Catheter-Related Infections, Kidney Failure, Chronic
Conditions
Keywords
Kidney Failure, Chronic, Catheter-Related Infections, Central Venous Catheter
Brief summary
The purpose of this study is determine safety and effectiveness of Neutrolin, a catheter lock solution, for prevention of central venous catheter associated bloodstream infection in hemodialysis patients.
Detailed description
The objective of this study is to demonstrate the efficacy and safety of Neutrolin® as a catheter lock solution (CLS) on prevention of catheter-related bloodstream infection (CRBSI), and the incidence of treatment-emergent adverse events in subjects receiving hemodialysis (HD) for the treatment of End Stage Renal Disease (ESRD) when compared with heparin 4,000 USP Units/4mL (1,000 USP Units/mL). This is a randomized, double-blind, active control, parallel-arm, multicenter study. Six hundred and thirty two subjects will be randomized in a 1:1 ratio to receive either Neutrolin® or the active control heparin (Heparin sodium USP 1,000 units/mL, Benzyl alcohol 9.45 mg/mL and Sodium chloride 9.0 mg/mL) as a CLS. Approximately 632 randomized subjects are planned for this trial. In this study, one-half of the subjects (316 subjects) will receive Neutrolin as a study drug and the other half will receive heparin 4,000 USP Units/4mL (1,000 USP Units/mL) with benzyl alcohol preservative as a comparator. Subjects will be assigned in a 1:1 ratio using permuted blocks without additional stratification for both groups. The primary objective of this study is to demonstrate the effectiveness of Neutrolin® as a CLS in ESRD subjects undergoing HD treatment using a permanent, cuffed, tunneled silicone or polyurethane HD catheter. The study will evaluate whether Neutrolin® is superior to the active control heparin by documenting the time to CRBSI and consequently delaying the time until the occurrence of CRBSI.
Interventions
DRUGNeutrolin
Neutrolin® will be instilled into central venous HD catheters at the discontinuation of all dialysis sessions and will be withdrawn prior to the initiation of the next dialysis session
DRUGHeparin
Heparin will be instilled into central venous HD catheters at the discontinuation of all dialysis sessions and will be withdrawn prior to the initiation of the next dialysis session
Sponsors
PPD Development, LP
JMI Laboratories
Spectra Clinical Research
Davita Clinical Research
Frenova Renal Research
CorMedix
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Subject has ESRD and undergoes chronic HD at least two times per week 2. Subject has a HD catheter that has demonstrated the ability to achieve a minimum blood flow of at least 250 mL/min for at least two consecutive dialysis sessions blood flow to enable successful HD 3. The HD catheter is implanted with the tip in a jugular or subclavian vein 4. The subject is not expected to expire within 180 days 5. The subject is likely to require the use of a CVC for at least 90 days 6. The subject (or the legal guardian) understands the nature of the study and provides written informed consent prior to the study enrollment 7. The subject is willing to comply with specified follow-up evaluations and prescribed dialysis therapy and 8. If female and of childbearing potential, the subject must have a negative pregnancy test at the screening visit (i.e., subject is not pregnant); not be lactating; and use an acceptable method of contraception, including abstinence, a barrier method (diaphragm or condom), Depo-Provera, or hormonal contraceptive (oral, implant, ring, patch) for the duration of the study. (NOTE: The subject must have used the chosen method of birth control for at least 1 month/cycle prior to enrollment into the study).
Exclusion criteria
1. Subjects who received antibiotics within the last 14 days 2. Visible evidence of compromised skin integrity is present at the catheter exit site or evidence of a catheter exit site infection 3. Subject has received any thrombolytic treatment (i.e., tPA) in their current catheter within 30 days of randomization 4. Fill volume of HD catheter is unknown or cannot be determined 5. Subjects using any type of antimicrobial-coated or heparin-coated catheter 6. Documented chronic bleeding diathesis, active or recurrent bleeding within 1 month prior to randomization 7. Documented history of an atrial thrombus or known hypercoagulable state 8. Subjects with open, non-healing skin ulcers 9. Current requirement for systemic immunosuppression that would increase risk of infection 10. Active malignancy requiring or anticipated to require chemotherapy likely to cause leukopenia and/or immunosuppression 11. Known allergy or absolute contraindication to citrate, taurolidine or heparin or a history of heparin-induced thrombocytopenia 12. Unstable malignancy 13. Cirrhosis with encephalopathy 14. Subject is currently taking another medication with known systemic drug interaction with citrate, taurolidine, or heparin 15. Subject is currently enrolled in another investigational device and/or drug trial or has participated in another investigational device and/or drug trial within 30 days prior to enrollment 16. Subject is anticipated to receive a renal transplant within 90 days (subjects can be on the transplant list, but a subject with a known or anticipated transplant date within the next 90 days should be excluded) 17. Any other medical condition which renders the subject unable to or unlikely to complete the study, or which would interfere with optimal participation in the study or produce significant risk to the subject. \-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Presence of a CAC-Adjudicated Catheter-Related Bloodstream Infection (CRBSI) in Subjects Receiving Hemodialysis for the Treatment