Hyponatremia, Acute Decompensated Heart Failure
Conditions
Keywords
hyponatremia, euvolemic hyponatremia, hypervolemic hyponatremia, acute decompensated heart failure, conivaptan, Vaprisol
Brief summary
This study will evaluate the safety and effectiveness of Conivaptan, a vasopressin antagonist, in the treatment of hyponatremic subjects having symptomatic acute decompensated heart failure (ADHF).
Detailed description
Subjects will be recruited from the Emergency Department. It is expected that subjects will be treated according to the institution's accepted conventional therapy protocol for the treatment of ADHF. Therapy may also include the use of loop diuretics for the relief of pulmonary congestion and maintenance of adequate urine output.
Interventions
DRUGconivaptan
Premix bag
DRUGplacebo
Premix bag
Sponsors
Cumberland Pharmaceuticals
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Presents to emergency department with documented history of CHF and symptomatic ADHF, will be treated for ADHF, and primary reason for admission to the hospital is ADHF * Dyspnea at rest or with minimal exertion and must have moderate shortness of breath (SOB) in any of the first three Provocative Dyspnea Assessment positions * Severe pulmonary congestion as evidenced by jugular venous distention or lower extremity/sacral edema or rales upon chest auscultation or chest x-ray. * BNP \> 400 or NT-pro BNP \> 1500 drawn during Screening * Systolic blood pressure \>= 100 mmHg to \< 180 mmHg at time of start of study drug * Serum sodium value \>= 115 mEq/L (115 mmol/L) and \< 135 mEq/L (135 mmol/L) during Screening
Exclusion criteria
* Clinical evidence of volume depletion * Active ongoing acute coronary syndrome or acute ST segment elevation myocardial infarction (or has experienced a myocardial infarction within 30 days of Screening) * In cardiogenic shock * Calculated creatinine clearance \< 30 mL/min/1.73 m2 as estimated by the Modification of Diet in Renal Disease (MDRD) equation, has received intravenous (IV) contrast agent within 72 hours prior to randomization or is expected to receive IV contrast agent within the first 72 hours of study participation * Ultrafiltration within the past 72 hours. * Currently using or expected to use inotropic therapy * Cardiac bypass grafts in the past 60 days * Cerebrovascular accident in the past 30 days * Uncontrolled brady- or ventricular tachyarrhythmias requiring emergent pacemaker placement or treatment * Hemodynamically significant uncorrected primary cardiac valvular disease or hypertrophic cardiomyopathy * Untreated severe hypothyroidism, hyperthyroidism or adrenal insufficiency based on medical history * ALT or AST elevations \> 5 times upper limit of normal * Biliary liver cirrhosis, history or presence of severe hepatic encephalopathy, ascites, esophageal variceal bleeding within the past three months, severe portal hypertension or surgical portosystemic shunt. * Received any organ transplant, clinical diagnosis of pneumonia, symptomatic hyponatremia requiring urgent intervention or any concurrent illness which, in the opinion of the investigator, may interfere with treatment or evaluation of safety * Pregnant or lactating * Currently using vasopressin, oxytocin or desmopressin
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Renal Function From Baseline at 72 Hours Assessed by Calculated Creatinine Clearance (MDRD Equation) | Baseline and 72 Hours | MDRD = Modification of Diet in Renal Disease The MDRD equation is a standard calculation for estimated glomerular filtration rate. Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination. |
| Assessment of Dyspnea at 24 Hours as Determined by a 7-point Likert Scale | 24 Hours | Dyspnea is defined as the sensation of uncomfortable or difficult breathing. Changes in Dyspnea were assessed using the following 7-point scale: 1-Markedly worse; 2-Moderately worse; 3-Mildly worse; 4-No change; 5-Mildly improved; 6-Moderately improved; 7-Markedly better/improved. Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Use of Rescue Therapy or Other Intervention (Including Dialysis) Because of Worsening Renal Function | Day 9 | Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination. |
| Termination of Study Drug Due to an Adverse Event or Intolerability | 48.5 Hours | Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination. |
| Assessment of Dyspnea at Baseline, Hours 6, 12, 24 and 48 Using a Relative Dyspnea Assessment | Baseline, 6 Hours, 12 Hours, 24 Hours and 48 Hours | Dyspnea is defined as the sensation of uncomfortable or difficult breathing. Changes in Dyspnea were assessed using the following 7-point Likert scale: 1-Markedly worse; 2-Moderately worse; 3-Mildly worse; 4-No change; 5-Mildly improved; 6-Moderately improved; 7-Markedly better/improved. Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination. |
| Change in Renal Function From Baseline at Hours 24, 48 and 72 as Assessed by Urine Creatinine Clearance | Baseline, 24 Hours, 48 Hours and 72 Hours | Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination. |
| Change From Baseline in Body Weight at Hours 24, 48 and 72 and Days 6 and 9 (or Day of Discharge) | Baseline, 24 Hours, 48 Hours, 72 Hours, Day 6 and Day 9 | Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination. |
| Total Loop Diuretic Use Through 48 Hours | 48 Hours | Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination. |
| Total Urine Output at Hours 6, 12, 24, 48 and 72 | 6 Hours, 12 Hours, 24 Hours, 48 Hours and 72 Hours | Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination. |
| Assessment of Dyspnea at Baseline, Hours 6, 12, 24 and 48 Using a Provocative Dyspnea Assessment | Baseline, 6 Hours, 12 Hours, 24 Hours and 48 Hours | Dyspnea is defined as the sensation of uncomfortable or difficult breathing. The Provocative Dyspnea Assessment assesses dyspnea and changes in dyspnea from Baseline on a 5-point Likert scale at 5 different positions and assigns a Dyspnea Severity Score that ranges from 1 (worst severity) to 25 (least severity). Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination. |
