ClinicalTrials.gg
RecruitingNCT06249373Updated May 16, 2024

The Effect of LIPUS on the Maturation of Newly Constructed Autogenous AVF

An interventional study of Low intensity pulse ultrasound (LIPUS) intervention for arteriovenous fistula anastomosis in Uremia; Chronic, sponsored by Suzhou Municipal Hospital. Recruiting at 1 site in China. Open to participants aged 18 Years to 75 Years. Per ClinicalTrials.gov, last updated 2024-05-16.

Sponsored by Suzhou Municipal Hospital · Not applicable, Interventional, and Treatment

From the registry’s dates

  • Primary completion was expected by Dec 2025, 10 months ago, but the record still lists the study as recruiting.
  • Started Feb 2024; still recruiting 2 years 8 months later.
Phase
Not applicable
Study type
Interventional
Enrollment
300
Allocation
Randomized
Ages
18 Years to 75 Years
Sex
All
01

Study summary

This study aims to evaluate the effect of 12 week low-intensity pulse ultrasound (LIPUS) intervention on the maturation of newly constructed autologous arteriovenous fistulas in uremic patients. This study is a prospective, blinded, randomized controlled trial. This trial is divided into two stages. The first stage is a concept validation trial, which is a single center, prospective, blinded, randomized controlled clinical study. Subjects who meet the screening criteria are randomly divided into an intervention group and a control group in a 1:1 ratio. All subjects underwent safety and efficacy evaluations at the 2nd, 4th, 8th, 12th, and 4th week after treatment. After completing a 4-week follow-up of the 20th study subject, an analysis was conducted with the preset goal of achieving a higher maturation rate of arteriovenous fistula in the intervention group compared to the control group at the follow-up point, and the safety of the study was evaluated. The second stage is a key trial, which is a multicenter, prospective, blinded, randomized controlled clinical study. The inclusion criteria, primary and secondary endpoints, and safety endpoints of the study subjects remain unchanged, and the safety and efficacy of the overall population are evaluated.

02

Conditions studied

  • Uremia; Chronic
03

In context

Uremia

53 studies on the registry are indexed under Uremia; 10 are open to participants now.

This study's planned enrollment of 300 is above the median of 60 across 38 interventional studies indexed under Uremia.

Browse Uremia studies →

Lead sponsor

Suzhou Municipal Hospital is the lead sponsor of 9 studies on the registry; 7 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years to 75 Years
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

1.18 years old ≤ Age ≤ 75 years old, regardless of gender or ethnicity;

2.Dialysis or non-dialysis patients who have newly established autologous arteriovenous fistula in the wrist and have not yet used the fistula for hemodialysis treatment;

3.Before establishing an autologous arteriovenous fistula in the wrist, ultrasound examination will be performed. The radial artery diameter at the intended surgical site is>1.5mm, and the head vein diameter is>2mm (using a tourniquet). The arterial and venous blood flow are unobstructed, and the distance between the vein and the skin is\<6mm;

  1. After introducing dialysis, the calcium ion concentration in the dialysate will be maintained at 1.5mmol/L during the dialysis period, and low molecular weight heparin will be used for anticoagulation. The dosage of low molecular weight heparin remains unchanged (±1000U) during the study period;
  1. Sign an form.

Exclusion criteria

Exclusion Criteria:

  1. Poor healing of internal fistula surgical incision;
  2. Active bacterial or viral infections;
  3. Pregnant women;
  4. The patient underwent kidney transplantation or was transferred to peritoneal dialysis during the study period;
  5. Subject , AST ≥ 3 × values;
  6. Within 3 months, according to classification, heart function is classified as level III-IV;
  7. Newly diagnosed unstable angina and cerebrovascular events within 3 months;
  8. Blood pressure below 90/60mmHg or above 180/100mmHg in the past 2 weeks;
  9. During the study period, patients did not follow medical advice and arbitrarily changed the types and dosages of other anticoagulants or anticoagulants (such as aspirin, clopidogrel, Agat Roban, etc.);
  10. Combine the use of and , such as tacrolimus, cyclosporine, MMF, azathioprine, leflunomide, Tripterygium wilfordii glycosides, etc;
  11. Other researchers consider inappropriate situations, such as coexisting with malignant tumors, where the expected lifespan is less than 6 months;
  12. I have participated in other clinical trials within 4 weeks prior to the start of this study.
Terms in these criteria, in plain language(6)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

NYHA class (heart failure)

The New York Heart Association’s four classes of how much heart failure limits physical activity.

