Pharmacologic Treatment of Congenital Nephrogenic Diabetes Insipidus

Condition(s) targeted: Nephrogenic Diabetes Insipidus

Intervention: sildenafil (Drug); calcitonin (Drug); hydrochlorothiazide/amiloride (Drug); indomethacin (Drug); Placebo for sildenafil (Drug); placebo for calcitonin (Drug)

Phase: N/A

Status: Recruiting

Sponsored by: University of Colorado, Denver

Official(s) and/or principal investigator(s):
Melissa A Cadnapaphornchai, MD, Principal Investigator, Affiliation: University of Colorado, Denver

Overall contact:
Melissa A Cadnapaphornchai, MD, Phone: 720-777-6263, Email: melissa.cadnapaphornchai@ucdenver.edu

The purpose of this research study is to determine if two investigational medications will be more effective in decreasing urine output than the currently available and routinely used medications in patients with congenital nephrogenic diabetes insipidus (NDI).

Official title: Pharmacologic Treatment of Congenital Nephrogenic Diabetes Insipidus

Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Crossover Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment

Primary outcome: Urine volume

Secondary outcome:

Frequency of urination

Urine osmolality

Detailed description: The study involves the use of the investigational medications sildenafil and calcitonin. These medications have shown promise as treatment for NDI in laboratory (non-human) studies but have not been used for treatment of NDI in humans. At this time, there is no guarantee that these investigational medications will provide additional benefit to people with NDI.

The study is open to males, between the ages of 5 and 25 years who have been diagnosed with NDI and who have normal kidney and bladder function. A total of 40 patients with NDI will be enrolled in the study. The study will involve two outpatient clinic visits, followed by a 9-night hospital stay, followed by a final follow-up outpatient clinic visit. All visits will take place within a 20-day time period.

At the first clinic visit, blood and urine testing for kidney and liver function and blood count will be performed. If the genetic alteration which causes your NDI has not been previously identified, blood for DNA testing will also be obtained. If a kidney and bladder ultrasound has not been performed in the past 6 months, it will be obtained. The ultrasound is to make sure that there is no problem with drainage of urine from the kidneys and bladder. You will be asked to fill out food preference questionnaires to use for planning of meals for the hospital stay. You will be given containers to collect two consecutive 24-hour urine samples at home. These urine collections will help determine how well your routine medicines are working to control your NDI.

At the second clinic visit, you will bring in the two 24-hour urine samples. Blood will again be collected for further testing of kidney function. You will be given containers to collect another 24-hour urine just prior to the hospital visit.

The third visit requires hospital admission and will be scheduled at the study site closest to your home (The Children's Hospital, Denver, Colorado; Emory University, Atlanta, GA; University of Aarhus, Denmark). For the hospital visit, you will need to stop your usual NDI medications for 48 hours prior to the visit. You will perform another 24-hour urine collection on the day prior to your hospital admission. This urine sample will be turned in to the laboratory when you are admitted to the hospital for the research study. The length of the hospital stay is 10 days/9 nights. During the stay, you can expect to have your weight, heart rate, and blood pressure checked three times a day. All urine will be collected. Blood testing will be performed every other day. You will need to eat the meals provided at the hospital; all meals will be provided according to a low-salt diet restriction. You may drink fluids as desired but you will need to avoid caffeine-containing beverages and alcohol.

On the first day of the hospital stay, testing will be performed to confirm your diagnosis of NDI. This test involves administration of the medicine dDAVP (Desmopressin) through an IV catheter (into a vein) with collection of urine every 30 minutes for 4 hours. You will be randomized (like the toss of a coin) to receive either the investigational medication treatment for 4 days followed by the routine medication treatment for 4 days or vice versa. When you receive the routine medication treatment, you will receive placebos (inactive substances like a sugar pill) in place of the investigational medicines. In this way, neither you nor the investigator will know whether you are receiving the investigational or the routine medication treatment first. Medicines will be given twice a day during the hospital stay. On the last day of the hospital stay, you will be instructed to resume your normal diet and medications.

