Proteomic Prediction and Renin Angiotensin Aldosterone System Inhibition Prevention Of Early Diabetic nephRopathy In TYpe 2 Diabetic Patients With Normoalbuminuria (PRIORITY)
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ClinicalTrials.gov Identifier: NCT02040441 |
Recruitment Status :
Completed
First Posted : January 20, 2014
Last Update Posted : December 21, 2018
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This is a prospective, multicenter, randomized, double blind, placebo-controlled and a prospective observational study.
This study will be conducted at 15 study centers in various European countries. 1777 participant between 18 to 75 years old with Type 2 diabetes mellitus and normoalbuminuria participate in the study. The study period is 2 - 4.5 years (excluding the 6 week screening period). Depending on the risk score of the urinary protein pattern, participants have been stratified into an observational group or an interventional group. Participants with the low risk pattern (observational group) attend visits annually after screening and baseline. Participants with the high risk pattern (interventional group) attend study visits every 13 weeks after screening and baseline.
The interventional group has been allocated into one treatment group either receiving spironolactone or placebo. A placebo is a medicine without a pharmaceutical substance. The allocation to one of the two treatment groups has been done by a random distribution procedure established before the study start.
The results of the urine sample from the Screening visit has been analysed and the urine proteomic pattern is determined to be either low- or high risk pattern and will determine the further study program.
Participants with a low-risk pattern (observational group):
During the study period, participants attend an annual project visit, were regular diabetes care is performed and three urine samples are analysed for albuminuria.
Participants with a high-risk pattern (intervention group):
Participants with a high-risk pattern have been randomized to either spironolactone treatment or placebo. The treatment is one tablet for oral use to be taken once a day for the entire study period. Four times each year (every 13th week) a study visit is conducted including examination of three urine samples for albuminuria.
This study aims to:
- Confirm in a prospective multicenter study of normoalbuminuric type 2 DM patients that the urinary proteome test identifies patients with a high risk for development of microalbuminuria.
- Demonstrate the clinical utility of the test by showing that aldosterone blockade in high-risk patients can reduce progression to microalbuminuria in comparison to placebo, on the top of standard treatment in a randomized double-blind, placebo-controlled multicenter study.
Condition or disease | Intervention/treatment | Phase |
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Diabetic Nephropathy Diabetic Retinopathy | Drug: Spironolactone Drug: Placebo Drug: Standard care | Phase 2 Phase 3 |

Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 1777 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) |
Primary Purpose: | Diagnostic |
Official Title: | Proteomic Prediction and Renin Angiotensin Aldosterone System Inhibition Prevention Of Early Diabetic nephRopathy In TYpe 2 Diabetic Patients With Normoalbuminuria |
Actual Study Start Date : | March 2014 |
Actual Primary Completion Date : | November 2018 |
Actual Study Completion Date : | November 2018 |

Arm | Intervention/treatment |
---|---|
Active Comparator: Spironolactone
High-risk pattern: Spironolactone 25 mg once daily + Standard care
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Drug: Spironolactone Drug: Standard care Standard diabetes care |
Placebo Comparator: Placebo
High-risk pattern: One placebo tablet once daily + Standard care
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Drug: Placebo Drug: Standard care Standard diabetes care |
Observational
Low-risk pattern: Standard care
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Drug: Standard care
Standard diabetes care |
- Albuminuria [ Time Frame: Screening, (Low-risk: year 1, 2 and 3), (high-risk: week 13, 26, 39, 52, 65, 78, 91, 104, 117, 130, 143, 156) ]Development of confirmed microalbuminuria (UACR >30 mg/g) in at least two out of three first morning voids with ≥ 30% increase (geometric mean) in UACR from "run-in" period samples OR > 40 mg/g (geometric mean).
- Cardiovascular disease and mortality [ Time Frame: Screening, (Low-risk: year 1, 2 and 3), (high-risk: week 13, 26, 39, 52, 65, 78, 91, 104, 117, 130, 143, 156) ]Comparison of composite fatal and non-fatal cardiovascular outcome (myocardial infarction, stroke, coronary artery bypass, coronary re-vascularisation, hospitalization for heart failure and cardiovascular death), and all-cause mortality during the study.
- Retinopathy [ Time Frame: Screening, (Low-risk: year 1, 2 and 3), (high-risk: week 13, 26, 39, 52, 65, 78, 91, 104, 117, 130, 143, 156) ]Comparison of incidence of retinopathy and frequency of laser treatment. Data collected from self-reported adverse events.