I
No limits: ordinary activity causes no undue tiredness or breathlessness.
II
Slight limits: comfortable at rest, ordinary activity causes symptoms.
III
Marked limits: comfortable at rest, less than ordinary activity causes symptoms.
IV
Symptoms even at rest; any activity makes them worse.

Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

Immunosuppression

A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.

Read whether the line is about a condition or about medicines, and which medicines and doses it means.

05

Study design

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

Study arms

  • Experimental
    LIPUS intervention group

    Low intensity pulse ultrasound (LIPUS) intervenes at the anastomotic site, and if the ultrasound examination indicates the presence of a narrow site in the outflow tract, it also intervenes at the narrow site. It belongs to non-invasive extracorporeal intervention, with three times a week (during dialysis) for 20 minutes each time. The sound intensity is 350mW/cm2, the pulse frequency is 1MHz, the pulse repetition frequency is 100Hz, the pulse frequency is 100 times, and the treatment period is 12 weeks.

    Device: Low intensity pulse ultrasound (LIPUS) intervention for arteriovenous fistula anastomosis

  • No intervention
    Simulated LIPUS control group

    Using the same forearm wearable portable ultrasound as the LIPUS arteriovenous fistula intervention group, but not issuing low-intensity pulse ultrasound.

Interventions

  • DeviceLow intensity pulse ultrasound (LIPUS) intervention for arteriovenous fistula anastomosis

    The LIPUS intervention group for arteriovenous fistula should receive forearm wearable portable low-intensity pulse ultrasound (LIPUS) intervention at the anastomotic site no more than 3 days after suture removal two weeks after the fistula surgery. If the ultrasound examination indicates the presence of stenosis in the outflow tract, the intervention should also be performed at the same time. It belongs to non-invasive extracorporeal intervention, with three times a week (during dialysis) for 20 minutes each time. The sound intensity is 350mW/cm2, the pulse frequency is 1MHz, the pulse repetition frequency is 100Hz, the pulse frequency is 100 times, and the treatment period is 12 weeks.

06

What researchers measure

Primary outcomes

  1. Maturity rate of arteriovenous fistula

    Puncture segment venous diameter

    Time frame: 12 weeks after enrollment

  2. Maturity rate of arteriovenous fistula

    Brachial artery blood flow rate

    Time frame: 12 weeks after enrollment

Secondary outcomes

  1. Changes in hemodynamic parameters

    Blood flow

    Time frame: 2 weeks,4weeks,8weeks,12weeks after enrollment, and 4 weeks after follow-up.

  2. Changes in hemodynamic parameters

    Minimum outflow venous diameter

    Time frame: 2 weeks,4weeks,8weeks,12weeks after enrollment, and 4 weeks after follow-up.

  3. Changes in hemodynamic parameters

    Primary patency rate

    Time frame: 2 weeks,4weeks,8weeks,12weeks after enrollment, and 4 weeks after follow-up.

  4. Changes in hemodynamic parameters

    Secondary patency rate

    Time frame: 2 weeks,4weeks,8weeks,12weeks after enrollment, and 4 weeks after follow-up.

