End-stage Renal Disease
Conditions
Keywords
Arteriovenous graft, Propaten, Heparin-bonded, hemodialysis vascular access, Surgical, Arteriovenous Shunt
Brief summary
The purpose for this study is to evaluate the patency and outcomes of conventional and heparin anticoagulant bonded arteriovenous grafts in patients with end stage renal disease.
Detailed description
Study Design: This is a prospective, multi-institution, parallel-group, single-blinded, randomized-controlled, two-arm, effectiveness study comparing heparin-bonded (Propaten®) versus non-heparin-bonded arteriovenous grafts. Procedure: In patients without usable native vein, prosthetic arteriovenous grafts will be implanted for hemodialysis access. Patients will be randomized intraoperatively to either conventional (Gore® Stretch) or heparin-bonded grafts (Gore® Propaten). Course of Study: The study will accrue patients over the course of 5 years. Enrollment: Enrollment will consist of adult patients who require hemodialysis. If the patient cannot have a native vein arteriovenous fistula, the patient is a candidate for arteriovenous graft. Patients will be screened and consented preoperatively. If the intraoperative decision is made that the patient will require a graft, randomization will occur and the patient will be considered enrolled. Recruitment: The target population comprises of all adult patients aged 18 years and above with end stage renal disease requiring arteriovenous access for hemodialysis. The target for enrollment will be 200 patients. Risks: The standard or known adverse events associated with graft implantation include thrombosis, infection, pseudoaneurysm, hematoma, and venous stenosis. There are case reports of heparin sensitivity. The investigators do not expect any additional physical risks other than an unintentional disclosure of sensitive patient health information. Data Safety Monitoring: As the Principal Investigator of this study, Dr. Charlton-Ouw from the Department of Cardiothoracic and Vascular Surgery at The University of Texas at Houston Medical School will conduct the data safety monitoring of this study. He will annually meet with all other co-investigators to review the patients enrolled in this study. As part of the data safety monitoring plan, all patients enrolled until that point in time would be unblinded in order to review the outcomes. Interim analyses will be conducted at the one-year follow up time. IND#: The devices that will be used are already approved by the FDA and do not have IND#. Proposed Funding Source: The study is internally funded. Communication of Study Results: The communication of study results will occur only between authorized individuals who are listed to take part in the study through our department. The individuals who will take part in the study will acknowledge and adhere to the importance of patient safety and the protection of their private information. The results of this study will be analyzed and published after the approval of the principal investigator, co-investigators, and biostatistician in a peer-reviewed scientific journal and/or presented at an international/national scientific conference or meeting regardless of outcome.
Interventions
Heparin-bonded graft implantation for hemodialysis vascular access
non-heparin bonded conventional hemodialysis vascular access graft
Sponsors
Study design
Eligibility
Inclusion criteria
* Aged ≥18 years of all ethnicities * End-stage Renal Disease stage 4 (GFR 15-29 ml/min 1.73m2) or stage 5 (GFR \<15ml/min 1.73m2) per National Kidney Foundation guidelines * Currently undergoing hemodialysis with a failure of previous access * Expected to undergo hemodialysis within 6 months of presentation
Exclusion criteria
* Unable/refuse to abide with follow-up * Known hypercoagulability syndrome or a bleeding disorder * On a previous anticoagulant treatment * Intraoperative decision in favor of fistula instead of graft * Pregnant or breast-feeding women * A documented history of heparin induced thrombocytopenia or allergy * Active infections * Evidence or suspicion of central vein stenosis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Primary Graft Patency Rate | 12 months | Primary graft patency refers to the successful use of a vascular access for hemodialysis without any surgical or endovascular intervention. |
| Primary-Assisted Graft Patency Rate | 12 months | Primary-assisted graft patency is defined as a patent access with evidence of malfunction that requires an open surgical or endovascular intervention. |
| Secondary Graft Patency Rate | 12 months | Secondary graft patency is defined as a functional access following intervention for thrombosis or after any interposition grafting for any reason including stenosis, aneurysm or pseudoaneurysm. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Complications or Morbidity Attributable to the Study | at least 1 year but up to two years | Complication/morbidity associated with both types of interventions |
| Number of Postoperative Re-interventions | at least 1 year but up to two years | — |
| Cost Estimation and Analysis | During the study period based on an average participant follow-up of 2 years after graft placement | Will be based on the difference between total cost analysed on the basis of the specific graft price, cost of re-intervention procedures if any, treatment of complications, hospital stay, etc., and compared for each study arm. |
| Quality of Life (QoL) Comparison | Participants would be followed for a period of 2 years after graft placement | Comparative assessment of quality of life reported by the patients in two arms |
Countries
United States
Participant flow
Pre-assignment details
103 were enrolled, but only 97 started (a difference of 6 subjects). These 6 subjects who were enrolled but did not start the study presented to the day-surgery operating room but had not followed instructions to stop Coumadin; therefore, their cases were cancelled.
