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Renal HEIR Study: Renal Hemodynamics, Energetics and Insulin Resistance in Youth Onset Type 2 Diabetes Study (Renal-HEIR)

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ClinicalTrials.gov Identifier: NCT03584217
Recruitment Status : Recruiting
First Posted : July 12, 2018
Last Update Posted : October 19, 2018
Sponsor:
Information provided by (Responsible Party):
Petter Bjornstad, University of Colorado, Denver

Brief Summary:
Type 2 diabetes (T2D) in youth is increasing in prevalence in parallel with the obesity epidemic. In the US, almost half of patients with renal failure have DKD, and ≥80% have T2D. Compared to adult-onset T2D, youth with T2D have a more aggressive phenotype with greater insulin resistance (IR), more rapid β-cell decline and higher prevalence of diabetic kidney disease (DKD), arguing for separate and dedicated studies in youth-onset T2D. Hyperfiltration is common in youth with T2D, and predicts progressive DKD. Hyperfiltration may also be associated with early changes in intrarenal hemodynamic function, including increased renal plasma flow (RPF) and glomerular pressure. Despite the high prevalence and gravity of DKD in youth-onset T2D, widely effective therapeutic options are lacking. The investigators' preliminary data support a strong association between IR and hyperfiltration in youth-onset T2D, but the pathology contributing to this relationship remains unclear. A better understanding of the pathophysiology underlying hyperfiltration and its relationship with IR is critical to inform development of new therapeutics. The investigators' overarching hypotheses are that: 1) hyperfiltration in youth-onset T2D is associated with changes in intrarenal hemodynamics, resulting in increased renal oxygen demand, 2) the demand is unmet by the inefficient fuel profile associated with IR (decreased glucose oxidation and increase free fatty acid [FFA] oxidation), resulting in renal hypoxia and ultimately renal damage. To address these hypotheses, the investigators will measure peripheral insulin sensitivity, adipose insulin sensitivity (FFA suppression), glomerular filtration rate (GFR), RPF, and renal oxygenation in youth with T2D (n=30), obesity (n=20) and in lean (n=20) controls.

Condition or disease Intervention/treatment Phase
Type 2 Diabetes Mellitus Obesity Nephropathy Adolescent Obesity Drug: Aminohippurate Sodium Inj 20% Drug: Iohexol Inj 300 MG/ML Phase 1 Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 70 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: Renal HEIR Study: Renal Hemodynamics, Energetics and Insulin Resistance in Youth Onset Type 2 Diabetes Study
Actual Study Start Date : October 1, 2018
Estimated Primary Completion Date : June 2023
Estimated Study Completion Date : June 2023

Resource links provided by the National Library of Medicine

Drug Information available for: Iohexol

Arm Intervention/treatment
Clinical Investigation
All participants will undergo GFR (Iohexol Inj 300 MG/ML), ERPF (Aminohippurate Sodium Inj 20%) in addition to renal BOLD and ASL MRI.
Drug: Aminohippurate Sodium Inj 20%
Diagnostic aid/agent used to measure effective renal plasma flow (ERPF)
Other Names:
  • Sodium 4-amino hippurate (PAH) inj 20% 2g/10mL
  • Para-aminohippurate
  • Aminohippuric acid

Drug: Iohexol Inj 300 MG/ML
Diagnostic aid/agent used to measure glomerular filtration rate (GFR)
Other Name: omnipaque 300




Primary Outcome Measures :
  1. Effective renal plasma flow (ERPF) [ Time Frame: 4 hours ]
    Measured by PAH clearance

  2. Glomerular filtration rate (GFR) [ Time Frame: 4 hours ]
    Measured by iohexol clearance


Secondary Outcome Measures :
  1. Insulin sensitivity [ Time Frame: 4 hours ]
    Measured by hyperinsulinemic-euglycemic clamp

  2. Renal oxygenation [ Time Frame: 60 min ]
    Blood oxygen level dependent (BOLD) MRI

  3. Renal perfusion [ Time Frame: 10 min ]
    Arterial spin labeling (ASL) MRI



Information from the National Library of Medicine

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Ages Eligible for Study:   12 Years to 21 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Obese youth with and without T2D (≥54 kg) and lean controls
  • Age 12-21 years
  • Weight <300 lbs., no implanted metal devices
  • HbA1c < 11% and no recent diabetic ketoacidosis or hyperosmolar hyperglycemia
  • No anemia
  • BMI >5th percentile for lean controls

Exclusion Criteria:

  • T2D onset (diagnosis) > 18 years of age
  • Prepubertal
  • eGFR <60ml/min/1.73m2 or creatinine > 1.5mg/dl or history of ACR≥300mg/g
  • ACE inhibitors, angiotensin receptor blockers (ARB), diuretics, sodium-glucose co-transport (SGLT) 2 or 1 blockers, daily NSAIDs or aspirin, sulfonamides, procaine, thiazosulfone or probenecid.
  • Seafood or iodine allergy
  • Pregnancy
  • MRI scanning contraindications (claustrophobia, implantable devices, >300 lbs)

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): NCT03584217


Contacts
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Contact: Susan Gross, MS, RD 7207776143 susan.gross@childrenscolorado.org
Contact: Petter Bjornstad, MD 7207774659 petter.bjornstad@childrenscolorado.org

Locations
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United States, Colorado
Children's Hospital Colorado Recruiting
Aurora, Colorado, United States, 80238
Contact: Petter Bjornstad, M.D.         
Principal Investigator: Petter Bjornstad, M.D.         
Sub-Investigator: Kristen Nadeau, M.D.         
Sponsors and Collaborators
University of Colorado Denver School of Medicine Barbara Davis Center
Investigators
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Principal Investigator: Petter Bjornstad, MD University of Colorado School of Medicine

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Responsible Party: Petter Bjornstad, Assistant Professor, University of Colorado, Denver
ClinicalTrials.gov Identifier: NCT03584217     History of Changes
Other Study ID Numbers: 16-1752
First Posted: July 12, 2018    Key Record Dates
Last Update Posted: October 19, 2018
Last Verified: October 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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

Additional relevant MeSH terms:
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Diabetes Mellitus
Obesity
Diabetes Mellitus, Type 2
Insulin Resistance
Pediatric Obesity
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Overnutrition
Nutrition Disorders
Overweight
Body Weight
Signs and Symptoms
Hyperinsulinism