Diabetes Mellitus, Type 2, Diabetic Kidney Disease
Conditions
Brief summary
In this study, we seek to explore the importance of fat accumulation in the kidneys in relation to diabetic kidney disease (DKD). To do this, we conduct an intervention trial in individuals with type 2 diabetes (T2D) and DKD where we investigate whether the inhibition of intestinal cholesterol absorption with ezetimibe affects albuminuria (a strong risk factor for diabetic complications) and kidney fat accumulation. At the same time and to confirm that kidney fat accumulation is, in fact, abnormal in T2D and DKD, we conduct a cross-sectional study in which we compare kidney fat accumulation in participants at baseline from the intervention trial with a group of individuals with T2D and no DKD and a group of healthy individuals.
Detailed description
Objective: 1. To compare cross-sectionally the fractions of kidney lipid between controls, individuals with type 2 diabetes and no diabetic kidney disease and individuals with type 2 diabetes and non-severe diabetic kidney disease. 2. To assess by intervention trial whether ezetimibe reduces albuminuria and kidney parenchymal triglyceride fraction in individuals with type 2 diabetes and non-severe diabetic kidney disease. Design: 1. Cross-sectional study on 30 controls, 30 individuals with type 2 diabetes and no diabetic kidney disease and 60 individuals with type 2 diabetes and non-severe diabetic kidney disease. 2. Single-center, randomized, double-blinded, placebo-controlled and parallel intervention trial in 60 individuals with type 2 diabetes and non-severe diabetic kidney disease Comparative treatment regime: Ezetimibe 10mg per day versus placebo for 16 weeks Primary endpoint in cross-sectional study: * Kidney parenchymal triglyceride fraction (estimated by magnetic resonance spectroscopy) Primary endpoint in intervention trial: * Urinary albumin creatinine ratio Secondary endpoint in intervention trial: • Kidney parenchymal triglyceride fraction (estimated by magnetic resonance spectroscopy) Main eligibility criteria for control group (cross-sectional study alone): • Age 40-75 years • No diabetes mellitus • No kidney disease or urinary albumin creatinine ratio ≥ 30mg/g • No contraindication to examination by magnetic resonance Main eligibility criteria for group of individuals with type 2 diabetes and no diabetic kidney disease (cross-sectional study alone): • Age 40-75 years * Type 2 diabetes * No kidney disease or urinary albumin creatinine ratio ≥ 30mg/g * No contraindication to examination by magnetic resonance Main eligibility criteria for group of individuals with type 2 diabetes and non-severe diabetic kidney disease (intervention trial): • Age 40-75 years * Type 2 diabetes * Estimated glomerular filtration rate ≥30ml/min/1,73m2 * Urinary albumin creatinine ratio ≥ 30mg/g * No contraindication to examination by magnetic resonance Recruitment * Controls are recruited via announcements on relevant websites and, if necessary, in newspapers * Individuals with type 2 diabetes are primarily recruited from the ambulatory at Steno Diabetes Center Copenhagen
Interventions
DRUGEzetimibe 10mg
Ezetimibe is a cholesterol absorption inhibitor with marketing approval. The recommended dose as per label is 10mg once a day.
DRUGPlacebo
Matching placebo
Sponsors
Department of Clinical Physiology, Nuclear Medicine and PET at Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
Aalborg University Hospital
Capital Region's Pharmacy (Region Hovedstadens Apotek), Marielundvej 25, 2730 Herlev, Denmark
Alessia Fornoni, MD PhD, Professor of Medicine, Chief, Katz Family Division of Nephrology and Hypertension
Steno Diabetes Center Copenhagen
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
To ensure blinding to the trial drug, the tablets containing either ezetimibe or placebo are incapsulated with gelatin and thus identical in appearance (size, color and shape).
Intervention model description
This study consists of a cross-sectional study and an intervention trial. The latter is a single-center, randomized, double-blinded, placebo-controlled and parallel trial in participants with T2D and non-severe diabetic kidney disease. Trial participants (n=60), by virtue of their baseline examinations (e.g. MR-examinations), also participate in the cross-sectional part of this study where they constitute one of three groups. The other two groups contain controls (n=30) and individuals with T2D and no diabetic kidney disease (n=30).
Eligibility
Sex/Gender
ALL
Age
40 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
for the intervention trial * Age ≥ 40 and ≤ 75 years * T2D (World Health Organization criteria) * eGFR ≥ 30ml/min/1,73m2 at screening * Persistent UACR ≥ 30mg/g (in more than two out of three valid measurements over a minimum of three months) * LDL \> 1.5mmol/L at screening * Ability to communicate with the investigator and give informed consent
Exclusion criteria
for the intervention trial * Chronic kidney disease primarily ascribed to other causes than diabetes * Acute kidney disease within 3 months * No UACR ≥ 3000mg/g in history * Current or recent (within 3 months) treatment with ezetimibe * Initiation or adjustment in dosage within 1 month of an angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB), glucagon-like peptide-1 receptor (GLP-1RA) agonists, sodium-glucose cotransporter 2 (SGLT-2) inhibitors or anti-dyslipidemia drug, e.g. a statin * Any contraindication to MR-examination (e.g. magnetic foreign body that cannot easily be removed from the body prior to the examination, claustrophobia or body size not compatible with the scanner) * Intolerance to trial drug components * Any previous major organ transplantation * Elective major surgery during the trial * Pregnancy, planned pregnancy or breastfeeding during the trial * Insufficient contraception during the trial in women of childbearing potential * Severe alcohol consumption or abuse of recreational drugs * Moderate to severe liver failure (Child Pugh 7-15) * Any surgical or medical condition which can be expected to significantly alter the absorption of the trial drug (e.g. major gastrointestinal tract surgery or inflammatory bowel disease) * Recent (within 30 days or 5-half-lives, whichever is longer) or current participation in another clinical study in which an investigational medicinal product or device has been received * Any medical condition or history thereof or any deviation from normal laboratory values that, in the opinion of the investigator, clinically contraindicates or hinders the completion of the trial * Any reason for suspecting a considerable lack of compliance to the trial Inclusion criteria for the control group (cross-sectional study alone): * Age ≥ 40 and ≤ 75 years * eGFR ≥60ml/min/1,73m2 at screening * Ability to communicate with the investigator and give informed consent
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Urinary albumin creatinine ratio (UACR) | Change over 16 weeks of treatment |
Secondary
| Measure | Time frame |
|---|---|
| Magnetic resonans estimate of kidney parenchymal triglyceride fraction | Change over 16 weeks of treatment |
Other
| Measure | Time frame | Description |
|---|---|---|
| Urine metabolomic profile | Change over 16 weeks of treatment | Metabolomic profiling of polar and non-polar urinary metabolites |
| Plasma extracellular vesicles | Change over 16 weeks of treatment | number, number from relevant cell types and for all extracellular vesicles the presence of fatty acid transporter proteins |
| Urine extracellular vesicles | Change over 16 weeks of treatment | number, number from relevant cell types and for all extracellular vesicles the presence of fatty acid transporter proteins |
Countries
Denmark
Outcome results
None listed