A Phase 4 interventional study of Placebo and Co-Enzyme Q10 in Chronic Kidney Diseases, sponsored by Tanta University. Recruiting at 1 site in Egypt. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-06-19.
Sponsored by Tanta University · Phase 4, Interventional, and Treatment
This randomized placebo controlled double blind parallel clinical study will be conducted on 44 non-dialysis chronic kidney disease (CKD) patients (Stages 2-3b).Clinical Study Evaluating the Role of Coenzyme Q10 as Adjuvant Therapy to Angiotensin Converting Enzyme Inhibitor on Blood Pressure, Proteinuria and Bone Metabolism in Patients with Chronic Kidney Disease. Patients will be recruited from, Internal Medicine Department, Nephrology Unit, Alexandria Main University Hospital, Egypt. Patients with albumin-to-creatinine ratio ≥ 30 mg/g, with serum Potassium \< 5 mEq/L and newly diagnosed patients with hypertension. The study duration will be 6 months. The patients will be randomized using stratified random block method into two groups.
Group 1: Control group Non-dialysis chronic kidney disease (CKD) patients (Stages 2-3b). Patients will be treated with ramipril 10 mg/day and a placebo match Coenzyme Q10 capsules once per day.The dose of ramipril may be modified according to blood pressure control.
Group 2: Coenzyme Q10 Non-dialysis chronic kidney disease (CKD) patients (Stages 2-3b).Patients will be treated with ramipril 10 mg/day and Coenzyme Q10 capsules (CoQ10) 200 mg/day. The dose of ramipril may be modified according to blood pressure control.
Participants will be followed-up by weekly telephone calls and monthly direct meetings to assess their adherence for 6 months.
Chronic kidney disease (CKD) is defined by a reduction in the kidney function (shown by reduced estimated glomerular filtration rate (eGFR) or markers of kidney damage, or both, for at least three months). It varies depending on the amount of blood pressure control, the degree of proteinuria, the previous rate of decline in GFR, and the underlying renal disease, including diabetes.
Phosphorus excretion decreases in many kidney disorders, and as a result, the amount of fibroblast growth factor 23 (FGF-23) rises.FGF-23 levels have appeared to predict risk of death in individuals with chronic renal disease as the estimated glomerular filtration rate declines, and a corresponding increase in FGF-23 can be noted.
FGF-23 is a hormone with a molecular weight of 30 kDa works on fibroblast growth factor receptors (FGFR1-4) in the kidney, heart, colon, and parathyroid gland. It is secreted by osteocytes and, to a lesser extent by osteoblasts into the bloodstream. A rise in FGF-23 could indicate kidney dysfunction, and concurrent bone disease. Patients with CKD are well known to have greater risk for developing bone fractures.
The term "chronic kidney disease-mineral bone disorder" (CKD-MBD) refers to the decline in bone quality and the subsequent development of disorders in bone and mineral metabolism caused by impaired kidney function. In addition to PTH, vitamin D, calcium and phosphorus, fibroblast growth factor-23 (FGF-23) play a role in CKD-MBD.
Treatment of the underlying disease, if possible, and treatment of secondary factors, such as increased blood pressure and proteinuria, are the two main ways to limit the rate of CKD progression. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are renin-angiotensin system (RAS) inhibitors that are more effective than other antihypertensive medications in reducing proteinuria and slowing the rate of progression of proteinuria during CKD, regardless of the etiology.
Ramipril inhibits ACE, which lowers FGF-23 expression in the kidney and attenuates proteinuria. Angiotensin inhibition frequently causes mild to moderate decrease in GFR and hyperkalemia following the treatment initiation or following dose escalation. If CKD is progressive, hyperkalemia may develop quickly after the start of treatment or at a later time.
Coenzyme Q10 (CoQ10) is an organic molecule can be found in both reduced (ubiquinol) and oxidised (ubiquinone) forms in mitochondria and cell membranes. Patients with CKD have been found to have considerably reduced plasma CoQ10 levels. CoQ10 lowers the level of aldosterone and modifies the angiotensin effect on sodium retention. An increase in CoQ10 availability may have altered renin-angiotensin-aldosterone action resulting in a decrease in ACE level. Additionally, the endothelium appears to be directly affected by CoQ10, causing vasodilation and reducing blood pressure. High dose CoQ10 supplementation in cases where the condition is treated early resulted in an improvement in renal function and a reduction in proteinuria.CoQ10 prevent an increase of FGF-23 and also provides a reduction in cardiovascular risk.The aim of this work is to evaluate the role of Coenzyme Q10 (CoQ10) as adjuvant therapy to angiotensin converting enzyme inhibitor on blood pressure, proteinuria and bone metabolism in patients with chronic kidney disease (CKD).
