DYNAMO
Research type
Research Study
Full title
DYNAMic renal assessment: NOvel methods to assess KIDNEY functional reserve
IRAS ID
305645
Contact name
Kate Bramham
Contact email
Sponsor organisation
King's College London
Clinicaltrials.gov Identifier
Duration of Study in the UK
0 years, 6 months, 31 days
Research summary
Many people with subclinical kidney disease maintain kidney function by increasing renal blood flow (hyperfiltration) which leads to further injury. They have limited ability to augment function in response to stressors (reduced ‘renal reserve’). Only when residual tissue can no longer compensate (~50% damage) will serum creatinine concentration (routine kidney function marker) rise, thus creatinine is a poor marker of early kidney disease.
Renal reserve describes the capacity for the kidney to increase its glomerular filtration. It has been proposed to be an important predictor of development and progression of CKD. Routine assessment of other organ function includes stress testing, but current methods to assess ‘renal reserve’ are impractical, costly and not used clinically.
We propose to compare standard ‘renal reserve’ testing with innovative approaches never previously studied as dynamic renal tests in healthy controls and patients with reduced renal reserve but preserved kidney function:
i) Regadenoson stress test: Tc-99m-DTPA (widely available) and contrast ultrasound will be combined with a routine cardiac stressor (Regadenoson) to accurately assess renal blood flow
ii) Sodium-glucose cotransporter-2 (SGLT2) inhibitor ‘inverse’ stress test: Urinary stress markers and serum creatinine will be assessed after SGLT2 inhibition, which causes a pronounced reduction in renal blood flow in people with hyperfiltration
We will also determine if drug induced blockade (trimethoprim/ cimetidine) of creatinine secretion prior to timed urine collection is a simple surrogate for formal Tc-99m-DTPA kidney function assessments.
REC name
London - Bromley Research Ethics Committee
REC reference
22/LO/0874
Date of REC Opinion
12 Jan 2023
REC opinion
Further Information Favourable Opinion