Pirfenidone Effect on the Recovery of Renal Function in Septic Acute Kidney Injury

Summary

Patients with Septic AKI will be randomized in three arms, group PFD 1,200 will receive PDF 600mg every 12 hrs per mouth, group PDF 600 will receive PFD 600mg in the morning and placebo equivalent at night and Group Placebo will receive placebo every 12 hrs, all for 7 days, all receive conventional treatment KDIGO guides. We analyze the recovery of renal function as a primary objective.

Timeline

Start

2015-10

Primary completion

2016-03

Completion

2016-07

Publications

• Background Hsu CY. Where is the epidemic in kidney disease? J Am Soc Nephrol. 2010 Oct;21(10):1607-11. doi: 10.1681/ASN.2010050546. Epub 2010 Sep 2. No abstract available.
• Background Hsu RK, McCulloch CE, Dudley RA, Lo LJ, Hsu CY. Temporal changes in incidence of dialysis-requiring AKI. J Am Soc Nephrol. 2013 Jan;24(1):37-42. doi: 10.1681/ASN.2012080800. Epub 2012 Dec 6.
• Background James M, Pannu N. Methodological considerations for observational studies of acute kidney injury using existing data sources. J Nephrol. 2009 May-Jun;22(3):295-305.
• Background Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C; Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005 Aug 17;294(7):813-8. doi: 10.1001/jama.294.7.813.
• Background Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ. Acute renal failure in intensive care units--causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit Care Med. 1996 Feb;24(2):192-8. doi: 10.1097/00003246-199602000-00003.
• Background Mehta RL, Pascual MT, Soroko S, Savage BR, Himmelfarb J, Ikizler TA, Paganini EP, Chertow GM; Program to Improve Care in Acute Renal Disease. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004 Oct;66(4):1613-21. doi: 10.1111/j.1523-1755.2004.00927.x.
• Background Metcalfe W, Simpson M, Khan IH, Prescott GJ, Simpson K, Smith WC, MacLeod AM; Scottish Renal Registry. Acute renal failure requiring renal replacement therapy: incidence and outcome. QJM. 2002 Sep;95(9):579-83. doi: 10.1093/qjmed/95.9.579.
• Background Grams ME, Rabb H. The distant organ effects of acute kidney injury. Kidney Int. 2012 May;81(10):942-948. doi: 10.1038/ki.2011.241. Epub 2011 Aug 3.
• Background Singbartl K, Kellum JA. AKI in the ICU: definition, epidemiology, risk stratification, and outcomes. Kidney Int. 2012 May;81(9):819-25. doi: 10.1038/ki.2011.339. Epub 2011 Oct 5.
• Background Heyman SN, Evans RG, Rosen S, Rosenberger C. Cellular adaptive changes in AKI: mitigating renal hypoxic injury. Nephrol Dial Transplant. 2012 May;27(5):1721-8. doi: 10.1093/ndt/gfs100.
• Background Heyman SN, Rosenberger C, Rosen S. Experimental ischemia-reperfusion: biases and myths-the proximal vs. distal hypoxic tubular injury debate revisited. Kidney Int. 2010 Jan;77(1):9-16. doi: 10.1038/ki.2009.347.
• Background Kinsey GR, Sharma R, Okusa MD. Regulatory T cells in AKI. J Am Soc Nephrol. 2013 Nov;24(11):1720-6. doi: 10.1681/ASN.2013050502. Epub 2013 Oct 17.
• Background Kaushal GP, Shah SV. Challenges and advances in the treatment of AKI. J Am Soc Nephrol. 2014 May;25(5):877-83. doi: 10.1681/ASN.2013070780. Epub 2014 Jan 30.
