EMPRA (EMPagliflozin and RAs in Kidney Disease)

Overview

This study will be a prospective, clinical pilot study in CKD patients to show whether Empagliflozin in addition to ACEi treatment significantly increases Ang 1-7 levels compared to ACEi treatment alone. Null and alternative hypotheses: H0: Empagliflozin in addition to ACEi treatment does not increase Ang 1-7 levels more than ACEi treatment alone. H1: Empagliflozin in addition to ACEi treatment significantly increases Ang 1-7 levels compared to ACEi treatment alone Methodology: Two groups of 24 chronic kidney disease (CKD) patients, respectively, with and without type 2 diabetes will be randomized into the study medication or placebo group. The number of patients per treatment arms is n = 12. Included and consented patients will be subjected to an initial 2-week run-in period for conversion of current RAS blocking medications to ACEi therapy with enalapril or ramipril and respective dose titration to 10 mg enalapril 2 x daily and 10 mg ramipril 1 x daily. Additional antihypertensive medication will be standardized as feasible, with the primary goal of keeping blood pressure as recommended by KDIGO. Following the 2-week run-in phase, all study patients will be subjected to blood collection including the first RAS quantification (RAS Fingerprint) and assessment of HDL composition, as well as urinary analysis and bioimpedance fluid status assessment (BCM measurement). Subsequently, patients will be randomized to either receive empagliflozin (at a dose of 10 mg daily) or placebo. Subsequently, biweekly study visits including electrolyte and glucose (plasma and urine) monitoring as well as BCM measurement will take place. After 12 weeks of study medication intake, a concluding study visit will be scheduled for final RAS quantification (RAS Fingerprint) and HDL analyses as well as final blood and urinary analysis and BCM measurement. Initially, blood and urine will be collected at the clinical visit as part of the routine blood obtainment (no additional effort on patients). From these routine measurements we will be able to extract information regarding the patient's current CKD stage as well as other relevant laboratory parameters (e.g. HbA1c, UACR, etc.). Furthermore, we will document the patient's current medication and significant comorbidities. Primary analysis variable/endpoint: The difference of Ang 1-7 increase from baseline between a 3-month treatment with empagliflozin on top of ACEi treatment compared to ACEi treatment alone Most important secondary analysis variables/endpoints: 1. Simultaneous quantitative changes of multiple RAS effector angiotensin levels determined by mass-spectrometry 2. Recurrence of Ang II levels determined by mass-spectrometry 3. HDL parameters (protein composition of HDL) 4. Renal parameters (albuminuria reduction measured by urinary albumin-creatinine ratio (UACR), renal function (estimated glomerular filtration rate (GFR), serum-creatinine) 5. Urinary electrolyte levels 6. Urinary glucose levels 7. Urinary RAS metabolites (angiotensinogen, ACE and ACE2 levels, ACE2 activity) 8. Blood pressure determined by ambulatory blood pressure measurements 9. Body volume determined by bioimpedance fluid status assessment (BCM measurement) 10. OCR and ECAR in PBMCs determined by Seahorse Flux Analyzer 11. Assessment of reduction of salt sensitivity by using salt sensitivity test with empagliflozin

Full Title of Study: “Effect of Empagliflozin on the Renin-angiotensin System in Patients With Chronic”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Triple (Participant, Investigator, Outcomes Assessor)
  • Study Primary Completion Date: June 18, 2019

Interventions

  • Drug: Empagliflozin 10 MG [Jardiance]
    • administered orally once daily
  • Drug: Placebo Oral Tablet
    • administered orally once daily

Arms, Groups and Cohorts

  • Experimental: Group A
    • Diabetic CKD patients receiving Empagliflozin 10 MG [Jardiance]
  • Placebo Comparator: Group B
    • Diabetic CKD patients receiving Placebo Oral Tablet
  • Experimental: Group C
    • Non-diabetic CKD patients receiving Empagliflozin 10 MG [Jardiance]
  • Placebo Comparator: Group D
    • Non-diabetic CKD patients receiving ‘Placebo Oral Tablet

Clinical Trial Outcome Measures

Primary Measures

  • The difference of Ang 1-7 increase from baseline between a 3-month treatment with empagliflozin on top of ACEi treatment compared to ACEi treatment alone
    • Time Frame: Visit 2 and Visit 8; 3 months
    • The difference of Ang 1-7 increase from baseline between a 3-month treatment with empagliflozin on top of ACEi treatment compared to ACEi treatment alone

