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Propaten Randomized Investigation on Cost-benefit and Efficacy

A Randomized Controlled Comparative Study on Efficacy and Cost-effectiveness of Heparin-bonded Versus Non-heparin-bonded Polytetrafluroethylene Hemodialysis Access Grafts.

Status
Terminated
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01601873
Acronym
PRICE
Enrollment
103
Registered
2012-05-18
Start date
2012-11-09
Completion date
2018-06-30
Last updated
2019-02-27

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

End-stage Renal Disease

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

DEVICEPROPATEN

Heparin-bonded graft implantation for hemodialysis vascular access

DEVICEStandard Graft

non-heparin bonded conventional hemodialysis vascular access graft

Sponsors

University Hospitals Cleveland Medical Center
CollaboratorOTHER
University of Arkansas
CollaboratorOTHER
Ochsner Health System
CollaboratorOTHER
The University of Texas Health Science Center, Houston
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

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

MeasureTime frameDescription
Primary Graft Patency Rate12 monthsPrimary graft patency refers to the successful use of a vascular access for hemodialysis without any surgical or endovascular intervention.
Primary-Assisted Graft Patency Rate12 monthsPrimary-assisted graft patency is defined as a patent access with evidence of malfunction that requires an open surgical or endovascular intervention.
Secondary Graft Patency Rate12 monthsSecondary 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

MeasureTime frameDescription
Number of Participants With Complications or Morbidity Attributable to the Studyat least 1 year but up to two yearsComplication/morbidity associated with both types of interventions
Number of Postoperative Re-interventionsat least 1 year but up to two years
Cost Estimation and AnalysisDuring the study period based on an average participant follow-up of 2 years after graft placementWill 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) ComparisonParticipants would be followed for a period of 2 years after graft placementComparative 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

ArmCount
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
Total97

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyLost to Follow-up23

Baseline characteristics

CharacteristicPROPATENStandard GraftTotal
Age, Continuous64 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 Participants5 Participants14 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
41 Participants42 Participants83 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Region of Enrollment
United States
50 Participants47 Participants97 Participants
Sex: Female, Male
Female
30 Participants21 Participants51 Participants
Sex: Female, Male
Male
20 Participants26 Participants46 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
7 / 484 / 44
other
Total, other adverse events
19 / 4820 / 44
serious
Total, serious adverse events
0 / 480 / 44

Outcome results

Primary

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.

ArmMeasureValue (NUMBER)
PROPATENPrimary-Assisted Graft Patency Rate26 Percentage of participants
Standard GraftPrimary-Assisted Graft Patency Rate22 Percentage of participants
p-value: 0.786Log Rank
Primary

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.

ArmMeasureValue (NUMBER)
PROPATENPrimary-Assisted Graft Patency Rate57 Percentage of participants
Standard GraftPrimary-Assisted Graft Patency Rate60 Percentage of participants
p-value: 0.946Wilcoxon (Mann-Whitney)
Primary

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.

ArmMeasureValue (NUMBER)
PROPATENPrimary Graft Patency Rate24 Percentage of participants
Standard GraftPrimary Graft Patency Rate25 Percentage of participants
p-value: 0.538Log Rank
Primary

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.

ArmMeasureValue (NUMBER)
PROPATENPrimary Graft Patency Rate35 Percentage of participants
Standard GraftPrimary Graft Patency Rate33 Percentage of participants
p-value: 0.884Wilcoxon (Mann-Whitney)
Primary

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.

ArmMeasureValue (NUMBER)
PROPATENSecondary Graft Patency Rate48 Percentage of participants
Standard GraftSecondary Graft Patency Rate38 Percentage of participants
p-value: 0.185Log Rank
Primary

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.

ArmMeasureValue (NUMBER)
PROPATENSecondary Graft Patency Rate62 Percentage of participants
Standard GraftSecondary Graft Patency Rate52 Percentage of participants
p-value: 0.294Wilcoxon (Mann-Whitney)
Secondary

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.

Secondary

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.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
PROPATENNumber of Participants With Complications or Morbidity Attributable to the Study0 Participants
Standard GraftNumber of Participants With Complications or Morbidity Attributable to the Study0 Participants
Secondary

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.

ArmMeasureValue (MEAN)Dispersion
PROPATENNumber of Postoperative Re-interventions2.7 post-operative re-interventionsStandard Deviation 5
Standard GraftNumber of Postoperative Re-interventions2.0 post-operative re-interventionsStandard Deviation 2.5
Secondary

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.

Source: ClinicalTrials.gov · Data processed: Feb 26, 2026