Effects of High Cut-off (HCO) Hemodialysis on Central Memory CD4+ T and Treg Cells in Patients With End-stage Kidney Disease
Recruitment status was Recruiting
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Purpose
In this study, the investigators will evaluate whether CD4+ TCM producing effector cytokines can be distinguished on the basis of their expression of the IL-7 receptor alpha-chain (CD127). Using CD154 production as a marker of Ag-specific CD4+ T cells, the investigators will also test the hypothesis that the phenotype and function of TCM are influenced by the type of Ag they recognize. TCM specific for two cleared protein Ag, tetanus toxoïd (TT) and hepatitis B surface (HBs), inducing an early stage of CD4+ T cell differentiation will be compared to TCM specific for cytomegalovirus (CMV), a persistent virus inducing an advanced stage of CD4+ T cell differentiation.
The primary endpoint is to demonstrate in uremic patients who will begin chronic HD and in patients already chronically hemodialyzed any improvement in CD4+ T cell function ex vivo and in vitro. These analyzes will focus on memory T-cell subsets (i.e. Th17 and Tregs population) using HCO membranes or polyamide dialyzers.
The secondary endpoint is a clinical one, namely, to show any improvement in T cell response to HB and TT vaccination (blood antibody titers).
| Condition | Intervention | Phase |
|---|---|---|
|
End-stage Kidney Disease CD4 T Cells Central Memory T Cells Regulatory T Cells Uremic Toxins |
Device: Polyamide HD membrane |
Phase 2 Phase 3 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Crossover Assignment Masking: Single Blind (Subject) Primary Purpose: Treatment |
| Official Title: | Effects of High Cut-off Hemodialysis on Central Memory CD4+ T Cells and Regulatory T Cells in Patients With End-stage Kidney Disease |
- HCO 1100 membrane effect on T CM and Tregs in patients with ESKD chronically hemodialzed [ Time Frame: 12 HD sessions ] [ Designated as safety issue: Yes ]The primary endpoint is to demonstrate in uremic patients who will begin chronic HD and in patients already chronically hemodilyzed any improvement in CD4+ T cell function ex vivo and in vitro. These analyzes will focus on memory T-cell subsets (i.e. Th17 and Tregs population) using HCO membranes or polyamide dialyzers.
- Immunogenicity of the HB-AS04 vaccine in patients dialyzed with HCO 1100 or polyamide membranes [ Time Frame: 12 months study ] [ Designated as safety issue: Yes ]The secondary endpoint is a clinical one, namely, to show any improvement in T cell response to HB and TT vaccination (blood antibody titers).
| Estimated Enrollment: | 20 |
| Study Start Date: | April 2011 |
| Estimated Study Completion Date: | February 2012 |
| Estimated Primary Completion Date: | December 2011 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Active Comparator: Polyamide 210 H
Chronic HD patients will be treated in random order with either polyamide or HCO membranes (Polyflux 210 H or HCO 1100) for one month (12 HD sessions) before the crossover.
|
Device: Polyamide HD membrane
Single use polyamide membrane
|
|
Experimental: HCO 1100
Chronic HD patients will be treated in random order with either polyamide or HCO membranes (Polyflux 210 H or HCO 1100) for one month (12 HD sessions) before the crossover.
|
Device: Polyamide HD membrane
Single use polyamide membrane
|
Show Detailed Description
Eligibility| Ages Eligible for Study: | 18 Years to 70 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Patients with ESKD (CKD stage 5D according to K/DOQI guidelines) regularly treated by bicarbonate HD 3 times a week for at least 4 h at a blood flow rate of 300 ml/min will be included
Exclusion Criteria:
- Only non-smokers will be enrolled in the study
- Patients with recent (< 3 mo) major trauma, surgery, myocardial infarction, coronary revascularization (coronary angioplasty or bypass surgery), or stroke will be excluded from the study
- Diabetes mellitus
- The presence of an acute or chronic inflammatory process, infection
- Malnutrition (determined by Subjective Global Nutritional Assessment)
- The use of immunosuppressive drugs or evidence of malignancy
- Pregnant women, women who are breast feeding or are of child-bearing potential and not using adequate contraceptive precautions are excluded
- A pregnancy test will be performed in female patients before the inclusion
- Except for aspirin and statin, those patients taking anti-inflammatory medications in the prior 4 weeks will be excluded.
- All patients have to be negative for circulating hepatitis B antigen, hepatitis C antibody (Ab) and HIV
- They will have no active liver disease
- No patient will be nephrectomized
- Arterial blood pH will be between 7.38 and 7.42
- No patient will receive a blood transfusion in the 6 mo before the study
Contacts and Locations| Contact: Pascal Meier, MD | +41276034000 ext 8647 | pascal.meier@hopitalvs.ch |
| Switzerland | |
| Hôpital de Sion CHCVs | Recruiting |
| Sion, Valais, Switzerland, 1951 | |
| Contact: Pascal Meier, MD +41276034000 ext 8647 pascal.meier@rsv-gnw.ch | |
| Principal Investigator: Pascal Meier, MD | |
| Principal Investigator: | Pascal Meier, MD | Nephrology service CHCVs Hôpital de Sion/Switzerland |
More Information
Additional Information:
Publications:
| Responsible Party: | Pascal Meier MD, CHCVs Hôpital de Sion |
| ClinicalTrials.gov Identifier: | NCT01103076 History of Changes |
| Other Study ID Numbers: | HighCO Hemo study, HCO study |
| Study First Received: | April 13, 2010 |
| Last Updated: | July 6, 2011 |
| Health Authority: | Switzerland: Swissmedic |
Keywords provided by Centre Hospitalier du Centre du Valais:
|
Immune dysfunction Hemodialysis HBV Vaccination Immune response |
Additional relevant MeSH terms:
|
Kidney Diseases Kidney Failure, Chronic Urologic Diseases Renal Insufficiency, Chronic Renal Insufficiency |
ClinicalTrials.gov processed this record on May 22, 2013