• Background Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002 May;39(5):930-6. doi: 10.1053/ajkd.2002.32766.
• Background Mehta RL. Management of acute kidney injury: it's the squeaky wheel that gets the oil! Clin J Am Soc Nephrol. 2011 Sep;6(9):2102-4. doi: 10.2215/CJN.07720811. Epub 2011 Aug 18. No abstract available.
• Background Yang F, Zhang L, Wu H, Zou H, Du Y. Clinical analysis of cause, treatment and prognosis in acute kidney injury patients. PLoS One. 2014 Feb 21;9(2):e85214. doi: 10.1371/journal.pone.0085214. eCollection 2014.
• Background Akcay A, Turkmen K, Lee D, Edelstein CL. Update on the diagnosis and management of acute kidney injury. Int J Nephrol Renovasc Dis. 2010;3:129-40. doi: 10.2147/IJNRD.S8641. Epub 2010 Sep 29.
• Background Brady HR, Singer GG. Acute renal failure. Lancet. 1995 Dec 9;346(8989):1533-40. doi: 10.1016/s0140-6736(95)92057-9. No abstract available.
• Background Hilton R. Acute renal failure. BMJ. 2006 Oct 14;333(7572):786-90. doi: 10.1136/bmj.38975.657639.AE. No abstract available.
• Background Waikar SS, Curhan GC, Wald R, McCarthy EP, Chertow GM. Declining mortality in patients with acute renal failure, 1988 to 2002. J Am Soc Nephrol. 2006 Apr;17(4):1143-50. doi: 10.1681/ASN.2005091017. Epub 2006 Feb 22.
• Background Chiao H, Kohda Y, McLeroy P, Craig L, Housini I, Star RA. Alpha-melanocyte-stimulating hormone protects against renal injury after ischemia in mice and rats. J Clin Invest. 1997 Mar 15;99(6):1165-72. doi: 10.1172/JCI119272.
• Background Thompson JD, Kornbrust DJ, Foy JW, Solano EC, Schneider DJ, Feinstein E, Molitoris BA, Erlich S. Toxicological and pharmacokinetic properties of chemically modified siRNAs targeting p53 RNA following intravenous administration. Nucleic Acid Ther. 2012 Aug;22(4):255-64. doi: 10.1089/nat.2012.0371.
• Background Sugimoto H, LeBleu VS, Bosukonda D, Keck P, Taduri G, Bechtel W, Okada H, Carlson W Jr, Bey P, Rusckowski M, Tampe B, Tampe D, Kanasaki K, Zeisberg M, Kalluri R. Activin-like kinase 3 is important for kidney regeneration and reversal of fibrosis. Nat Med. 2012 Feb 5;18(3):396-404. doi: 10.1038/nm.2629.
• Background 24. A study to evaluate the safety and efficacy of AC607 for the treatment of kidney injury in cardiac surgery subjects (ACT-AKI).
• Background Briguori C, Visconti G, Focaccio A, Airoldi F, Valgimigli M, Sangiorgi GM, Golia B, Ricciardelli B, Condorelli G; REMEDIAL II Investigators. Renal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II): RenalGuard System in high-risk patients for contrast-induced acute kidney injury. Circulation. 2011 Sep 13;124(11):1260-9. doi: 10.1161/CIRCULATIONAHA.111.030759. Epub 2011 Aug 15.
• Background Pickkers P, Heemskerk S, Schouten J, Laterre PF, Vincent JL, Beishuizen A, Jorens PG, Spapen H, Bulitta M, Peters WH, van der Hoeven JG. Alkaline phosphatase for treatment of sepsis-induced acute kidney injury: a prospective randomized double-blind placebo-controlled trial. Crit Care. 2012 Jan 23;16(1):R14. doi: 10.1186/cc11159.
• Background Tumlin J, Wali R, Williams W, Murray P, Tolwani AJ, Vinnikova AK, Szerlip HM, Ye J, Paganini EP, Dworkin L, Finkel KW, Kraus MA, Humes HD. Efficacy and safety of renal tubule cell therapy for acute renal failure. J Am Soc Nephrol. 2008 May;19(5):1034-40. doi: 10.1681/ASN.2007080895. Epub 2008 Feb 13.
