Extrait

Background and study aims About 1 in 10 people are living with reduced kidney function because mild (early stage) chronic kidney disease (CKD) is common and kidney function reduces with age. Patients with CKD have reduced survival rate due to high rate of heart and blood vessel diseases. Even people with mild CKD have premature stiffening and reduced function of their heart and blood vessels. Our previous research of 112 people with early CKD from a specialist hospital kidney clinic showed that a 'water tablet' called spironolactone improves heart structure and function as well as reduced blood vessel stiffness. This study aims to confirm the findings in people with early CKD managed at general practices. Who can participate? The study will recruit 240 adult patients from 20 general practices in South Birmingham area who have estimated kidney function between 30- 59% on the blood test (mild CKD). What does the study involve? Patients who are willing to participate in the study will be assigned to receive ‘study medication’, which are either spironolactone or placebo (dummy capsules) at random. Both participants and doctors will not know who is taking which capsules. Blood and urine test, blood pressure and blood vessel stiffness will be measured before starting the ‘study medication’. Blood vessel stiffness is measured by how fast the pulse travels from neck to groin using cuffs which detect pulse on both sites. Participants will be taking the ‘study medication’ for 40 weeks, during which time they will be followed-up and monitored regularly at their local general practices with blood tests, blood pressure measurements and side effect questionnaire. After 40 weeks of receiving the ‘study medication’, all participants will have repeat blood and urine tests, blood pressure and blood vessel stiffness measured. All the tests will be repeated 6 weeks after stopping the ‘study medication’. The total duration of the study is 46 weeks. What are the possible benefits and risks of participating? Our previous research study showed that spironolactone improves heart function and reduces hardening of the blood vessels in patients with mild kidney disease in specialist hospital kidney clinic setting. Patients’ participation in this study will contribute to an improved understanding of spironolactone and its effects on blood vessel and kidney disease in the primary care setting. The information gained from this study will also contribute to further studies and may help improve the treatment of people with kidney disease in the future. The most common side effects from spironolactone are diarrhoea, drowsiness, headache, nausea, stomach cramping and vomiting. Such effects are usually mild and temporary and resolve when the drug is stopped. Other less common but serious side effects are severe allergic reactions (rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips, or tongue), black, tarry, or bloody stools, change in the amount of urine produced, confusion, dark urine, decreased sexual ability, enlarged breasts in men, irregular or missed menstrual periods, severe or persistent stomach pain, symptoms of abnormal fluid or electrolyte levels (i.e.: fast, slow, or irregular heartbeat, increased thirst, muscle weakness, severe or persistent dry mouth, nausea, or vomiting, severe or persistent dizziness or drowsiness, unusual fatigue or sluggishness, tingling sensation), yellowing of the skin or eyes. With the exception of the blood tests, study procedures should not cause any pain or discomfort. There are small risks of increased levels of salts in the blood, reduced kidney function or low blood pressure with the use of spironolactone, requiring the withdrawal of the study medication. However, the dose of the trial medication is relatively low and all participants will be closely monitored by kidney specialists during study to ensure that those risks are minimised. Where is the study run from? The study is run from the local general practices in South Birmingham area When is the study starting and how long is it expected to run for? June 2013 to June 2015 Who is funding the study? National Institute for Health Research - Research for Patient Benefit (UK) Who is the main contact? Dr Odettte Chagoury [email protected]

Critère d'inclusion

• Early stage chronic kidney disease

Liens

• isrctn
• ictrp