At a final outpatient clinic visit, blood testing and urinalysis will be performed.

Potential benefits of participation include a no-cost health examination, laboratory studies, and an evaluation of current management of NDI. There is no cost for participation in this research study. No pay will be given to participants in this research study.

This research study has been approved by the ethical review boards of the following institutions: Colorado Multiple Institutional Review Board (#06-0588), Emory University Institutional Review Board (#729-2005), and the University of Aarhus (#20050183). Individuals who decide to take part in this research study will need to sign a specific consent form at a participating institution as well as a release for use of personal health information (HIPAA form).

Minimum age: 5 Years. Maximum age: 25 Years. Gender(s): Male.

Criteria:

Inclusion Criteria:

- Known diagnosis of CNDI

- Age 5 to 25 years

- Normal kidney function

- Post-void residual urine < 200 ml (determined by bladder ultrasound)

Exclusion Criteria:

- Impaired kidney function

- Known urinary retention or bladder dysfunction

- High blood pressure

- Other significant chronic medical disease (e. g., heart failure, liver disease, etc.)

- Allergy to study drugs

Melissa A Cadnapaphornchai, MD, Phone: 720-777-6263, Email: melissa.cadnapaphornchai@ucdenver.edu

University of Aarhus, Aarhus, Denmark; Recruiting
Soren Rittig, MD, Principal Investigator
Jorgen Frokiaer, MD, Sub-Investigator

University of Colorado at Denver and Health Sciences Center, Aurora, Colorado 80045, United States; Recruiting
Melissa A Cadnapaphornchai, MD, Principal Investigator
Robert W Schrier, MD, Sub-Investigator

Emory University, Atlanta, Georgia 30322, United States; Recruiting
Jeff Sands, MD, Principal Investigator
Arlene Chapman, MD, Sub-Investigator

Nephrogenic Diabetes Insipidus Foundation

Related publications:

Bichet DG. Nephrogenic diabetes insipidus. Adv Chronic Kidney Dis. 2006 Apr;13(2):96-104. Review.

Fujiwara TM, Bichet DG. Molecular biology of hereditary diabetes insipidus. J Am Soc Nephrol. 2005 Oct;16(10):2836-46. Epub 2005 Aug 10. Review.

Schrier RW, Cadnapaphornchai MA. Renal aquaporin water channels: from molecules to human disease. Prog Biophys Mol Biol. 2003 Feb;81(2):117-31. Review.

Schrier RW, Cadnapaphornchai MA, Umenishi F. Water-losing and water-retaining states: role of water channels and vasopressin receptor antagonists. Heart Dis. 2001 May-Jun;3(3):210-4. Review.

Nielsen S, Kwon TH, Frokiaer J, Agre P. Regulation and dysregulation of aquaporins in water balance disorders. J Intern Med. 2007 Jan;261(1):53-64. Review.

Kotnik P, Nielsen J, Kwon TH, Krzisnik C, Frokiaer J, Nielsen S. Altered expression of COX-1, COX-2, and mPGES in rats with nephrogenic and central diabetes insipidus. Am J Physiol Renal Physiol. 2005 May;288(5):F1053-68. Epub 2005 Jan 11.

Nielsen S, Frokiaer J, Marples D, Kwon TH, Agre P, Knepper MA. Aquaporins in the kidney: from molecules to medicine. Physiol Rev. 2002 Jan;82(1):205-44. Review.

Bouley R, Pastor-Soler N, Cohen O, McLaughlin M, Breton S, Brown D. Stimulation of AQP2 membrane insertion in renal epithelial cells in vitro and in vivo by the cGMP phosphodiesterase inhibitor sildenafil citrate (Viagra). Am J Physiol Renal Physiol. 2005 Jun;288(6):F1103-12. Epub 2005 Jan 11.

Starting date: May 2007
Last updated: October 22, 2009