| Change in Renal Function From Baseline at Hours 24, 48 and Day 9 (or Day of Discharge) as Assessed by Serum Creatinine Concentration and Calculated Creatinine Clearance | Baseline, 24 Hours, 48 Hours and Day 9 | Calculated creatinine clearance is only calculated through hour 72 using the MDRD equation. MDRD = Modification of Diet in Renal Disease The MDRD equation is a standard calculation for estimated glomerular filtration rate. Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination. |
Countries
India
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Placebo Matching loading dose and continuous intravenous infusion for 48 hours | 3 |
| Conivaptan 20mg loading dose followed by a 20mg/ day continuous intravenous infusion for 48 hours | 6 |
| Total | 9 |
Baseline characteristics
| Characteristic | Placebo | Conivaptan | Total |
|---|---|---|---|
| Age, Continuous | 56.7 years STANDARD_DEVIATION 13.05 | 65.8 years STANDARD_DEVIATION 7.78 | 62.8 years STANDARD_DEVIATION 10.07 |
| Race/Ethnicity, Customized Asian | 3 participants | 6 participants | 9 participants |
| Sex: Female, Male Female | 1 Participants | 1 Participants | 2 Participants |
| Sex: Female, Male Male | 2 Participants | 5 Participants | 7 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 1 / 3 | 5 / 6 |
| serious Total, serious adverse events | 1 / 3 | 1 / 6 |
Outcome results
Primary
Assessment of Dyspnea at 24 Hours as Determined by a 7-point Likert Scale
Dyspnea is defined as the sensation of uncomfortable or difficult breathing. Changes in Dyspnea were assessed using the following 7-point scale: 1-Markedly worse; 2-Moderately worse; 3-Mildly worse; 4-No change; 5-Mildly improved; 6-Moderately improved; 7-Markedly better/improved. Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination.
Time frame: 24 Hours
Population: Study was terminated - assessment of this Outcome Measure was not performed.
Primary
Change in Renal Function From Baseline at 72 Hours Assessed by Calculated Creatinine Clearance (MDRD Equation)
MDRD = Modification of Diet in Renal Disease The MDRD equation is a standard calculation for estimated glomerular filtration rate. Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination.
Time frame: Baseline and 72 Hours
Population: Study was terminated - assessment of this Outcome Measure was not performed.
Secondary
Assessment of Dyspnea at Baseline, Hours 6, 12, 24 and 48 Using a Provocative Dyspnea Assessment
Dyspnea is defined as the sensation of uncomfortable or difficult breathing. The Provocative Dyspnea Assessment assesses dyspnea and changes in dyspnea from Baseline on a 5-point Likert scale at 5 different positions and assigns a Dyspnea Severity Score that ranges from 1 (worst severity) to 25 (least severity). Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination.
Time frame: Baseline, 6 Hours, 12 Hours, 24 Hours and 48 Hours
Population: Study was terminated - assessment of this Outcome Measure was not performed.
Secondary
Assessment of Dyspnea at Baseline, Hours 6, 12, 24 and 48 Using a Relative Dyspnea Assessment
Dyspnea is defined as the sensation of uncomfortable or difficult breathing. Changes in Dyspnea were assessed using the following 7-point Likert scale: 1-Markedly worse; 2-Moderately worse; 3-Mildly worse; 4-No change; 5-Mildly improved; 6-Moderately improved; 7-Markedly better/improved. Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination.
Time frame: Baseline, 6 Hours, 12 Hours, 24 Hours and 48 Hours
Population: Study was terminated - assessment of this Outcome Measure was not performed.
Secondary
Change From Baseline in Body Weight at Hours 24, 48 and 72 and Days 6 and 9 (or Day of Discharge)
Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination.
Time frame: Baseline, 24 Hours, 48 Hours, 72 Hours, Day 6 and Day 9
Population: Study was terminated - assessment of this Outcome Measure was not performed.
Secondary
Change in Renal Function From Baseline at Hours 24, 48 and 72 as Assessed by Urine Creatinine Clearance
Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination.
Time frame: Baseline, 24 Hours, 48 Hours and 72 Hours
Population: Study was terminated - assessment of this Outcome Measure was not performed.
Secondary
Change in Renal Function From Baseline at Hours 24, 48 and Day 9 (or Day of Discharge) as Assessed by Serum Creatinine Concentration and Calculated Creatinine Clearance
Calculated creatinine clearance is only calculated through hour 72 using the MDRD equation. MDRD = Modification of Diet in Renal Disease The MDRD equation is a standard calculation for estimated glomerular filtration rate. Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination.
Time frame: Baseline, 24 Hours, 48 Hours and Day 9
Population: Study was terminated - assessment of this Outcome Measure was not performed.
Secondary
Incidence of Use of Rescue Therapy or Other Intervention (Including Dialysis) Because of Worsening Renal Function
Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination.
Time frame: Day 9
Population: Study was terminated - assessment of this Outcome Measure was not performed.
Secondary
Termination of Study Drug Due to an Adverse Event or Intolerability
Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination.
Time frame: 48.5 Hours
Population: Study was terminated - assessment of this Outcome Measure was not performed.
Secondary
Total Loop Diuretic Use Through 48 Hours
Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination.
Time frame: 48 Hours
Population: Study was terminated - assessment of this Outcome Measure was not performed.
Secondary
Total Urine Output at Hours 6, 12, 24, 48 and 72
Outcome Measures were not analyzed due to the abbreviated enrollment at early study termination.
Time frame: 6 Hours, 12 Hours, 24 Hours, 48 Hours and 72 Hours
Population: Study was terminated - assessment of this Outcome Measure was not performed.