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Optimalization of Nephroprotection Using N-Acetylcysteine

Information source: Medical University of Gdansk
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Chronic Kidney Disease; Proteinuria

Intervention: ACC (N-acetylcysteine) 1200 mg (Drug)

Phase: N/A

Status: Completed

Sponsored by: Medical University of Gdansk

Official(s) and/or principal investigator(s):
Boleslaw Rutkowski, MD PhD, Principal Investigator, Affiliation: Department of Nephrology Transplantology and Internal Medicine. Medical University of Gdansk

Summary

The main purpose of the study is find whether the addition of N-acetylcysteine (antioxidant) to dual renin-angiotensin-aldosterone system blockade involving angiotensin converting enzyme inhibitor and AT-1 angiotensin II receptor blocker leads to the reduction of proteinuria, main prognostic marker of chronic kidney disease progression.

Clinical Details

Official title: The Effect of N-Acetylcysteine on Proteinuria and Markers of Tubular Injury in Non-Diabetic Patientswith Chronic Kidney Disease-Placebo Controlled, Randomized,Open, Cross-Over Study

Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Crossover Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: Investigate the antiproteinuric effect of adding antioxidant, N-acetylcysteine to the combination therapy with angiotensin converting enzyme inhibitor and AT-1 receptor blocker in maximal recommended doses.

Secondary outcome: Investigate the effect of the study intervention on urine excretion of N-acetyl-β-D-glucosaminidase, alfa1-microglobulin and amino-terminal propeptide of type III procollagen

Detailed description: The renin-angiotensin-aldosterone system (RAAS) plays an important role in the progression of chronic kidney diseases (CKD), and inhibition of the RAAS with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II type 1 receptor blockers (ARB) may retard CKD progression. Dual pharmacological blockade of the RAAS with ACEI and ARB is recommended as a standard renoprotective management at least in patients with nondiabetic proteinuric CKD. However, neither ACEI nor ARB, even in high doses or in concomitant usage, abrogate the progression of CKD completely. Innovative approaches are needed to keep patients with CKD off dialysis. Additional antioxidant (N-acetylcysteine) may prove to be such beneficial therapeutic concept. To shed more light on this issue, we performed a randomised open controlled study to evaluate the influence of triple N-acetylcysteine and RAAS therapy on surrogate markers of kidney injury, i. e. proteinuria, markers of tubular involvement and kidney fibrosis.

Eligibility

Minimum age: 18 Years. Maximum age: 65 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Chronic kidney disease

- Stable proteinuria above 300 mg/24 hours (no variations above 25% in the last 6

months)

- Normal or slightly impaired stable renal function defined as serum creatinine level

below 1. 7 mg/dl (eGFR > 45 ml/min) Exclusion Criteria:

- Nephrotic syndrome

- Steroids or other immunosuppressive treatment minimum during six months before the

study

- Diabetes mellitus

- Potassium serum level > 5. 1 mEq/L

- Albumin serum level < 2. 0mg/dL

- Creatinine serum level >2 mg/dl

- Current diagnosis of heart failure New York Heart Association (NYHA) Class II-IV

- Clinically significant valvular heart disease or second or third degree heart block

without a pacemaker

- History of hypertensive encephalopathy, cerebrovascular accident or transient

ischemic cerebral attack

- History of myocardial infarction, unstable angina pectoris, coronary bypass surgery,

or any percutaneous coronary intervention

- History of malignancy including leukemia and lymphoma (but not basal cell skin

carcinoma) within the past five years

- Pregnant or nursing women

- Any surgical or medical condition which might significantly alter the absorption,

distribution, metabolism, or excretion of study drugs.

- History of alcohol abuse

- NSAID abuse (more than 2 doses per week)

- Known or suspected contraindications to the study medications, including history of

allergy to ACE inhibitors, AT-1 receptor blockers and N-acetylcysteine

Locations and Contacts

Additional Information

Starting date: January 2005
Last updated: December 12, 2007

Page last updated: August 23, 2015

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