E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Chronic kidney disease (CKD) with hyperkalaemia or at risk of hyperkalaemia |
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E.1.1.1 | Medical condition in easily understood language |
Chronic kidney disease (CKD) with elevated blood potassium level or at risk of elevated blood potassium level |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cardiovascular Diseases [C14] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 23.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10076410 |
E.1.2 | Term | Chronic kidney disease stage 3 |
E.1.2 | System Organ Class | 100000004857 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 23.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10076411 |
E.1.2 | Term | Chronic kidney disease stage 4 |
E.1.2 | System Organ Class | 100000004857 |
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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 determine if treatment with SZC, as adjunct to ACEi/ARB therapy*, is superior to placebo in slowing CKD progression, assessed as the reduction in participant’s expected eGFR decline over time
*lisinopril or valsartan; in case of a local market valsartan shortage, irbesartan will be temporarily used instead. |
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E.2.2 | Secondary objectives of the trial |
- To determine if treatment with SZC, as adjunct to ACEi/ARB therapy* is superior to placebo in reducing the incidence of the composite of kidney failure outcomes comprising: sustained ≥ 40% decline in eGFR, onset of ESKD,and death from kidney failure - To determine if treatment with SZC, as adjunct to ACEi/ARB therapy* is superior to placebo in reducing the incidence of lisinopril/valsartan dose decrease in participants on lisinopril/valsartan at randomisation - To determine if treatment with SZC, as adjunct to ACEi/ARB therapy* is superior to placebo in reducing albuminuria - To determine if treatment with SZC, as adjunct to ACEi/ARB therapy* is superior to placebo in increasing serum bicarbonate levels - To determine if treatment with SZC, as adjunct to ACEi/ARB therapy* is superior to placebo on maintenance of normokalaemia
*lisinopril or valsartan; in case of a local market valsartan shortage, irbesartan will be temporarily used instead. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Capable of giving signed informed consent which includes compliance with the requirements and restrictions listed in the ICF and protocol
- Must be ≥ 18 years of age at the time of signing the informed consent.
- Must have eGFR ≥ 25 and ≤ 59 mL/min/1.73m2 as calculated by central laboratory (CKD-EPI formula) at screening (Visit 1)
- Must have UACR ≥ 200 and ≤ 5000 mg/g as calculated by central laboratory at screening (Visit 1). If the first sample does not fulfil eligibility criteria, a second sample can be obtained during the screening period; if so, the UACR measurement from the second sample must be within the eligibility range.
- Must have UACR ≥ 200 and ≤ 5000 mg/g as calculated by central laboratory at screening (Visit 1)
- Any of the following criteria, a or b, at screening (Visit 1): (a) Cohort A: Hyperkalaemia (S-K > 5.0 to ≤ 6.5 mmol/L) as measured by the central laboratory, and on adequate* or limited** RAASi therapy due to hyperkalaemia. (b) Cohort B: Normokalaemia (S-K ≥ 3.5 to ≤ 5.0 mmol/L) as measured by the central laboratory and on limited** RAASi therapy due to high risk of hyperkalaemia. High risk of hyperkalaemia is defined as: (i) Participants with a previous medical history or record of hyperkalaemia within the prior 24 months, who are on limited** RAASi therapy despite indication in CKD. (ii) Participants in whom RAASi therapy is indicated in CKD, who are on limited** RAASi therapy and have S-K ≥ 4.7 to ≤ 5.0 mmol/L. (iii) Participants in whom RAASi therapy has been discontinued or reduced to suboptimal* doses because of hyperkalaemia.
*Adequate RAASi dose levels are defined in protocol; doses lower than these are considered as suboptimal. **Limited RAASi therapy is defined as no or suboptimal RAASi therapy according to dosing guidance provided in protocol.
- If on thiazide or loop diuretics, the dose must have been stable for 2 weeks prior to screening (Visit 1).
- If on RAASi therapy, the dose must have been stable for one month prior to screening (Visit 1) and remain stable during screening.
- If on an SGLT2 inhibitor (ie, dapagliflozin and canagliflozin), finerenone, or any other medications in these 2 classes that are approved for CKD, the dose must have been stable for 3 months prior to screening (Visit 1). |
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E.4 | Principal exclusion criteria |
- New York Heart Association class III to IV congestive heart failure at the time of screening (Visit 1) or previous history of severe or symptomatic heart failure.
- Myocardial infarction, unstable angina, stroke, or transient ischaemic attack within 3 months prior to screening (Visit 1).
- Participants with a known history of systolic blood pressure ≥ 160 mmHg or diastolic blood pressure ≥ 95 mmHg, within 2 weeks prior to screening (Visit 1) are excluded. In addition, any participant with systolic blood pressure ≥ 160 mmHg or diastolic blood pressure ≥ 95 mmHg as measured at screening (Visit 1) and confirmed by repeated measurement is excluded. Participants may be rescreened once blood pressure is controlled.
- QTcF > 550 msec at screening (Visit 1).
- History of QT prolongation associated with other medications that required discontinuation of that medication.
- Congenital long QT syndrome.
