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Angiotensin in Septic Kidney Injury Trial (ASK-IT)

The recruitment status of this study is unknown. The completion date has passed and the status has not been verified in more than two years.
Verified January 2009 by Austin Health.
Recruitment status was:  Recruiting
Sponsor:
ClinicalTrials.gov Identifier:
NCT00711789
First Posted: July 9, 2008
Last Update Posted: June 23, 2011
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Collaborators:
Northern Health and Social Care Trust
Western Hospital, Australia
Information provided by:
Austin Health
  Purpose

The purpose of this study is to determine the effect of a systemic infusion of angiotensin II on haemodynamics and urine output in critically ill patients with severe sepsis/septic shock and acute renal failure.

It will also help determine the feasibility of conducting a definitive and adequately powered randomised controlled trial of angiotensin II in such patients that would assess mortality and need for renal replacement therapy as endpoints.


Condition Intervention Phase
Acute Renal Failure Sepsis Septic Shock Drug: Angiotensin II Drug: Saline placebo Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Pilot Crossover Randomised Controlled Trial of Angiotensin II in Critically Ill Patients With Severe Sepsis and Acute Renal Failure

Resource links provided by NLM:


Further study details as provided by Austin Health:

Primary Outcome Measures:
  • Urine output [ Time Frame: During the 24 hours of infusion of study drug ]
  • Arterial blood pressure [ Time Frame: During the 24 hour infusion of study drug ]

Secondary Outcome Measures:
  • Serum creatinine [ Time Frame: At the end of the 24 hour infusion of study drug ]
  • Serum urea [ Time Frame: At the end of the 24 hour infusion of study drug ]
  • Serum Cystatin C [ Time Frame: At the end of the 24 hour infusion of study drug ]
  • Serum neutrophil gelatinase associated lipocalin (NGAL) [ Time Frame: At the end of the 24 hour infusion of study drug ]
  • Urinary cystatin C [ Time Frame: At the end of the 24 hour infusion of study drug ]
  • Urinary NGAL [ Time Frame: At the end of the 24 hour infusion of study drug ]
  • Urinary IL-18 [ Time Frame: At the end of the 24 hour infusion of study drug ]
  • Need for renal replacement therapy [ Time Frame: During ICU admisison ]
  • Mortality [ Time Frame: ICU and 28 days ]

Estimated Enrollment: 12
Study Start Date: February 2010
Estimated Primary Completion Date: February 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Angiotensin II Drug: Angiotensin II
Angiotensin II will be given by continuous infusion for 24 hours starting at a dose of 5ng/kg/min and then titrated to a maximum dose of 15 ng/kg/min according to a blood pressure based protocol
Placebo Comparator: Placebo Drug: Saline placebo
Saline placebo will be given by continuous infusion according to a blood-pressure base protocol. This protocol will also incorporate noradrenaline for blood pressure control (as is true in the active drug arm), such that blood pressure targets will be rapidly achieved in both arms of the study; the only difference being that in the active drug arm, at least part of the pressor effect will be provided by angiotensin II.

Detailed Description:

Sepsis is the most common cause of ARF in the ICU. In last 50 years there have been no significant advances in our understanding of the pathogenesis, prevention or treatment of septic ARF, except for the use of renal replacement therapy (RRT) once it is established.

It has been assumed that hypotension induced by severe sepsis results in organ hypoperfusion and subsequent kidney ischaemia. This ischaemia has been believed to be one of the main factors, if not the principal factor, contributing to development of ARF in severe sepsis. Surprisingly, there is little evidence to support this assumption. Rather, emerging evidence seriously questions this traditional ischaemic-acute tubular necrosis (ATN) paradigm of septic ARF. Patients with severe sepsis have been found to have increased, rather than decreased, renal blood flow, and post mortem examination of kidneys from patients who have died with septic acute renal failure rarely show the appearance of ATN. An animal model of septic ARF found that renal blood flow was increased, while glomerular filtration rate was decreased.

These facts lead us to hypothesise that profound efferent arteriolar vasodilatation may be the cause of the observed decrease in GFR in septic ARF. The only logical explanation for the observation that RBF increases while GFR falls is that both efferent and afferent arterioles dilate, but that efferent vasodilation is greater. A selective efferent arteriolar vasoconstrictor would be expected to restore GFR. Angiotensin II is the most selective known efferent vasoconstrictor.