- Change in albuminuria [ Time Frame: Screening, (Low-risk: year 1, 2 and 3), (high-risk: week 13, 26, 39, 52, 65, 78, 91, 104, 117, 130, 143, 156) ]In addition to the categorical analysis of urinary albumin excretion, an analysis will be performed with changes in geometric mean albuminuria throughout the study period in all patients by assessing the slope of albuminuria changes and absolute changes from inclusion to end of trial
- Microalbuminuria [ Time Frame: Screening, (Low-risk: year 1, 2 and 3), (high-risk: week 13, 26, 39, 52, 65, 78, 91, 104, 117, 130, 143, 156) ]Development of microalbuminuria (UACR >30 mg/g) in at least one morn-ing void urine sample will be used as a secondary outcome instead of con-firmed microalbuminuria
- Macroalbuminuria [ Time Frame: Screening, (Low-risk: year 1, 2 and 3), (high-risk: week 13, 26, 39, 52, 65, 78, 91, 104, 117, 130, 143, 156) ]Development of macroalbuminuria (UACR >300 mg/g) in 2 out 3 first morning void urine samples)
- Change in CKD class [ Time Frame: Screening, (Low-risk: year 1, 2 and 3), (high-risk: week 13, 26, 39, 52, 65, 78, 91, 104, 117, 130, 143, 156) ]For patients with estimated GFR ≥ 60 at baseline, development of estimated GFR<60 ml/min/1.73m2. Estimated GFR will be measured from serum creatinine (standard-ized traceable method) on blood samples tested in local laboratories.
- Slope of estimated GFR [ Time Frame: Screening, (Low-risk: year 1, 2 and 3), (high-risk: week 13, 26, 39, 52, 65, 78, 91, 104, 117, 130, 143, 156) ]Change in estimated GFR (slope and absolute from baseline and from 3 month post-baseline to end of study)

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Ages Eligible for Study: | 18 Years to 75 Years (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Written informed consent must be provided before participation. Patient information and consent form must be approved by relevant independent ethical committee. Specifically, all participating patients will be asked to give informed consent for long-term follow-up and collection of follow-up data
- Male or female patients ≥ 18 years and < 75 years of age at Screening visit
- Type 2 DM (WHO criteria)
- Persistent normoalbuminuria (at least 2 of 3 UACR < 30 mg/g samples from "run in"-period)
- Estimated GFR >45 ml/min/1.73m2 (MDRD formula) at Screening visit
- The patient must be willing and able to comply with the protocol for the duration of the study
- Female without child-bearing potential at the screening visit. Defined as one or more of following:
7.1) Female patients ≥ 50 years of age at the day of inclusion, who have been postmenopausal for at least 1 year 7.2) Female patients < 50 years of age at the day of inclusion, who have been postmenopausal for at least 1 year and serum follicle stimulating hormone levels > 40 milli International unit / mL as well as serum estrogen levels < 30 pg/ml or a negative estrogen test.
7.3) 6 weeks after surgical sterilization by bilateral tubal ligation or bilateral ovariectomy with or without hysterectomy.
OR a negative urine pregnancy test at the Screening visit AND one or more of following:
7.4) Correct use of reliable contraception methods. This includes one or more of the following: hormonal contraceptive (such as injection, transdermal patch, implant, cervical ring or oral) or an intrauterine device (IUD) OR correct use of double barrier with one of the following: barrier methods (diaphragm, cervical cap, Lea contraceptive or condom) AND in combination with a spermicide.
7.5) General sexual abstinence from the time of screening/ baseline, during the study until a minimum of 30 days after the last administration of study medication if this is already established as the patient's preferred and usual lifestyle.
7.6) Having only female sexual partners. 7.7) Sexual relationship with sterile male partners only
Exclusion Criteria:
- Average of systolic BP< 110 or >160 mm Hg at baseline
- Average of diastolic BP > 100 mm Hg at baseline
- Type 1 DM (WHO criteria)
- HbA1c <6.5% (48 mmo l/ mol) AND > 5 years of known duration of diabetes type 2 AND never treated with an antidiabetic drug of any kind.
- Current in treatment with more than one RAAS blocking agent (Angiotensin Converting Enzyme inhibitor, Angiotensin Receptor Blocker or Direct Renin Inhibitor)
- Current lithium treatment
- Known or suspected hypersensitivity to Spironolactone or to any of its excipients.
- Current use of potassium sparing diuretics, such as: Spironolactone, Eplerenone or Amiloride etc.
- Screening (week -6) plasma (or serum) potassium level >5.0 mmol/L
- Low plasma sodium determine by the investigator
- Current cancer treatment or within five years from baseline (except basal cell skin cancer or squamous cell skin cancer)
- Any clinically significant disorder, except for conditions associated with type 2 DM history, which in the Investigators opinion could interfere with the results of the trial
- Cardiac disease defined as: Heart failure (NYHA class III-IV) and/or diagnosis of unstable angina pectoris and/or myocardial ischemia, stroke, cardiac re-vascularisation or coronary artery bypass within the last 3 months
- Diagnosis of non-Diabetic CKD current or in the past
- Diagnosis of liver cirrhosis with current impaired liver function within the last 3 years.
