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Assessment of Dialysis Initiation by a Fuzzy Mathematics Equation (ADIFE)

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ClinicalTrials.gov Identifier: NCT03385902
Recruitment Status : Not yet recruiting
First Posted : December 29, 2017
Last Update Posted : January 3, 2018
Sponsor:
Collaborators:
Chinese PLA General Hospital
Fudan University
RenJi Hospital
Guangdong General Hospital
Beijing Friendship Hospital
Huashan Hospital
West China Hospital
First Affiliated Hospital, Sun Yat-Sen University
Chinese Academy of Medical Sciences, Fuwai Hospital
First Affiliated Hospital of Harbin Medical University
The Second Affiliated Hospital of Harbin Medical University
General Hospital of Benxi Iron and Steel CO., LTD.
Dalian Municipal Central Hospital
An Steel Group Hospital
Xijing Hospital
General Hospital of Mining Industry Group Fuxin
The Affiliated Zhongshan Hospital of Dalian University
General Hospital of Shenyang Military Region
Daping Hospital and the Research Institute of Surgery of the Third Military Medical University
General Hospital of Ningxia Medical University
LanZhou University
First Affiliated Hospital Xi'an Jiaotong University
Henan Provincial Hospital
Zhejiang Provincial People’s Hospital
First Affiliated Hospital of Xinjiang Medical University
Shengjing Hospital
First Hospital of China Medical University
Central hospital affiliated to shenyang medical college
Information provided by (Responsible Party):
The First Affiliated Hospital of Dalian Medical University

Brief Summary:
The purpose of this study is to evaluate the impact of the optimal and late initiation of dialysis on the mortality and quality of life in advanced chronic kidney disease patients by the Dialysis Initiation based on Fuzzy mathematics Equation (DIFE), which is a novel equation for the assessment of timing of dialysis initiation established by Fuzzy mathematics.

Condition or disease Intervention/treatment Phase
Chronic Kidney Disease Other: optimal start time Other: late start time Not Applicable

Detailed Description:
The optimal time of dialysis initiation is still controversial. Estimated glomerular filtration rate (eGFR) which is now widely used as the assessment of timing of dialysis is lack of specificity. Some clinical factors such as heart failure, volume overload, malnutrition also determine the dialysis time. But these subjective judgements do not have a standard. So there is no quantitative assessment of timing of dialysis initiation. The research team developed a novel equation named DIFE (Dialysis Initiation based on Fuzzy mathematics Equation) with data from a retrospective multicenter cohort by fuzzy mathematical methods to combine these clinical factors and lab indexes. The DIFE was confirmed to be more accurate and convenient to use in clinical practice than eGFR only at the assessment of dialysis initiation time in the internal validation. For further validation of the DIFE, the team will conduct a multicenter randomized controlled trial. Patients who need hemodialysis will be randomized to optimal start group or late start group by the assessment of the DIFE. Based on the comparison of the two groups, this trial will provide evidence for the optimal timing of dialysis initiation in patients with advanced chronic kidney disease by the DIFE.

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 496 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Impact on Mortality of Timing of Dialysis Initiation in Patients With End-stage Renal Disease by a Novel Assessment Based on Fuzzy Mathematics
Estimated Study Start Date : January 2018
Estimated Primary Completion Date : January 2020
Estimated Study Completion Date : January 2021

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: optimal start group
The DIFE will be used as the assessment of initiation time of dialysis. Patients in this group will start dialysis when their results of the DIFE reaching to 30-35, which defined as the optimal start time.
Other: optimal start time
patients will start hemodialysis when their DIFE reach 35, and can not wait if the DIFE decline to 30.

Active Comparator: late start group
the DIFE will be used as the assessment of initiation time of dialysis. Patients in this group will start dialysis when their results of the DIFE less than 30, which defined as late start time.
Other: late start time
patients will start hemodialysis when their DIFE less than 30




Primary Outcome Measures :
  1. all-cause mortality [ Time Frame: from the date of enrollment until the end of study, assessed up to 3 years ]
    proportion of patients who die from any cause

  2. cerebro-cardiovascular mortality [ Time Frame: 3 years, from the date of enrollment until the end of study ]
    proportion of patients who die from cerebro-cardiovascular disease


Secondary Outcome Measures :
  1. cerebro-cardiovascular events [ Time Frame: from the date of enrollment until the date of death from any cause, or the end of study, which ever came first, assessed up to 3 years ]
    proportion of patients who suffer from cardiovascular events, which include nonfatal myocardial infarction, nonfatal stroke, transient ischemic attack,new-onset angina, acute heart failure or severe arrhythmia.