07

Study locations

1 of 1 sites recruiting
  • The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital
    Suzhou, Jiangsu, China
    Recruiting
08

References and documents

Publications

  • Nunes NS, Chandran P, Sundby M, Visioli F, da Costa Goncalves F, Burks SR, Paz AH, Frank JA. Therapeutic ultrasound attenuates DSS-induced colitis through the cholinergic anti-inflammatory pathway. EBioMedicine. 2019 Jul;45:495-510. doi: 10.1016/j.ebiom.2019.06.033. Epub 2019 Jun 26. PubMed 31253515 ↗
  • Salmela B, Hartman J, Peltonen S, Alback A, Lassila R. Thrombophilia and arteriovenous fistula survival in ESRD. Clin J Am Soc Nephrol. 2013 Jun;8(6):962-8. doi: 10.2215/CJN.03860412. Epub 2013 Feb 14. PubMed 23411429 ↗
  • Sifuentes-Franco S, Padilla-Tejeda DE, Carrillo-Ibarra S, Miranda-Diaz AG. Oxidative Stress, Apoptosis, and Mitochondrial Function in Diabetic Nephropathy. Int J Endocrinol. 2018 Apr 1;2018:1875870. doi: 10.1155/2018/1875870. eCollection 2018. PubMed 29808088 ↗
  • Masengu A, McDaid J, Maxwell AP, Hanko JB. Preoperative radial artery volume flow is predictive of arteriovenous fistula outcomes. J Vasc Surg. 2016 Feb;63(2):429-35. doi: 10.1016/j.jvs.2015.08.106. Erratum In: J Vasc Surg. 2016 Apr;63(4):1133. PubMed 26804217 ↗
  • Riella MC, Roy-Chaudhury P. Vascular access in haemodialysis: strengthening the Achilles' heel. Nat Rev Nephrol. 2013 Jun;9(6):348-57. doi: 10.1038/nrneph.2013.76. Epub 2013 Apr 16. PubMed 23591442 ↗
  • Al-Jaishi AA, Oliver MJ, Thomas SM, Lok CE, Zhang JC, Garg AX, Kosa SD, Quinn RR, Moist LM. Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis. Am J Kidney Dis. 2014 Mar;63(3):464-78. doi: 10.1053/j.ajkd.2013.08.023. Epub 2013 Oct 30. PubMed 24183112 ↗
  • Dember LM, Beck GJ, Allon M, Delmez JA, Dixon BS, Greenberg A, Himmelfarb J, Vazquez MA, Gassman JJ, Greene T, Radeva MK, Braden GL, Ikizler TA, Rocco MV, Davidson IJ, Kaufman JS, Meyers CM, Kusek JW, Feldman HI; Dialysis Access Consortium Study Group. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA. 2008 May 14;299(18):2164-71. doi: 10.1001/jama.299.18.2164. PubMed 18477783 ↗
  • Irish AB, Viecelli AK, Hawley CM, Hooi LS, Pascoe EM, Paul-Brent PA, Badve SV, Mori TA, Cass A, Kerr PG, Voss D, Ong LM, Polkinghorne KR; Omega-3 Fatty Acids (Fish Oils) and Aspirin in Vascular Access Outcomes in Renal Disease (FAVOURED) Study Collaborative Group. Effect of Fish Oil Supplementation and Aspirin Use on Arteriovenous Fistula Failure in Patients Requiring Hemodialysis: A Randomized Clinical Trial. JAMA Intern Med. 2017 Feb 1;177(2):184-193. doi: 10.1001/jamainternmed.2016.8029. PubMed 28055065 ↗
  • Remuzzi A, Bozzetto M, Brambilla P. Is shear stress the key factor for AVF maturation? J Vasc Access. 2017 Mar 6;18(Suppl. 1):10-14. doi: 10.5301/jva.5000686. Epub 2017 Mar 5. PubMed 28297046 ↗
  • Dolan JM, Kolega J, Meng H. High wall shear stress and spatial gradients in vascular pathology: a review. Ann Biomed Eng. 2013 Jul;41(7):1411-27. doi: 10.1007/s10439-012-0695-0. Epub 2012 Dec 11. PubMed 23229281 ↗
  • Kaygin MA, Halici U, Aydin A, Dag O, Binici DN, Limandal HK, Arslan U, Kiymaz A, Kahraman N, Calik ES, Savur AI, Erkut B. The relationship between arteriovenous fistula success and inflammation. Ren Fail. 2013 Sep;35(8):1085-8. doi: 10.3109/0886022X.2013.815100. Epub 2013 Aug 1. PubMed 23906289 ↗
  • Asare Y, Schmitt M, Bernhagen J. The vascular biology of macrophage migration inhibitory factor (MIF). Expression and effects in inflammation, atherogenesis and angiogenesis. Thromb Haemost. 2013 Mar;109(3):391-8. doi: 10.1160/TH12-11-0831. Epub 2013 Jan 17. PubMed 23329140 ↗
  • Stangenberg S, Nguyen LT, Chen H, Al-Odat I, Killingsworth MC, Gosnell ME, Anwer AG, Goldys EM, Pollock CA, Saad S. Oxidative stress, mitochondrial perturbations and fetal programming of renal disease induced by maternal smoking. Int J Biochem Cell Biol. 2015 Jul;64:81-90. doi: 10.1016/j.biocel.2015.03.017. Epub 2015 Apr 4. PubMed 25849459 ↗