- Diagnosis of Addison's disease.
- Being lactating.
- Intend to become pregnant within the duration of the study or not use adequate birth control.
- Known or suspected abuse of alcohol or narcotics
- Not able to understand informed consent form
- Participation in any other intervention trial than PRIORITY or a related sub-study is not allowed within 30 days before inclusion or concurrent to this study

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): NCT02040441
Belgium | |
Universitair Ziekenhuis | |
Gent, Belgium | |
Czechia | |
Institut Klinické a Experimentální Mediciny | |
Prague, Czechia | |
Universita Karlova v Praze | |
Prague, Czechia | |
Denmark | |
Steno Diabets Center Copenhagen | |
Gentofte, Denmark, 2820 | |
Germany | |
Universitätsklinikum Carl Gustav Carus, Technischen Universität Dresden | |
Dresden, Germany | |
Diabetologen Hessen | |
Hessen, Germany | |
Klinikum St. Georg gGmbH | |
Leipzig, Germany | |
Greece | |
Geniko Nosikomeico Athinas Ippokrateio, Hospital Diabetes Center | |
Athens, Greece | |
Italy | |
Instituto de Ricerche Farmacologiche Mario Negri | |
Bergamo, Italy, 24020 | |
Macedonia, The Former Yugoslav Republic of | |
Department of Nephrology, University of Skopje | |
Skopje, Macedonia, The Former Yugoslav Republic of | |
Netherlands | |
University Medical Center Groningen | |
Groningen, Netherlands | |
Diabetes Vascular Research Foundation | |
Hoogeveen, Netherlands | |
Stichting VUMC | |
Hoorn, Netherlands | |
Spain | |
Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz | |
Madrid, Spain, 28040 | |
United Kingdom | |
University of Glasgow | |
Glasgow, United Kingdom, G12 8TA |
Study Chair: | Peter Rossing, Prof. MD | Steno Diabetes Center Copenhagen | |
Principal Investigator: | Matias Trillini, MD | Istituto de Ricerche Farmacologiche Mario Negri | |
Principal Investigator: | Alberto Ortiz, MD | Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz | |
Principal Investigator: | Christian Delles, MD | University of Glasgow | |
Principal Investigator: | Gerjan Navis, MD | University Medical Center Groningen | |
Principal Investigator: | Ivan Rychlik, MD | Univerzita Karlova v Praze | |
Principal Investigator: | Joachim Beige, MD | Klinikum St. Georg gGmbH | |
Principal Investigator: | Marina Noutsou, MD | Geniko Nosikomeico Athinas Ippokrateio, Hospital Diabetes Center | |
Principal Investigator: | Peter Girman, MD | Institut Klinické a Experimentální Mediciny | |
Principal Investigator: | Goce Spasovski, MD | Department of Nephrology, University of Skopje | |
Principal Investigator: | Adriaan Kooy, MD | Diabetes Vascular Research Foundation Hoogeveen | |
Principal Investigator: | Marjin Speeckaert, MD | Universitair Ziekenhuis Gent | |
Principal Investigator: | Joline Beulens, MD | Stichting VUMC | |
Principal Investigator: | Rüdiger Göke, MD | Diabetologen Hessen | |
Principal Investigator: | Andreas Birkenfeld, MD | Universitätsklinikum Carl Gustav Carus, Technischen Universität Dresden |
Documents provided by Peter Rossing, Steno Diabetes Center Copenhagen:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: | Peter Rossing, Professor, Chief Physician, MD, DMSc, Steno Diabetes Center Copenhagen |
ClinicalTrials.gov Identifier: | NCT02040441 |
Other Study ID Numbers: |
2012-000452-34 2012-000452-34 ( EudraCT Number ) |
First Posted: | January 20, 2014 Key Record Dates |
Last Update Posted: | December 21, 2018 |
Last Verified: | December 2018 |
Proteomics Diabetes Chronic kidney disease Diabetic nephropathy |
Diabetic retinopathy Mineralocorticoid receptor antagonists Spironolactone Microalbuminuria |
Retinal Diseases Diabetic Retinopathy Kidney Diseases Diabetic Nephropathies Diabetes Mellitus Endocrine System Diseases Urologic Diseases Eye Diseases Diabetic Angiopathies Vascular Diseases |
Cardiovascular Diseases Diabetes Complications Spironolactone Mineralocorticoid Receptor Antagonists Hormone Antagonists Hormones, Hormone Substitutes, and Hormone Antagonists Physiological Effects of Drugs Diuretics, Potassium Sparing Diuretics Natriuretic Agents |