  2. hospitalization [ Time Frame: from the date of enrollment until the date of death from any cause, or the end of study, which ever came first, assessed up to 3 years ]
    proportion of patients admitted to hospital

  3. Nutrition assessment [ Time Frame: from the date of enrollment until the date of death from any cause, or the end of study, which ever came first, assessed up to 3 years ]
    assess the patient's nutritional status by subjective global assessment (SGA) assessment and serum albumin level

  4. quality of life [ Time Frame: from the date of enrollment until the date of death from any cause, or the end of study, which ever came first, assessed up to 3 years ]
    use short form-36 reported by the patients to assess the patient's quality of life

  5. Medical cost [ Time Frame: from the date of enrollment until the date of death from any cause, or the end of study, which ever came first, assessed up to 3 years ]
    the cost by the patient, family and insurance during treatment

  6. Hemodialysis complications [ Time Frame: from the date of enrollment until the date of death from any cause, or the end of study, which ever came first, assessed up to 3 years ]
    the proportion of patients who suffer from hemodialysis complications including blood assess revise, assess infection, severe fluid and electrolyte disorders

  7. cognitive dysfunction [ Time Frame: from the date of enrollment until the date of death from any cause, or the end of study, which ever came first, assessed up to 3 years ]
    assess cognitive dysfunction by Montreal Cognitive Assessment (MoCA)



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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
Criteria

Inclusion Criteria:

  • Have progressive chronic kidney disease with an eGFR less than 15 ml/min/1.73m2 and a DIFE between 30-35
  • Expected to commence maintenance hemodialysis as their renal replacement treatment
  • Agreeable to randomization

Exclusion Criteria:

  • Acute kidney injury (AKI) or AKI on chronic kidney disease (CKD)
  • With the primary disease of systemic lupus erythematosus (SLE) or systemic vasculitis
  • Have received or planning to receive a kidney transplant or peritoneal dialysis during the study
  • Has a recently diagnosed cancer that was likely to affect survival (except for the following cases: the cancer has been confirmed to be cured or relieved for over 5 years, have had the radical resection for the basal cell carcinoma or squamous carcinoma of skin or carcinoma in-situ of any part of the body )
  • Hepatocirrhosis
  • Positive test of Human Immunodeficiency Virus (HIV), the hepatitis B virus antigen (HBsAg) or anti-hepatitis C virus antibody (HCV Ab)
  • Acute infection within 1 month
  • Bad habit which is difficult to withdrawal such as alcohol abuse
  • Poor compliance and could not be treated according to the protocol
  • Being pregnant, nursing or having a plan for pregnancy
  • Life expectancy less than 1 year
  • The investigator confirm that should not enroll in the study with any other cases

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): NCT03385902


Contacts
Contact: Ying Liu, MD 86041183635963 ext 3535 liuying@dlmedu.edu.cn
Contact: Ming Fang, MD 86041183635963 ext 3535 fangming0411@126.com

Locations
China, Liaoning
the First Affiliated Hospital of Dalian Medical University
Dalian, Liaoning, China, 116011
Sponsors and Collaborators
The First Affiliated Hospital of Dalian Medical University
Chinese PLA General Hospital
Fudan University
RenJi Hospital
Guangdong General Hospital
Beijing Friendship Hospital
Huashan Hospital
West China Hospital
First Affiliated Hospital, Sun Yat-Sen University
Chinese Academy of Medical Sciences, Fuwai Hospital
First Affiliated Hospital of Harbin Medical University
The Second Affiliated Hospital of Harbin Medical University
General Hospital of Benxi Iron and Steel CO., LTD.
Dalian Municipal Central Hospital
An Steel Group Hospital
Xijing Hospital
General Hospital of Mining Industry Group Fuxin
The Affiliated Zhongshan Hospital of Dalian University
General Hospital of Shenyang Military Region
Daping Hospital and the Research Institute of Surgery of the Third Military Medical University
General Hospital of Ningxia Medical University
LanZhou University
First Affiliated Hospital Xi'an Jiaotong University
Henan Provincial Hospital
Zhejiang Provincial People’s Hospital
First Affiliated Hospital of Xinjiang Medical University
Shengjing Hospital
First Hospital of China Medical University
Central hospital affiliated to shenyang medical college
Investigators
Study Director: Hongli Lin, MD, PhD The First Affiliated Hospital of Dalian Medical University

Publications of Results:

Other Publications:
Responsible Party: The First Affiliated Hospital of Dalian Medical University
ClinicalTrials.gov Identifier: NCT03385902     History of Changes
Other Study ID Numbers: YJ-KY-2017-119
First Posted: December 29, 2017    Key Record Dates
Last Update Posted: January 3, 2018
Last Verified: November 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by The First Affiliated Hospital of Dalian Medical University:
advanced chronic kidney disease
timing of dialysis initiation
hemodialysis
fuzzy mathematics
glomerular filtration rate

Additional relevant MeSH terms:
Kidney Diseases
Renal Insufficiency, Chronic
Urologic Diseases
Renal Insufficiency