a definitive trial through the measures outlined under Outcome Measures
End stage renal disease ESRD patients wait-listed for kidney transplantation will be randomized to undergo selective screening for CAD in which patients are only screened if they develop symptoms suggestive of CAD or the current standard of care that involves regular screening for CAD at fixed time intervals based on the presence of risk factors Patients will remain on the pilot trial protocol until death non-fatal MI transplantation permanent removal from the waiting list for any reason or 24 months after enrolment in the pilot trial During wait-listing follow-up telephone interviews and chart reviews will be performed every six months After transplantation an in-person follow up visit and chart review will occur at the time of discharge from hospital and a telephone interview and chart review will be performed 3 months after transplantation Patients will be followed for 24 months from the date of enrolment Patients who receive a kidney transplant during the study will be followed for 27 months
For the pilot trial descriptive analyses are planned Feasibility will be summarized with proportions rates means and medians as appropriate Comparison of the definitive trial outcomes between treatment groups will not be done at the end of the internal pilot as these patients will be included in the definitive trial Analyses of enrolment rates and consent rates will be done after the enrolment phase of the pilot trial in late 2014 An interim analysis of protocol adherence is planned in mid 2016 in support of the definitive trial funding application in September 2016
Currently there is no strong evidence for or against using routine cardiac screening of asymptomatic transplant patients more evidence based randomized clinical trials are needed This need is further highlighted by a number of factors such as wait-listed patients are increasing in number and medical complexity longer wait times and changing donor characteristics can increase CAD risk wait-listed patients are at high risk for CAD but are commonly asymptomatic the standard of care is not evidence based and is expensive the current standard may be harmful The study will determine feasibility of a definitive trial through the measures outlined under Outcome Measures
End stage renal disease ESRD patients wait-listed for kidney transplantation will be randomized to undergo selective screening for CAD in which patients are only screened if they develop symptoms suggestive of CAD or the current standard of care that involves regular screening for CAD at fixed time intervals based on the presence of risk factors Patients will remain on the pilot trial protocol until death non-fatal MI transplantation permanent removal from the waiting list for any reason or 24 months after enrolment in the pilot trial During wait-listing follow-up telephone interviews and chart reviews will be performed every six months After transplantation an in-person follow up visit and chart review will occur at the time of discharge from hospital and a telephone interview and chart review will be performed 3 months after transplantation Patients will be followed for 24 months from the date of enrolment Patients who receive a kidney transplant during the study will be followed for 27 months
For the pilot trial descriptive analyses are planned Feasibility will be summarized with proportions rates means and medians as appropriate Comparison of the definitive trial outcomes between treatment groups will not be done at the end of the internal pilot as these patients will be included in the definitive trial Analyses of enrolment rates and consent rates will be done after the enrolment phase of the pilot trial in late 2014 An interim analysis of protocol adherence is planned in mid 2016 in support of the definitive trial funding application in September 2016
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None
Secondary IDs
| Secondary ID | Type | Domain | Link |
|---|---|---|---|
| MOP 133509 | OTHER_GRANT | Canadian Institutes of Health Research | None |