Participants by arm
| Arm | Count |
|---|---|
| PROPATEN patients with heparin-bonded graft implantation
PROPATEN: Heparin-bonded graft implantation for hemodialysis vascular access | 50 |
| Standard Graft patients undergoing ePTFE hemodialysis graft implantation
Standard Graft: non-heparin bonded conventional hemodialysis vascular access graft | 47 |
| Total | 97 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 2 | 3 |
Baseline characteristics
| Characteristic | PROPATEN | Standard Graft | Total |
|---|---|---|---|
| Age, Continuous | 64 years STANDARD_DEVIATION 12.6 | 65 years STANDARD_DEVIATION 11.9 | 64.6 years STANDARD_DEVIATION 12.2 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 9 Participants | 5 Participants | 14 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 41 Participants | 42 Participants | 83 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Region of Enrollment United States | 50 Participants | 47 Participants | 97 Participants |
| Sex: Female, Male Female | 30 Participants | 21 Participants | 51 Participants |
| Sex: Female, Male Male | 20 Participants | 26 Participants | 46 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 7 / 48 | 4 / 44 |
| other Total, other adverse events | 19 / 48 | 20 / 44 |
| serious Total, serious adverse events | 0 / 48 | 0 / 44 |
Outcome results
Primary-Assisted Graft Patency Rate
Primary-assisted graft patency is defined as a patent access with evidence of malfunction that requires an open surgical or endovascular intervention.
Time frame: 24 months after graft placement
Population: 2 in the propaten group and 3 in the standard graft group were lost to follow up.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PROPATEN | Primary-Assisted Graft Patency Rate | 26 Percentage of participants |
| Standard Graft | Primary-Assisted Graft Patency Rate | 22 Percentage of participants |
Primary-Assisted Graft Patency Rate
Primary-assisted graft patency is defined as a patent access with evidence of malfunction that requires an open surgical or endovascular intervention.
Time frame: 12 months
Population: 1 in the propaten arm and 3 in the standard graft arm were lost to follow up.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PROPATEN | Primary-Assisted Graft Patency Rate | 57 Percentage of participants |
| Standard Graft | Primary-Assisted Graft Patency Rate | 60 Percentage of participants |
Primary Graft Patency Rate
Primary graft patency refers to the successful use of a vascular access for hemodialysis without any surgical or endovascular intervention.
Time frame: 24 months after graft placement
Population: 2 in the propaten group and 3 in the standard graft group were lost to follow up.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PROPATEN | Primary Graft Patency Rate | 24 Percentage of participants |
| Standard Graft | Primary Graft Patency Rate | 25 Percentage of participants |
Primary Graft Patency Rate
Primary graft patency refers to the successful use of a vascular access for hemodialysis without any surgical or endovascular intervention.
Time frame: 12 months
Population: 1 in the propaten arm and 3 in the standard graft arm were lost to follow up.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PROPATEN | Primary Graft Patency Rate | 35 Percentage of participants |
| Standard Graft | Primary Graft Patency Rate | 33 Percentage of participants |
Secondary Graft Patency Rate
Secondary graft patency is defined as a functional access following intervention for thrombosis or after any interposition grafting for any reason including stenosis, aneurysm or pseudoaneurysm.
Time frame: 24 months after graft placement
Population: 2 in the propaten group and 3 in the standard graft group were lost to follow up.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PROPATEN | Secondary Graft Patency Rate | 48 Percentage of participants |
| Standard Graft | Secondary Graft Patency Rate | 38 Percentage of participants |
Secondary Graft Patency Rate
Secondary graft patency is defined as a functional access following intervention for thrombosis or after any interposition grafting for any reason including stenosis, aneurysm or pseudoaneurysm.
Time frame: 12 months
Population: 1 in the propaten arm and 3 in the standard graft arm were lost to follow up.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| PROPATEN | Secondary Graft Patency Rate | 62 Percentage of participants |
| Standard Graft | Secondary Graft Patency Rate | 52 Percentage of participants |
Cost Estimation and Analysis
Will be based on the difference between total cost analysed on the basis of the specific graft price, cost of re-intervention procedures if any, treatment of complications, hospital stay, etc., and compared for each study arm.
Time frame: During the study period based on an average participant follow-up of 2 years after graft placement
Population: The cost data were not collected.
Number of Participants With Complications or Morbidity Attributable to the Study
Complication/morbidity associated with both types of interventions
Time frame: at least 1 year but up to two years
Population: 2 in the propaten group and 3 in the standard graft group were lost to follow up.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| PROPATEN | Number of Participants With Complications or Morbidity Attributable to the Study | 0 Participants |
| Standard Graft | Number of Participants With Complications or Morbidity Attributable to the Study | 0 Participants |
Number of Postoperative Re-interventions
Time frame: at least 1 year but up to two years
Population: 2 in the propaten group and 3 in the standard graft group were lost to follow up.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| PROPATEN | Number of Postoperative Re-interventions | 2.7 post-operative re-interventions | Standard Deviation 5 |
| Standard Graft | Number of Postoperative Re-interventions | 2.0 post-operative re-interventions | Standard Deviation 2.5 |
Quality of Life (QoL) Comparison
Comparative assessment of quality of life reported by the patients in two arms
Time frame: Participants would be followed for a period of 2 years after graft placement
Population: Qol data was collected, but because results of a planned interim futility analysis did not meet the study criteria for continuation, we do not believe analysis of the QoL data would be meaningful. Analysis of QoL data is an extremely onerous process that would take months to conduct. It is not worth the resources required to perform this analysis.