| E.1 Medical condition or disease under investigation |
| E.1.1 | Medical condition(s) being investigated |
| patients with known chonic kidney disease with functional or absolute Iron deficiency Anaemia, and are greater than 18 years will be given repleacement iron therapy accoring to current local protocols and NICE guidelines |
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| MedDRA Classification |
| E.1.2 Medical condition or disease under investigation |
| E.1.2 | Version | 15.0 |
| E.1.2 | Level | LLT |
| E.1.2 | Classification code | 10022973 |
| E.1.2 | Term | Iron deficiency anaemias |
| E.1.2 | System Organ Class | 10005329 - Blood and lymphatic system disorders |
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| E.1.3 | Condition being studied is a rare disease | No |
| E.2 Objective of the trial |
| E.2.1 | Main objective of the trial |
To assess whether three preparations of intravenous iron therapy affect markers of kidney injury including NGAL levels in serum and urine as a result of intravenous Iron therapy in patients with chronic kidney disease (CKD). The primary objective of this study is to: •To assess the effects of three preparations of intravenous (IV) iron in a cohort of CKD patients with biochemical functional or absolute iron deficiency (ferritin level less than 200 microg/l or/and transferrin saturation of <20%) on measures renal injury. •To determine whether iron isomaltoside, iron sucrose and iron dextran differ in their effects on markers of renal injury in comparison to baseline measures during the lead in period. •To determine whether IVI iron leads to potential transient AKI from assessment of changes in markers of renal injury from baseline markers prior to iron administration. To determine for iron isomaltoside if there is a difference related to dose of drug (low dose and normal dose) |
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| E.2.2 | Secondary objectives of the trial |
Secondary objectives are to determine •The effect (efficacy) of iron supplementation on haematinic profiles and haemoglobin levels. •Incidence of significant side affects •Whether hepcidin measurements are a reliable estimate of iron repletion and deficiency in CKD
•Change in urinary protein excretion •Change in patients’ Quality of Life (Measured using the SF-36v2™ questionnaire) •NHS health care resources used |
|
| E.2.3 | Trial contains a sub-study | No |
| E.3 | Principal inclusion criteria |
Patients with established chronic kidney disease. (Stages III-V) (GFR using MDRD <60ml/min) who are to undergo iron therapy Male, female over 18 years Written and signed informed patient consent No previous iron administration in the last 6 weeks Serum ferritin levels less than 200 mcg/l and/or transferrin saturation <20% Able to meet all study requrements
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| E.4 | Principal exclusion criteria |
Pregnancy Age < 18 years Ferritin greater than 200 mcg/l and Transferrin saturation >40% Known allergy to iron therapy Haemochromatosis Parenteral iron therapy within the previous 6 weeks Inability to co-operate with study protocol Patients with potential confounding factors to NGAL measurement Patients who do not have renal failure (CKD stage I and II) Patients who are unable or do not wish to give consent. Patients being investigated for potential blood loss Patients with a haematological malignancy/ haemolysis Patients with known haemaglobinopathy Patients with a diagnosis of myeloma current smokers Any other contraindications to Monofer, Venofer or Cosmofer therapy listed on SPC
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| E.5 End points |
| E.5.1 | Primary end point(s) |
The primary outcome variable of this study is the time course of markers of renal injury, their quantification and relationship to proteinuria and renal function and NGAL. Correlation curves will be drawn of serum creatinine/eGFR versus NGAL measurements (serum and urinary), and oxidative stress markers and NGAL and renal dysfunction. Patients will be grouped according to injury status at 24 hours as assessed by NGAL and oxidative stress measurements. Examination of the association between NGAL measurement and AKI status based on measurement at 24 hours will be carried out using logistic regression. Receiver operator analysis will be used to assess the ability of NGAL at various cut off values to discriminate between cases and non cases of injury based on oxidative stress. A cox proportional hazards model will be used to analyze the role of uNGAL in predicting the independent risk for acute kidney injury . Unless stated otherwise, all hypotheses tested are to be conducted at an alpha = 0.05 level of significance, with two-sided analysis. |
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| E.6 and E.7 Scope of the trial |
| E.6 | Scope of the trial |
| E.6.1 | Diagnosis | No |
| E.6.2 | Prophylaxis | No |
| E.6.3 | Therapy | Yes |
| E.6.4 | Safety | Yes |
| E.6.5 | Efficacy | Yes |
| E.6.6 | Pharmacokinetic | No |
| E.6.7 | Pharmacodynamic | No |
| E.6.8 | Bioequivalence | Yes |
| E.6.9 | Dose response | Yes |
| E.6.10 | Pharmacogenetic | No |
| E.6.11 | Pharmacogenomic | No |
| E.6.12 | Pharmacoeconomic | Yes |
| E.6.13 | Others | No |
| E.7 | Trial type and phase |
| E.7.1 | Human pharmacology (Phase I) | No |
| E.7.1.1 | First administration to humans | No |
| E.7.1.2 | Bioequivalence study | No |
| E.7.1.3 | Other | No |
| E.7.1.3.1 | Other trial type description | |
| E.7.2 | Therapeutic exploratory (Phase II) | No |
| E.7.3 | Therapeutic confirmatory (Phase III) | No |
| E.7.4 | Therapeutic use (Phase IV) | Yes |
| E.8 Design of the trial |
| E.8.1 | Controlled | Yes |
| E.8.1.1 | Randomised | Yes |
| E.8.1.2 | Open | Yes |
| E.8.1.3 | Single blind | No |
| E.8.1.4 | Double blind | No |
| E.8.1.5 | Parallel group | No |
| E.8.1.6 | Cross over | No |
| E.8.1.7 | Other | No |
| E.8.2 | Comparator of controlled trial |
| E.8.2.1 | Other medicinal product(s) | Yes |
| E.8.2.2 | Placebo | No |
| E.8.2.3 | Other | No |
| E.8.3 |
The trial involves single site in the Member State concerned
| No |
| E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
| E.8.5 | The trial involves multiple Member States | No |
| E.8.6 Trial involving sites outside the EEA |
| E.8.6.1 | Trial being conducted both within and outside the EEA | No |
| E.8.6.2 | Trial being conducted completely outside of the EEA | No |
| E.8.7 | Trial has a data monitoring committee | No |
| E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
| The end of the trial will occur when the patient has reached the end of the study period or death or adverse event necessitating withdrawal from the study. |
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| E.8.9 Initial estimate of the duration of the trial |
| E.8.9.1 | In the Member State concerned years | 2 |
| E.8.9.1 | In the Member State concerned months | 0 |
| E.8.9.1 | In the Member State concerned days | 0 |
| E.8.9.2 | In all countries concerned by the trial years | 2 |
| E.8.9.2 | In all countries concerned by the trial months | 0 |
| E.8.9.2 | In all countries concerned by the trial days | 0 |