- Symptomatic or uncontrolled atrial fibrillation despite treatment, or asymptomatic sustained ventricular tachycardia. Participants with atrial fibrillation and heart rate controlled by medication are permitted.
- Type 1 diabetes mellitus.
- Lupus nephritis or anti neutrophil cytoplasmic antibody-associated vasculitis.
- Change in renal function requiring hospitalisation or dialysis within 3 months prior to screening (Visit 1).
- History of renal transplant (or anticipated need for renal transplant during the study).
- Severe hepatic impairment, biliary cirrhosis, or cholestasis.
- History of hereditary or idiopathic angioedema.
- Any prior hypersensitivity to ACEi or ARB that in the investigator’s judgment precludes use of lisinopril and valsartan/irbesartan. Prior hypersensitivity reactions to consider include, but are not limited to, development of angioedema, icterus, hepatitis, or neutropaenia or thrombocytopaenia requiring treatment modification.
- Known hypersensitivity or previous anaphylaxis to SZC or to components thereof.
- Any condition outside the CV and renal disease area such as, but not limited to, malignancy, with a life expectancy of less than 2 years based on investigator´s clinical judgment.
- Active malignancy requiring treatment at the time of screening (Visit 1), except for successfully treated basal cell or treated squamous cell carcinoma.
- S-K > 6.5 or < 3.5 mmol/L by local laboratory within 1 day prior to the scheduled first dose of SZC in the initiation phase.
- Evidence of COVID-19 infection within 2 weeks prior to screening (Visit 1).
- Treated with dual blockade of RAAS (combined use of an ACEi and ARB) within 3 months prior to screening (Visit 1).
- Treated with an angiotensin receptor neprilysin inhibitor (ARNI; sacubitril/valsartan [Entresto®]) within 3 months prior to screening (Visit 1).
- Treated with an MRA not approved for CKD within 3 months prior to screening (Visit 1).
- Treated with aliskiren-containing products with 3 months prior to screening (Visit 1).
- Treated with SPS (eg, Kayexalate, Resonium), CPS (Resonium Calcium), patiromer (Veltassa®), or SZC (Lokelma®) within 7 days prior to screening (Visit 1).
- Participation in another clinical study with an investigational product administered within one month prior to screening (Visit 1).
- Not willing or not able to change to lisinopril or valsartan/irbesartan, the protocol-mandated RAASi study intervention. Note: For participants taking a fixed combination of an ACEi or ARB with another agent (eg, calcium blockers or diuretics) as SoC, the investigator must make a judgment that it will be safe and efficacious for such participants to change to the study ACEi or ARB and to the other drug as separate agents.
- Previous dosing with SZC in the present study.
- Currently pregnant (confirmed with positive pregnancy test at screening [Visit 1]) or breastfeeding.
- Judgment by the investigator that the participant is unlikely to comply with study procedures, restrictions, and requirements.
- Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff and/or staff at the study site). |
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E.5 End points |
E.5.1 | Primary end point(s) |
Co-primary * • Total slope: eGFR measurements starting at randomisation • Chronic slope: eGFR measurements, starting at 12 weeks after randomisation
* Both of the primary endpoints must be met in order for the study to be declared successful, ie, coprimary endpoints |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Co-primary * - Total slope: eGFR measurements starting at randomisation - Chronic slope: eGFR measurements, starting at 12 weeks after randomisation
* Both of the primary endpoints must be met in order for the study to be declared successful, ie, coprimary endpoints |
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E.5.2 | Secondary end point(s) |
- Time from randomisation to the first occurrence of any component in the composite of: Sustained ≥ 40% decline in eGFR Onset of ESKD (kidney transplantation, maintenance dialysis, or sustained low eGFR) Death from kidney failure
- Time from randomisation to first lisinopril/valsartan dose decrease
- UACR measurements
- Serum bicarbonate measurements
- S-K level classification; normal (3.5 - 5.0 mmol/L) or non-normal (< 3.5 or > 5.0 mmol/L) |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
- UACR measurements at scheduled visits after randomisation
- Serum bicarbonate measurements at scheduled visits after randomisation
- S-K level classification; normal (3.5 5.0 mmol/L) or non-normal (< 3.5 or > 5.0 mmol/L) at scheduled visits after randomisation |
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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 | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
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) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
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) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| Information not present in EudraCT |
E.8.4 | The trial involves multiple sites in the Member State concerned | Information not present in EudraCT |
E.8.4.1 | Number of sites anticipated in Member State concerned | 19 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 45 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Argentina |
Ukraine |
Taiwan |
Brazil |
Bulgaria |
Canada |
China |
Italy |
Japan |
Mexico |
Poland |
Russian Federation |
Spain |
Turkey |
United States |
Viet Nam |
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E.8.7 | Trial has a data monitoring committee | Yes |
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
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A participant is considered to have completed the study if he/she has completed all phases of the study, including the scheduled follow-up visit after the maintenance phase.
The end of the study globally is defined as the date of the last visit of the last participant. |
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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 | 3 |
E.8.9.1 | In the Member State concerned months | 3 |
E.8.9.1 | In the Member State concerned days | 19 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 3 |
E.8.9.2 | In all countries concerned by the trial days | 19 |