All the participants will be subjected to the following:
Clinical outcome will be assessed at baseline and 6 months after Intervention through:
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Exclusion criteria:
Non-dialysis chronic kidney disease (CKD) patients (Stages 2-3b). Patients will be treated with ramipril 10 mg/day and a placebo match Coenzyme Q10 capsules once per day.The dose of ramipril may be modified according to blood pressure control. Participants will be followed-up by weekly telephone calls and monthly direct meetings to assess their adherence for 6 months.
Drug: Placebo
Non-dialysis chronic kidney disease (CKD) patients (Stages 2-3b).Patients will be treated with ramipril 10 mg/day and Coenzyme Q10 capsules (CoQ10) 200 mg/day.The dose of ramipril may be modified according to blood pressure control. Participants will be followed-up by weekly telephone calls and monthly direct meetings to assess their adherence for 6 months.
Drug: Co-Enzyme Q10
Placebo match Coenzyme Q10 capsules once per day .
Patients will be treated with Coenzyme Q10 capsules (CoQ10) 200 mg/day.
The change in kidney function test measured by creatinine clearance (eGFR) mL/min/1.73m2 which will be calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation, 2021
Assessment of kidney functions at baseline, 4 weeks, 3 and 6 months after initiation of ACEI by assessment: Estimated glomerular filtration rate (eGFR) in mL/min/1.73m2 which will be calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation, 2021.
Time frame: The study duration will be 6 months.
The change in proteinuria level be assessed using Albumin-to-creatinine ratio (ACR) ratio (mg/g)
Assessment of Proteinuria at the time of enrollment, 3 and 6 months after intervention. Albumin-to-creatinine ratio will be calculated by dividing the urinary albumin concentration by the urinary creatinine concentration (mg/g)
Time frame: The study duration will be 6 months
The change in blood pressure (mmHg) will be done using a mercury sphygmomanometer
Measurement of blood pressure will be done using a mercury sphygmomanometer in accordance with recommendations of the American Heart Association and standardized office blood pressure measurements. The mean values of the duplicate measurements will be recorded. The blood pressure will be assessed at baseline and every 4 weeks.
Time frame: The study duration will be 6 months
The change in Blood urea nitrogen (BUN) (mg/dl)
Assessment of BUN (mg/dl) at baseline, 4 weeks, 3 and 6 months after initiation of ACEI
Time frame: The study duration will be 6 months
The change in serum potassium (meq/l).
Assessment of serum potassium (meq/l) at baseline, 4 weeks, 3 and 6 months after initiation of ACEI
Time frame: The study duration will be 6 months
The change in serum creatinine (mg/dl)
Assessment of serum creatinine (mg/dl) at baseline, 4 weeks, 3 and 6 months after initiation of ACEI
Time frame: The study duration will be 6 months
The change in serum urea (mg/dl)
Assessment of serum urea (mg/dl) at baseline, 4 weeks, 3 and 6 months after initiation of ACEI
Time frame: The study duration will be 6 months
The change in chronic kidney disease-mineral and bone disorder related parameters by assessment Serum level of Fibroblast growth factor-23 (FGF-23) (pg/ml)
Evaluation of Chronic Kidney Disease-Mineral and Bone Disorder Chronic Kidney Disease-Mineral and Bone Disorder (CKD MBD) will be assessed at baseline and at the end of intervention through evaluation of: - Serum level of Fibroblast growth factor-23 (FGF-23) (pg/ml)
Time frame: The study duration will be 6 months.
The change in I-PTH (pg/ml)
The change in I-PTH (pg/ml) will be assessed at baseline and at the end of intervention through evaluation
Time frame: The study duration will be 6 months
The change in vitamin D level (ng/ml)
The change in vitamin D level (ng/ml) will be assessed at baseline and at the end of intervention through evaluation
Time frame: The study duration will be 6 months
The change in serum calcium level (mg/dl)
The change in serum calcium level (mg/dl) will be assessed at baseline and at the end of intervention through evaluation
Time frame: The study duration will be 6 months
The change in serum phosphorus level (mg/dl)
The change in serum phosphorus level (mg/dl) will be assessed at baseline and at the end of intervention through evaluation
Time frame: The study duration will be 6 months.
Clinical outcome will be assessed by Kidney Disease and Quality of Life- Short Form (KDQOL-SF™) version 1.3 questionnaire
Clinical outcome will be assessed at baseline and 6 months after Intervention through: - Evaluation of Health Related Quality of Life (HRQOL) using the validated Arabic version of -Kidney Disease and Quality of Life- Short Form (KDQOL-SF™) version 1.3 questionnaire which was formerly used in Egypt for patients with CKD.
Time frame: The study duration will be 6 months
Plan to share: No
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