of End Stage Renal Disease (ESRD): Final Analysis | The event time was the number of days from randomization until the occurrence of a CAC-Adjudicated CRBSI or until the subject was censored. The mean participant duration of exposure to study drug was 174 days (range 4-884 days). | CRBSI was defined as the same organism grown from at least one positive blood culture from a peripheral site or bloodline sample, or either the arterial or venous catheter hub. The final assessment of CRBSI was determined by a Clinical Adjudication Committee (CAC) who used both clinical documentation and blood culture results in their assessment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Participants With a Study Catheter Removal for Any Reason | The event time was the number of days from randomization until catheter removal for any reason or until the subject was censored. The mean participant duration of exposure to study drug was 174 days (range 4-884 days). | Analysis of all catheter removals during the study or until the catheter was removed |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Neutrolin Arm Neutrolin: Neutrolin will be added to the central venous catheter after dialysis as a lock solution
Neutrolin: Neutrolin® will be instilled into central venous HD catheters at the discontinuation of all dialysis sessions and will be withdrawn prior to the initiation of the next dialysis session | 403 |
| Heparin Arm Heparin: Heparin will be added to the central venous catheter after dialysis as a lock solution
Heparin: Heparin will be instilled into central venous HD catheters at the discontinuation of all dialysis sessions and will be withdrawn prior to the initiation of the next dialysis session | 403 |
| Total | 806 |
Baseline characteristics
| Characteristic | Neutrolin Arm | Total | Heparin Arm |
|---|---|---|---|
| Age, Continuous | 60.8 years STANDARD_DEVIATION 14.22 | 60.9 years STANDARD_DEVIATION 14.3 | 60.9 years STANDARD_DEVIATION 14.39 |
| Race (NIH/OMB) American Indian or Alaska Native | 3 Participants | 5 Participants | 2 Participants |
| Race (NIH/OMB) Asian | 15 Participants | 33 Participants | 18 Participants |
| Race (NIH/OMB) Black or African American | 126 Participants | 238 Participants | 112 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 10 Participants | 14 Participants | 4 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 6 Participants | 5 Participants |
| Race (NIH/OMB) White | 248 Participants | 510 Participants | 262 Participants |
| Region of Enrollment United States | 403 participants | 806 participants | 403 participants |
| Sex: Female, Male Female | 184 Participants | 338 Participants | 154 Participants |
| Sex: Female, Male Male | 219 Participants | 468 Participants | 249 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 18 / 398 | 21 / 399 |
| other Total, other adverse events | 314 / 398 | 315 / 399 |
| serious Total, serious adverse events | 159 / 398 | 167 / 399 |
Outcome results
Primary
Presence of a CAC-Adjudicated Catheter-Related Bloodstream Infection (CRBSI) in Subjects Receiving Hemodialysis for the Treatment of End Stage Renal Disease (ESRD): Final Analysis
CRBSI was defined as the same organism grown from at least one positive blood culture from a peripheral site or bloodline sample, or either the arterial or venous catheter hub. The final assessment of CRBSI was determined by a Clinical Adjudication Committee (CAC) who used both clinical documentation and blood culture results in their assessment.
Time frame: The event time was the number of days from randomization until the occurrence of a CAC-Adjudicated CRBSI or until the subject was censored. The mean participant duration of exposure to study drug was 174 days (range 4-884 days).
Population: Full Analysis Population - all subjects randomized and receiving one or more doses of study medication.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Neutrolin Arm | Presence of a CAC-Adjudicated Catheter-Related Bloodstream Infection (CRBSI) in Subjects Receiving Hemodialysis for the Treatment of End Stage Renal Disease (ESRD): Final Analysis | 9 Participants |
| Heparin Arm | Presence of a CAC-Adjudicated Catheter-Related Bloodstream Infection (CRBSI) in Subjects Receiving Hemodialysis for the Treatment of End Stage Renal Disease (ESRD): Final Analysis | 32 Participants |
Comparison: The null hypothesis was that there was no difference in the survival functions for CRBSI between the two treatments. Based on 80% power to detect a 55% reduction in the risk of CRBSI relative to the control treatment, a 1:1 randomization, a 2-sided log-rank test, one interim analysis using the method of Pocock, and an overall alpha of 0.05, it was determined that 56 CRBSIs would be needed. These are the results of the final analysis.p-value: 0.000695% CI: [0.14, 0.62]Log Rank
Secondary
Participants With a Study Catheter Removal for Any Reason
Analysis of all catheter removals during the study or until the catheter was removed
Time frame: The event time was the number of days from randomization until catheter removal for any reason or until the subject was censored. The mean participant duration of exposure to study drug was 174 days (range 4-884 days).
Population: Full Analysis Population - all subjects randomized and receiving one or more doses of study medication.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Neutrolin Arm | Participants With a Study Catheter Removal for Any Reason | 236 Participants |
| Heparin Arm | Participants With a Study Catheter Removal for Any Reason | 225 Participants |
Comparison: The null hypothesis was that there was no difference in the time until catheter removal for any reason between the two treatments.p-value: 0.416195% CI: [0.9, 1.29]Log Rank