Secondary Measures

  • Mean quantitative changes of baseline multiple RAS effector angiotensin levels after 3 months of empagaliflozin treatment
    • Time Frame: Visit 2 and Visit 8; 3 months
    • Mean quantitative changes of baseline multiple RAS effector angiotensin levels after 3 months of empagaliflozin treatment
  • Mean changes of baseline Ang II levels after 3 months of empagaliflozin treatment
    • Time Frame: Visit 2 and Visit 8; : 3 months
    • Mean changes of baseline Ang II levels after 3 months of empagaliflozin treatment
  • Mean changes of baseline specific protein amount on HDL after 3 months of empagaliflozin treatment
    • Time Frame: Visit 2 and Visit 8; 3 months
    • Mean changes of baseline specific protein amount on HDL after 3 months of empagaliflozin treatment
  • Mean changes in specific renal parameters from baseline in 3 months of empagaliflozin treatment (albuminuria reduction, renal function)
    • Time Frame: Visit 2 ,3,4,5,6,7,8; 3 months
    • Mean changes in specific renal parameters from baseline in 3 months of empagaliflozin treatment (albuminuria reduction, renal function)
  • Mean changes from baseline relevant blood parameters (HbA1c, β-hydroxybutyrat, elektrolytes, lipids, etc.) after 3 months of empagaliflozin treatment
    • Time Frame: Visit 2 ,3,4,5,6,7,8; 3 months
    • Mean changes from baseline relevant blood parameters (HbA1c, β-hydroxybutyrat, elektrolytes, lipids, etc.) after 3 months of empagaliflozin treatment
  • Mean changes from baseline urinary RAS metabolites (angiotensinogen, ACE and ACE2 levels, ACE2 activity) after 3 months of empagaliflozin treatment
    • Time Frame: Visit 2 and Visit 8; 3 months
    • Mean changes from baseline urinary RAS metabolites (angiotensinogen, ACE and ACE2 levels, ACE2 activity) after 3 months of empagaliflozin treatment
  • Mean changes in baseline blood pressure after 3 months of empagaliflozin treatment
    • Time Frame: Visit 2 ,3,4,5,6,7,8; 3 months
    • Mean changes in baseline blood pressure after 3 months of empagaliflozin treatment
  • Mean changes in body fluid status after 3 months of empagaliflozin treatment
    • Time Frame: Visit 2 and Visit 8; 3 months
    • Mean changes in body fluid status after 3 months of empagaliflozin treatment
  • Mean changes in baseline oxygen consumption rate (OCR) and the extracellular acidification rate (ECAR) in peripheral peripheral blood mononuclear cells (PBMCs) after 3 months of empagliflozin treatment
    • Time Frame: Visit 2 and Visit 8; 3 months
    • Mean changes in baseline oxygen consumption rate (OCR) and the extracellular acidification rate (ECAR) in peripheral peripheral blood mononuclear cells (PBMCs) after 3 months of empagliflozin treatment
  • Mean changes in salt sensitivity after 3 months of empagliflozin treatment
    • Time Frame: Visit 2 and Visit 8; 3 months
    • Mean changes in salt sensitivity after 3 months of empagliflozin treatment

Participating in This Clinical Trial

Inclusion Criteria

for CKD patients with type 2 diabetes

  • Estimated GFR (calculated with the MDRD-IDMS formula) between 15 and 59 ml/min (with CKD stage IIIa/b to IV) – Albumin excretion rates of 30-300 mg/24 hours (UACR <300 mg/g) – Fasting plasma glucose levels >126 mg/dl [7mmol/L] or HbA1c levels >6.5% (Definition of type 2 diabetes according to the diagnostic criteria set forth by the American Diabetes Association in 2009) for CKD patients without Diabetes – Estimated GFR (calculated with the MDRD-IDMS formula) between 15 and 59 ml/min (with CKD stage IIIa/b to IV) – Albumin excretion rates of 30-300 mg/24 hours (UACR <300 mg/g) Exclusion Criteria:

CKD patients with type 2 diabetes

  • Age <18 years – Severely impaired renal function (eGFR <15ml/min) – Hyperkalemia above 4.5mmol/L – Hypotension (systolic blood pressure lower than 120 mmHg on ambulatory measurement) – Pregnant patients – Patients planning pregnancy – Body mass index < 18.5 kg/m2 for CKD patients without diabetes – Age <18 years – Diabetic kidney disease – Severely impaired renal function (eGFR <15ml/min) – Hypotension (systolic blood pressure lower than 120 mmHg on ambulatory measurement) – Pregnant patients – Patients planning pregnancy – Body mass index < 18.5 kg/m2 -

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Medical University of Vienna
  • Collaborator
    • Attoquant Diagnostics
  • Provider of Information About this Clinical Study
    • Principal Investigator: Assoc. Prof. Dr. Manfred Hecking, MD PhD, Assoc. Prof. PD. Dr.med. – Medical University of Vienna
  • Overall Official(s)
    • Manfred Hecking, MD, Principal Investigator, Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Austria

Clinical trials entries are delivered from the US National Institutes of Health and are not reviewed separately by this site. Please see the identifier information above for retrieving further details from the government database.

At TrialBulletin.com, we keep tabs on over 200,000 clinical trials in the US and abroad, using medical data supplied directly by the US National Institutes of Health. Please see the About and Contact page for details.