  • Yang B, Janardhanan R, Vohra P, Greene EL, Bhattacharya S, Withers S, Roy B, Nieves Torres EC, Mandrekar J, Leof EB, Mukhopadhyay D, Misra S. Adventitial transduction of lentivirus-shRNA-VEGF-A in arteriovenous fistula reduces venous stenosis formation. Kidney Int. 2014 Feb;85(2):289-306. doi: 10.1038/ki.2013.290. Epub 2013 Aug 7. PubMed 23924957 ↗
  • Veillat V, Carli C, Metz CN, Al-Abed Y, Naccache PH, Akoum A. Macrophage migration inhibitory factor elicits an angiogenic phenotype in human ectopic endometrial cells and triggers the production of major angiogenic factors via CD44, CD74, and MAPK signaling pathways. J Clin Endocrinol Metab. 2010 Dec;95(12):E403-12. doi: 10.1210/jc.2010-0417. Epub 2010 Sep 8. PubMed 20829186 ↗
  • Stracke S, Konner K, Kostlin I, Friedl R, Jehle PM, Hombach V, Keller F, Waltenberger J. Increased expression of TGF-beta1 and IGF-I in inflammatory stenotic lesions of hemodialysis fistulas. Kidney Int. 2002 Mar;61(3):1011-9. doi: 10.1046/j.1523-1755.2002.00191.x. PubMed 11849456 ↗
  • Dukkipati R, Molnar MZ, Park J, Jing J, Kovesdy CP, Kajani R, Kalantar-Zadeh K. Association of vascular access type with inflammatory marker levels in maintenance hemodialysis patients. Semin Dial. 2014 Jul-Aug;27(4):415-23. doi: 10.1111/sdi.12146. Epub 2013 Oct 9. PubMed 24118625 ↗
  • Vassalotti JA, Jennings WC, Beathard GA, Neumann M, Caponi S, Fox CH, Spergel LM; Fistula First Breakthrough Initiative Community Education Committee. Fistula first breakthrough initiative: targeting catheter last in fistula first. Semin Dial. 2012 May;25(3):303-10. doi: 10.1111/j.1525-139X.2012.01069.x. Epub 2012 Apr 4. PubMed 22487024 ↗
  • Lin CC, Chang CF, Lai MY, Chen TW, Lee PC, Yang WC. Far-infrared therapy: a novel treatment to improve access blood flow and unassisted patency of arteriovenous fistula in hemodialysis patients. J Am Soc Nephrol. 2007 Mar;18(3):985-92. doi: 10.1681/ASN.2006050534. Epub 2007 Jan 31. PubMed 17267744 ↗
  • Gigliotti JC, Huang L, Ye H, Bajwa A, Chattrabhuti K, Lee S, Klibanov AL, Kalantari K, Rosin DL, Okusa MD. Ultrasound prevents renal ischemia-reperfusion injury by stimulating the splenic cholinergic anti-inflammatory pathway. J Am Soc Nephrol. 2013 Sep;24(9):1451-60. doi: 10.1681/ASN.2013010084. Epub 2013 Aug 1. PubMed 23907510 ↗
  • Charles EJ, Tian Y, Zhang A, Wu D, Mehaffey JH, Gigliotti JC, Klibanov AL, Kron IL, Yang Z. Pulsed ultrasound attenuates the hyperglycemic exacerbation of myocardial ischemia-reperfusion injury. J Thorac Cardiovasc Surg. 2021 Apr;161(4):e297-e306. doi: 10.1016/j.jtcvs.2019.10.096. Epub 2019 Nov 2. PubMed 31839230 ↗
  • Zachs DP, Offutt SJ, Graham RS, Kim Y, Mueller J, Auger JL, Schuldt NJ, Kaiser CRW, Heiller AP, Dutta R, Guo H, Alford JK, Binstadt BA, Lim HH. Noninvasive ultrasound stimulation of the spleen to treat inflammatory arthritis. Nat Commun. 2019 Mar 12;10(1):951. doi: 10.1038/s41467-019-08721-0. PubMed 30862842 ↗
  • Xu T, Gu J, Li C, Guo X, Tu J, Zhang D, Sun W, Kong X. Low-intensity pulsed ultrasound suppresses proliferation and promotes apoptosis via p38 MAPK signaling in rat visceral preadipocytes. Am J Transl Res. 2018 Mar 15;10(3):948-956. eCollection 2018. PubMed 29636884 ↗
  • Su Z, Xu T, Wang Y, Guo X, Tu J, Zhang D, Kong X, Sheng Y, Sun W. Low-intensity pulsed ultrasound promotes apoptosis and inhibits angiogenesis via p38 signaling-mediated endoplasmic reticulum stress in human endothelial cells. Mol Med Rep. 2019 Jun;19(6):4645-4654. doi: 10.3892/mmr.2019.10136. Epub 2019 Apr 5. PubMed 30957188 ↗
  • Toyama Y, Sasaki K, Tachibana K, Ueno T, Kajimoto H, Yokoyama S, Ohtsuka M, Koiwaya H, Nakayoshi T, Mitsutake Y, Chibana H, Itaya N, Imaizumi T. Ultrasound stimulation restores impaired neovascularization-related capacities of human circulating angiogenic cells. Cardiovasc Res. 2012 Sep 1;95(4):448-59. doi: 10.1093/cvr/cvs173. Epub 2012 May 28. PubMed 22641844 ↗

