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Mid-HDF Randomized Controlled Study on Outcome (MILESTONE)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01693354
Recruitment Status : Unknown
Verified January 2017 by Antonio Santoro, Azienda Ospedaliera Universitaria di Bologna Policlinico S. Orsola Malpighi.
Recruitment status was:  Active, not recruiting
First Posted : September 26, 2012
Last Update Posted : January 13, 2017
Information provided by (Responsible Party):
Antonio Santoro, Azienda Ospedaliera Universitaria di Bologna Policlinico S. Orsola Malpighi

Brief Summary:
The purpose of this study is to determine whether mid-dilution hemodiafiltration is effective in the reduction of the crude mortality risk in patients who have been undergoing renal replacement treatment for less than 1 year. Patients will be randomized since the beginning of the study in two groups: standard HF dialysis and mid-dilution HDF.

Condition or disease Intervention/treatment Phase
End Stage Renal Disease Device: Mid-dilution HDF Device: HF dialysis Not Applicable

Detailed Description:

It is a matter of fact that in the last decades the Chronic Kidney Disease (CKD) population has widely changed. In Italy, for example, more than 50% of the incident dialysis patients are more than 70 year old, with diabetic and hypertension being the major underlying diseases; moreover a great percentage of the patients starts dialysis with a burden of at least 1-2 comorbidities [1]. Online hemodiafiltration (online HDF) has been recently associated with better patient survival in comparison with standard hemodialysis in two large trials [2,3]; the overall relative risk of mortality was found to be approximately 33% lower in patients treated with online HDF [2,3]. These impressive results were not obtained anyway on the whole population, but in a sub-group analysis. A strong correlation was found between the total convective volume obtained and the mortality risk reduction; HDF was found to be significantly better than standard hemodialysis when a total convective volume of 19-22 L/session (in 4 hours sessions of post-dilution HDF) was achieved.

These results support the importance of the "adequate convective dose" concept in order to improve the patient outcomes especially in frail patients, as recently demonstrated by a large randomised control trial, the MPO study [4], comparing High Flux versus Low Flux dialysis in patients with plasma albumin levels equal to or less than 4 gr/dl ( as a marker of patient comorbidities) and, in a post hoc analysis, in diabetic patients [4].

Mid-dilution HDF is a variant of classical HDF combining simultaneous pre- and post.-dilution in order to maximise middle and large solutes removal.

The MILESTONE study would aim to fully demonstrate for mid-dilution HDF the significant mortality risk reduction observed in the recent mentioned studies.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 500 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Mid-dilution Hemodiafiltration International Randomized Prospective Study on Incident Patients Focused on Outcome
Study Start Date : September 2012
Estimated Primary Completion Date : September 2017
Estimated Study Completion Date : September 2018

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Dialysis

Arm Intervention/treatment
Active Comparator: HF dialysis
HF (high-flux) dialysis is standard hemodialysis treatment performed by using a high permeability dialyzer instead of a low permeability one.
Device: HF dialysis
Standard hemodialyzers equipped with high permeability polyphenylene/polyethersulfone membranes
Other Names:

Experimental: Mid-dilution HDF
Mid-dilution is a newly developed hemodiafiltration therapy able to allow a simultaneous pre- and post-dilution infusion.
Device: Mid-dilution HDF
Mid-dilution HDF is a special, newly developed variant of online HDF which is characterized by a dedicated high-flux hemodialyzer named OLPUR MD able to support simultaneous pre- and post-dilution
Other Names:
  • OLPUR MD 220
  • OLPUR MD 190

Primary Outcome Measures :
  1. crude, all-causes mortality [ Time Frame: 5 years ]
    The primary objective will be assessed by the incidence rate of fatal events

Secondary Outcome Measures :
  1. Cardiovascular morbidity [ Time Frame: 5 years ]

    It will be assessed by taking into consideration:

    • Number of hospital admissions related to non fatal major CV events
    • Length of stay during hospitalization

  2. Quality of life and dialysis tolerance evaluated by questionnaire [ Time Frame: 1 year ]

    It will be assessed by taking into consideration:

    - Results of the SF-36 questionnaire given to the patients

  3. Micro-inflammation evaluation [ Time Frame: 1 year ]

    It will be assessed by measuring the pre-dialysis serum levels of:

    IL-6 CR Myoglobin RbP p-cresylsulfate beta2-microglobulin.

    The hospitals' laboratories will be in charge for the sample collection and analysis

  4. Nutrition and anaemia management [ Time Frame: 1 year ]

    It will be assessed by taking in consideration the pre-dialysis serum levels of:

    Hb albumin iron.

    ESAs and iron supplementation will be as well noted in apposite CRF.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • On a thrice/week RRT for at least 3 months
  • Dialysis vintage > 3 months
  • Signed informed consent
  • Blood flow > 300 mL/min

Exclusion Criteria:

  • On waiting list for living-donor transplant
  • Residual diuresis > 500 mL/day
  • Inability, as judget by the investigator, to follow or understand the protocol instructions
  • Active neoplastic disease
  • Single needle treatment
  • Patients with expectancy life lower than 6 months
  • Inclusion to other studies
  • Pregnancy

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01693354

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Cliniques Universitaires Saint-Luc
Brussels, Belgium, 3000
Hôpital de la Conception
Marseille, France, 13385
Azienda Ospedaliero-Universitaria di Bologna
Bologna, Italy, 40138
Hospital Clínic Barcelona
Barcelona, Spain, 08036
Sponsors and Collaborators
Azienda Ospedaliera Universitaria di Bologna Policlinico S. Orsola Malpighi
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Study Chair: Francisco Maduell, MD Hospital Clínic Barcelona, Spain
Study Chair: Vincenzo Panichi, MD, PhD AUSL 12 Viareggio, Italy
Study Chair: Pedro Aljama, MD, PhD Hospital Reina Sofia, Cordoba, Spain
Study Chair: Michel Jadoul, MD, PhD Cliniques Universitaires Saint-Luc, Brussels, Belgium
Study Chair: Philippe Brunet, MD, PhD Hôpital de la Conception, Marseille, France
Study Chair: Antonio Santoro, MD AOSP Bologna, Italy

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Responsible Party: Antonio Santoro, Professor Antonio Santoro MD, Chief of Nephrology, Azienda Ospedaliera Universitaria di Bologna Policlinico S. Orsola Malpighi Identifier: NCT01693354    
Other Study ID Numbers: MID-INT01
First Posted: September 26, 2012    Key Record Dates
Last Update Posted: January 13, 2017
Last Verified: January 2017
Keywords provided by Antonio Santoro, Azienda Ospedaliera Universitaria di Bologna Policlinico S. Orsola Malpighi:
cardiovascular stability
quality of life
Additional relevant MeSH terms:
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Kidney Failure, Chronic
Kidney Diseases
Urologic Diseases
Renal Insufficiency, Chronic
Renal Insufficiency