We hypothesise that early therapeutic intervention with angiotensin II in critically ill patients with severe sepsis/septic shock and kidney dysfunction may improve kidney function such that the need for renal replacement therapy is avoided. This would represent a significant improvement in the care of critically ill patients with severe sepsis/septic shock and ARF, a condition for which no interventions short of RRT have been shown to improve outcome. Novel and successful therapeutic interventions in this patient population would have widespread clinical implications, including improved survival and less need for long-term dialysis, with consequent resource savings.

  Eligibility

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • age ≥ 18 years
  • within the first 24 hours of ICU admission
  • an expected duration of ICU admission of at least 72 hours
  • informed consent by patient or by proxy (i.e. next of kin)
  • diagnosis of severe sepsis/septic shock
  • diagnosis of kidney dysfunction (minimum RIFLE criteria - 'R'); and
  • presence of a central venous catheter.

Exclusion Criteria:

  • inability to provide or obtain consent;
  • patient is moribund with expected death within 24 hours;
  • known chronic kidney disease (CKD) or end-stage renal disease (ESRD) receiving chronic RRT;
  • confirmed or suspected acute glomerulonephritis, acute interstitial nephritis, renal vasculitis or post-renal aetiology for kidney dysfunction;
  • patient is already receiving (or is about to start) CRRT for acute renal failure at the time of enrolment;
  • known or documented allergy to angiotensin II;
  • MAP consistently > 100 mmHg with no pressor support and no easily treatable cause (eg. pain); and
  • enrolling physician's belief that the study drug could not be administered for the expected study duration.
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00711789


Contacts
Contact: Michael C Reade, MBBS DPhil +61394964838 michael.reade@austin.org.au
Contact: Forbes McGain, MBBS FJFICM +613 8345 6639 forbes.mcgain@wh.org.au

Locations
Australia, Victoria
Northern Hospital Recruiting
Epping, Victoria, Australia, 3074
Contact: Michael C Reade, MBBS DPhil    +61394964838    michael.reade@austin.org.au   
Contact: Graeme Duke, MD FJFICM    +613 8405 8000    graeme.duke@nh.org.au   
Principal Investigator: Michael C Reade, MBBS DPhil         
Sub-Investigator: Graeme Duke, MD FJFICM         
Sub-Investigator: Mary Park, RN         
The Western Hospital Recruiting
Footscray, Victoria, Australia, 3011
Contact: Forbes McGain, MBBS FJFICM    +613 8345 6639    forbes.mcgain@wh.org.au   
Contact: Craig French, MBBS FJFICM    +613 8345 6639    craig.french@wh.org.au   
Principal Investigator: Forbes McGain, MBBS FJFICM         
Sub-Investigator: Craig French, MBBS FJFICM         
Sub-Investigator: John Mulder, MBBS FJFICM         
Sub-Investigator: Sathyajith Velandy-Koottayi, MBBS FJFICM         
Sub-Investigator: Heike Raunow, RN         
Sponsors and Collaborators
Austin Health
Northern Health and Social Care Trust
Western Hospital, Australia
Investigators
Principal Investigator: Michael C Reade, MBBS DPhil Northern Hospital, Epping, Victoria, Australia
Principal Investigator: Forbes McGain, MBBS FJFICM Western Hospital, Footscray, Victoria. Australia
  More Information

Responsible Party: Assoc. Prof. Michael C. Reade, The Northern Hospital
ClinicalTrials.gov Identifier: NCT00711789     History of Changes
Other Study ID Numbers: TNH 23/08
First Submitted: July 7, 2008
First Posted: July 9, 2008
Last Update Posted: June 23, 2011
Last Verified: January 2009

Keywords provided by Austin Health:
Acute renal failure
Septic shock
angiotensin II
neutrophil gelatinase associated lipocalin (NGAL)
cystatin C

Additional relevant MeSH terms:
Sepsis
Renal Insufficiency
Shock, Septic
Acute Kidney Injury
Infection
Systemic Inflammatory Response Syndrome
Inflammation
Pathologic Processes
Kidney Diseases
Urologic Diseases
Shock
Angiotensin II
Angiotensinogen
Vasoconstrictor Agents
Serine Proteinase Inhibitors
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action