Individual participant data

Plan to share: No

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

Started Feb 2024 (actual). Primary completion is estimated for Dec 2025, 22 months after the start.

How these figures are worked out, and which studies are left out of them.

Registered
Jan 29, 2024
First posted
Feb 8, 2024
StartActual
Feb 26, 2024
Primary completionEst.
Dec 31, 2025
CompletionEst.
Dec 31, 2026
Last update
May 16, 2024
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on May 16, 2024, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT06249373
Lead sponsor
Suzhou Municipal Hospital
Collaborators
The First Affiliated Hospital with Nanjing Medical University, The First Affiliated Hospital of Soochow University, Second Affiliated Hospital of Soochow University, Dushu Lake Hospital Affiliated to Soochow University
Responsible party
Qiang Chen (Head of Nephrology, Suzhou Municipal Hospital) — Principal investigator
First posted
Feb 8, 2024
Start date
Feb 26, 2024
Primary completion
Dec 31, 2025 (estimated)
Completion
Dec 31, 2026 (estimated)
Last update
May 16, 2024

Study contacts

Qiang Chen
Contact
chenqjs@126.com
+8618901547679
Xiangqing Kong
study chair · Suzhou Municipal Hospital
Huijuan Mao
study director · The First Affiliated Hospital with Nanjing Medical University

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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