• Background Tumlin JA, Chawla L, Tolwani AJ, Mehta R, Dillon J, Finkel KW, DaSilva JR, Astor BC, Yevzlin AS, Humes HD. The effect of the selective cytopheretic device on acute kidney injury outcomes in the intensive care unit: a multicenter pilot study. Semin Dial. 2013 Sep-Oct;26(5):616-23. doi: 10.1111/sdi.12032. Epub 2012 Oct 29.
• Background Faubel S, Chawla LS, Chertow GM, Goldstein SL, Jaber BL, Liu KD; Acute Kidney Injury Advisory Group of the American Society of Nephrology. Ongoing clinical trials in AKI. Clin J Am Soc Nephrol. 2012 May;7(5):861-73. doi: 10.2215/CJN.12191111. Epub 2012 Mar 22.
• Background Taniyama M, Ohbayashi S, Narita M, Nakazawa R, Hasegawa S, Azuma N, Teraoka S, Ota K, Yamauchi S, Margolin SB. Pharmacokinetics of an antifibrotic agent, pirfenidone, in haemodialysis patients. Eur J Clin Pharmacol. 1997;52(1):77-8. doi: 10.1007/s002280050252. No abstract available.
• Background Sutton TA, Fisher CJ, Molitoris BA. Microvascular endothelial injury and dysfunction during ischemic acute renal failure. Kidney Int. 2002 Nov;62(5):1539-49. doi: 10.1046/j.1523-1755.2002.00631.x.
• Background Okusa MD. The inflammatory cascade in acute ischemic renal failure. Nephron. 2002 Feb;90(2):133-8. doi: 10.1159/000049032.
• Background Kinsey GR, Li L, Okusa MD. Inflammation in acute kidney injury. Nephron Exp Nephrol. 2008;109(4):e102-7. doi: 10.1159/000142934. Epub 2008 Sep 18.
• Background Schrier RW, Wang W, Poole B, Mitra A. Acute renal failure: definitions, diagnosis, pathogenesis, and therapy. J Clin Invest. 2004 Jul;114(1):5-14. doi: 10.1172/JCI22353.
• Background Thadhani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Med. 1996 May 30;334(22):1448-60. doi: 10.1056/NEJM199605303342207. No abstract available.
• Background Star RA. Treatment of acute renal failure. Kidney Int. 1998 Dec;54(6):1817-31. doi: 10.1046/j.1523-1755.1998.00210.x.
• Background Conger JD. Interventions in clinical acute renal failure: what are the data? Am J Kidney Dis. 1995 Oct;26(4):565-76. doi: 10.1016/0272-6386(95)90590-1.
• Background Ronco C, Bellomo R. Prevention of acute renal failure in the critically ill. Nephron Clin Pract. 2003 Jan;93(1):C13-20. doi: 10.1159/000066646.
• Background Kelly KJ, Molitoris BA. Acute renal failure in the new millennium: time to consider combination therapy. Semin Nephrol. 2000 Jan;20(1):4-19.
• Background Shimizu T, Kuroda T, Hata S, Fukagawa M, Margolin SB, Kurokawa K. Pirfenidone improves renal function and fibrosis in the post-obstructed kidney. Kidney Int. 1998 Jul;54(1):99-109. doi: 10.1046/j.1523-1755.1998.00962.x.
• Background Hewitson TD, Kelynack KJ, Tait MG, Martic M, Jones CL, Margolin SB, Becker GJ. Pirfenidone reduces in vitro rat renal fibroblast activation and mitogenesis. J Nephrol. 2001 Nov-Dec;14(6):453-60.
• Background Shihab FS, Bennett WM, Yi H, Andoh TF. Effect of pirfenidone on apoptosis-regulatory genes in chronic cyclosporine nephrotoxicity. Transplantation. 2005 Feb 27;79(4):419-26. doi: 10.1097/01.tp.0000151721.99418.48.
