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CompletedNCT03428464Updated Oct 22, 2020

Bicarbonate Administration in Kidney Transplant Recipients

An interventional study of Sodium Bicarbonate and Placebo in Kidney Transplant; Complications and Metabolic Acidosis, sponsored by University of Colorado, Denver. Completed at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2020-10-22.

Sponsored by University of Colorado, Denver · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
20
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

Metabolic acidosis is associated with vascular endothelial dysfunction and is a common complication in patients who have received a kidney transplant. Kidney transplant recipients (KTR) with lower serum bicarbonate levels, even within the normal range, have an increased risk of graft loss and mortality. The investigators propose a prospective, double-blind, randomized, placebo-controlled, 18-week crossover pilot study to examine the effects of sodium bicarbonate on vascular endothelial function, graft function, and cognitive function in 20 KTR patients.

02

Conditions studied

  • Kidney Transplant; Complications
  • Metabolic Acidosis

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03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Age ≥ 18 years
  • Kidney transplant received at least 1 year ago
  • Serum bicarbonate 20-26 mEq/L on 2 separate measurements (at least 1 day apart)
  • eGFR >45 ml/min/1.73m2
  • Blood pressure \<140/90 mm Hg prior to randomization
  • BMI \< 40 kg/m2 (FMD measurements can be inaccurate in severely obese patients).
  • Able to provide consent
  • Stable kidney transplant medication regimen for at least 1 month prior to randomization
  • Stable anti-hypertensive regimen for at least one month prior to randomization
  • Not taking medications that interact with agents administered during experimental sessions (e.g. sildenafil interacts with nitroglycerin).

Exclusion criteria

Exclusion Criteria:

  • Significant comorbid conditions that lead the investigator to conclude that life expectancy is less than 1 year
  • Use of chronic daily oral alkali within the last 3 months (including sodium bicarbonate, calcium carbonate or baking soda)
  • Uncontrolled hypertension
  • Serum potassium \< 3.3 or ≥ 5.5 mEq/L at screening
  • New York Heart Association Class 3 or 4 heart failure symptoms, known EF ≤30%, or hospital admission for heart failure within the past 3 months · Factors judged to limit adherence to interventions
  • Current participation in another research study
  • Pregnancy or planning to become pregnant or currently breastfeeding
  • Chronic use of supplemental oxygen
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Crossover assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
20 participants (actual)

Study arms

  • Experimental
    Sodium bicarbonate

    During the treatment period, participants will receive 0.5 mEq/kg-lean body weight (LBW)/day of oral sodium bicarbonate for 8 weeks.

    Drug: Sodium Bicarbonate

  • Placebo comparator
    Placebo

    During the control period, participants will take the same number of placebo capsules as if they were assigned 0.5 mEq/kg-LBW/day of sodium bicarbonate.

    Other: Placebo

Interventions

  • DrugSodium Bicarbonate

    Participants will take ½ the daily dose of sodium bicarbonate in the morning and the other ½ in the evening.

    Also known as: Baking soda

  • OtherPlacebo

    Participants will take ½ the daily dose of a placebo in the morning and the other ½ in the evening.

05

What researchers measure

Primary outcomes

  1. Change in Brachial Artery Flow-Mediated Dilation

    Brachial artery Flow-Mediated Dilation (FMD) will be determined using high-resolution ultrasonography (Toshiba Xario 200) as described originally by Celermajer et al., and more recently by our group. FMD will be measured at the beginning and end of each study period for a total of 4 measurements. ECG-gated end-diastolic ultrasound images and Doppler flow of the brachial artery will be acquired during baseline and FMD conditions.

    Time frame: Baseline, 8, 10, and 18 weeks

Secondary outcomes

  1. Change in Transforming Growth Factor Beta 1 (TGF-B1)

    Urinary TGF-B1 will be measured from 24-hour urine collections. It will be measured by a commercially available ELISA (R\&D Systems). The within day precision for this assay is 6.7% at 257 pg/ml. All measurements will be performed at the Children's Pediatric CTRC at Children's Hospital Colorado.

    Time frame: Baseline, 8, 10, and 18 weeks

  2. Change in Cognitive Function

    Cognitive function will be assessed using the National Institutes of Health (NIH) Toolbox computerized tests to evaluate 1) attention, 2) episodic memory, 3) working memory, 4) language, 5) executive function, and 6) processing speed.

    Time frame: Baseline, 8, 10, and 18 weeks

06

Study locations

1 site
  • University of Colorado Hospital
    Aurora, Colorado 80045, United States
07

Registry details

Key details

Study ID
NCT03428464
Lead sponsor
University of Colorado, Denver
Responsible party
Sponsor
First posted
Feb 9, 2018
Start date
Dec 5, 2018
Primary completion
Mar 25, 2020
Completion
Mar 25, 2020
Last update
Oct 22, 2020

Study contacts

Jessica Kendrick, MD MPH
principal investigator · University of Colorado, Denver

Oversight

FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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