• Background Takakuta K, Fujimori A, Chikanishi T, Tanokura A, Iwatsuki Y, Yamamoto M, Nakajima H, Okada M, Itoh H. Renoprotective properties of pirfenidone in subtotally nephrectomized rats. Eur J Pharmacol. 2010 Mar 10;629(1-3):118-24. doi: 10.1016/j.ejphar.2009.12.011. Epub 2009 Dec 13.
• Background Takakura K, Tahara A, Sanagi M, Itoh H, Tomura Y. Antifibrotic effects of pirfenidone in rat proximal tubular epithelial cells. Ren Fail. 2012;34(10):1309-16. doi: 10.3109/0886022X.2012.718955. Epub 2012 Sep 24.
• Background Chen JF, Ni HF, Pan MM, Liu H, Xu M, Zhang MH, Liu BC. Pirfenidone inhibits macrophage infiltration in 5/6 nephrectomized rats. Am J Physiol Renal Physiol. 2013 Mar 15;304(6):F676-85. doi: 10.1152/ajprenal.00507.2012. Epub 2012 Nov 14.
• Background 46. Hartung J: A note on combining dependent tests of significance. Biometrical J 1999, 41:849-855.
• Background Macias-Barragan J, Sandoval-Rodriguez A, Navarro-Partida J, Armendariz-Borunda J. The multifaceted role of pirfenidone and its novel targets. Fibrogenesis Tissue Repair. 2010 Sep 1;3:16. doi: 10.1186/1755-1536-3-16.
• Background Shi S, Wu J, Chen H, Chen H, Wu J, Zeng F. Single- and multiple-dose pharmacokinetics of pirfenidone, an antifibrotic agent, in healthy Chinese volunteers. J Clin Pharmacol. 2007 Oct;47(10):1268-76. doi: 10.1177/0091270007304104.
• Background Cho ME, Kopp JB. Pirfenidone: an anti-fibrotic therapy for progressive kidney disease. Expert Opin Investig Drugs. 2010 Feb;19(2):275-83. doi: 10.1517/13543780903501539.
• Background Panacek EA, Marshall JC, Albertson TE, Johnson DH, Johnson S, MacArthur RD, Miller M, Barchuk WT, Fischkoff S, Kaul M, Teoh L, Van Meter L, Daum L, Lemeshow S, Hicklin G, Doig C; Monoclonal Anti-TNF: a Randomized Controlled Sepsis Study Investigators. Efficacy and safety of the monoclonal anti-tumor necrosis factor antibody F(ab')2 fragment afelimomab in patients with severe sepsis and elevated interleukin-6 levels. Crit Care Med. 2004 Nov;32(11):2173-82. doi: 10.1097/01.ccm.0000145229.59014.6c.
• Background Poltorak A, He X, Smirnova I, Liu MY, Van Huffel C, Du X, Birdwell D, Alejos E, Silva M, Galanos C, Freudenberg M, Ricciardi-Castagnoli P, Layton B, Beutler B. Defective LPS signaling in C3H/HeJ and C57BL/10ScCr mice: mutations in Tlr4 gene. Science. 1998 Dec 11;282(5396):2085-8. doi: 10.1126/science.282.5396.2085.
• Background Chow JC, Young DW, Golenbock DT, Christ WJ, Gusovsky F. Toll-like receptor-4 mediates lipopolysaccharide-induced signal transduction. J Biol Chem. 1999 Apr 16;274(16):10689-92. doi: 10.1074/jbc.274.16.10689.
• Background Samuelsson P, Hang L, Wullt B, Irjala H, Svanborg C. Toll-like receptor 4 expression and cytokine responses in the human urinary tract mucosa. Infect Immun. 2004 Jun;72(6):3179-86. doi: 10.1128/IAI.72.6.3179-3186.2004.
• Background El-Achkar TM, Huang X, Plotkin Z, Sandoval RM, Rhodes GJ, Dagher PC. Sepsis induces changes in the expression and distribution of Toll-like receptor 4 in the rat kidney. Am J Physiol Renal Physiol. 2006 May;290(5):F1034-43. doi: 10.1152/ajprenal.00414.2005. Epub 2005 Dec 6.
• Background Cunningham PN, Wang Y, Guo R, He G, Quigg RJ. Role of Toll-like receptor 4 in endotoxin-induced acute renal failure. J Immunol. 2004 Feb 15;172(4):2629-35. doi: 10.4049/jimmunol.172.4.2629.
• Background Patole PS, Schubert S, Hildinger K, Khandoga S, Khandoga A, Segerer S, Henger A, Kretzler M, Werner M, Krombach F, Schlondorff D, Anders HJ. Toll-like receptor-4: renal cells and bone marrow cells signal for neutrophil recruitment during pyelonephritis. Kidney Int. 2005 Dec;68(6):2582-7. doi: 10.1111/j.1523-1755.2005.00729.x.
• Background Morrell ED, Kellum JA, Hallows KR, Pastor-Soler NM. Epithelial transport during septic acute kidney injury. Nephrol Dial Transplant. 2014 Jul;29(7):1312-9. doi: 10.1093/ndt/gft503. Epub 2013 Dec 29.
• Background Leelahavanichkul A, Yasuda H, Doi K, Hu X, Zhou H, Yuen PS, Star RA. Methyl-2-acetamidoacrylate, an ethyl pyruvate analog, decreases sepsis-induced acute kidney injury in mice. Am J Physiol Renal Physiol. 2008 Dec;295(6):F1825-35. doi: 10.1152/ajprenal.90442.2008. Epub 2008 Oct 15.
• Background Miyaji T, Hu X, Yuen PS, Muramatsu Y, Iyer S, Hewitt SM, Star RA. Ethyl pyruvate decreases sepsis-induced acute renal failure and multiple organ damage in aged mice. Kidney Int. 2003 Nov;64(5):1620-31. doi: 10.1046/j.1523-1755.2003.00268.x.
• Background Chatterjee PK, Yeboah MM, Dowling O, Xue X, Powell SR, Al-Abed Y, Metz CN. Nicotinic acetylcholine receptor agonists attenuate septic acute kidney injury in mice by suppressing inflammation and proteasome activity. PLoS One. 2012;7(5):e35361. doi: 10.1371/journal.pone.0035361. Epub 2012 May 7.
• Background Morrell ED, Kellum JA, Pastor-Soler NM, Hallows KR. Septic acute kidney injury: molecular mechanisms and the importance of stratification and targeting therapy. Crit Care. 2014 Sep 2;18(5):501. doi: 10.1186/s13054-014-0501-5.
• Background Hoste EA, Schurgers M. Epidemiology of acute kidney injury: how big is the problem? Crit Care Med. 2008 Apr;36(4 Suppl):S146-51. doi: 10.1097/CCM.0b013e318168c590.
• Background Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb SA, Beale RJ, Vincent JL, Moreno R; Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013 Feb;41(2):580-637. doi: 10.1097/CCM.0b013e31827e83af.
• Background Bagshaw SM, Lapinsky S, Dial S, Arabi Y, Dodek P, Wood G, Ellis P, Guzman J, Marshall J, Parrillo JE, Skrobik Y, Kumar A; Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group. Acute kidney injury in septic shock: clinical outcomes and impact of duration of hypotension prior to initiation of antimicrobial therapy. Intensive Care Med. 2009 May;35(5):871-81. doi: 10.1007/s00134-008-1367-2. Epub 2008 Dec 9.
• Background Plataki M, Kashani K, Cabello-Garza J, Maldonado F, Kashyap R, Kor DJ, Gajic O, Cartin-Ceba R. Predictors of acute kidney injury in septic shock patients: an observational cohort study. Clin J Am Soc Nephrol. 2011 Jul;6(7):1744-51. doi: 10.2215/CJN.05480610.
• Chavez-Iniguez JS, Poo JL, Ibarra-Estrada M, Garcia-Benavides L, Navarro-Blackaller G, Cervantes-Sanchez C, Nungaray-Pacheco E, Medina-Gonzalez R, Armendariz-Borunda J, Garcia-Garcia G. Effect of Prolonged-Release Pirfenidone on Renal Function in Septic Acute Kidney Injury Patients: A Double-Blind Placebo-Controlled Clinical Trial. Int J Nephrol. 2021 Jan 13;2021:8833278. doi: 10.1155/2021/8833278. eCollection 2021.

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