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Trial registered on ANZCTR
Registration number
ACTRN12615000379516
Ethics application status
Approved
Date submitted
16/03/2015
Date registered
27/04/2015
Date last updated
27/04/2015
Type of registration
Prospectively registered
Titles & IDs
Public title
Comparison of fluid restriction with urea versus fluid restriction alone for inpatient management of syndrome of inappropriate antidiuretic hormone secretion (SIADH)
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Scientific title
Comparison of fluid restriction with urea versus fluid restriction alone for improving serum sodium in SIADH
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Secondary ID [1]
286365
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Nil
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Universal Trial Number (UTN)
U1111-1167-8576
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Syndrome of Inappropriate ADH secretion (SIADH)
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Hyponatremia
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Condition category
Condition code
Metabolic and Endocrine
294805
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0
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Metabolic disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
This is a prospective randomised open label trial involving all medical patients admitted to North Shore Hospital from April to July 2015 with hyponatremia secondary to SIADH. Patients will be randomised to one of two management groups: Fluid restriction <800ml alone, or a combination of fluid restriction with oral urea powder (10gm oral urea powder dissolved in 200ml of water or orange jouce given three times a day). The primary end points include time to reach sodium >128, and time to hospital discharge. Once the sodium is >128mmol/L, the primary trial will end and the fluid restriction will be changed to 1000ml and urea stopped. The primary investigator will discuss the intervention (fluid restriction and urea) with the patient and family as well as nursing staff to ensure it is adhered to.
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Intervention code [1]
291424
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Treatment: Drugs
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Intervention code [2]
291466
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Treatment: Other
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Comparator / control treatment
Control: Fluid restriction only (standard treatment). The patients will have a measuring jug left at their bed side to carefully measure all oral fluid intake. A sign stating "800ml fluid restriction" will be placed at each patient's bed so that other staff/family are aware of this fluid restriction. Nursing staff will be asked to carefully document all oral fluid intake on a daily basis. The fluid restriction will be changed to 1000 ml when sodium is >128mmol/L.
Treatment arm: Fluid restriction + Urea tablets
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Control group
Active
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Outcomes
Primary outcome [1]
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Time to reach sodium >128mmol/L (serum sodium assay taken daily)
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Assessment method [1]
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Timepoint [1]
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Monitored from time of enrolment for up to 7 days
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Primary outcome [2]
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Time to hospital discharge
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Assessment method [2]
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Timepoint [2]
294613
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From time of enrolment to hospital discharge
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Secondary outcome [1]
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None
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Assessment method [1]
313610
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Timepoint [1]
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-
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Eligibility
Key inclusion criteria
1. Medical patients admitted to North Shore hospital from April to July 2015
2. Acute moderate to severe hyponatremia (Na < 128) – This data will be provided daily by the biochemistry laboratory
3. Hyponatremia secondary to SIADH, as defined below
- Serum osmolality less than 280mosmol/kg
- An inappropriately elevated urine osmolality (above 100 mosmol/kg and usually above 300 mosmol/kg)
- A urine sodium concentration above 40 meq/L
- A normal serum creatinine concentration
- Normal adrenal and thyroid function
- Patient is clinically euvolemic
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Minimum age
17
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Hyponatremia with impaired consciousness or seizures
Chronic kidney disease stage 4-5
Liver cirrhosis
Congestive cardiac failure
Patients on diuretics
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
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Who is / are masked / blinded?
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Intervention assignment
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
28/04/2015
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
24
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
6754
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New Zealand
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State/province [1]
6754
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Auckland
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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There is no direct funding for this study. Standard of care procedures will be funded by Waitemata DHB (WDHB).
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Address [1]
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North Shore Hospital
124 Shakespeare Road
Westlake 0622
Auckland
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Country [1]
290934
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New Zealand
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Primary sponsor type
Hospital
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Name
North Shore Hospital
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Address
North Shore Hospital
124 Shakespeare Road
Westlake 0622
Auckland
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Country
New Zealand
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
289619
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Country [1]
289619
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
292540
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Health and Disability Ethics Committees (HDECs
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Ethics committee address [1]
292540
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Approved 14 April 2015
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Ethics committee country [1]
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New Zealand
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Date submitted for ethics approval [1]
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16/03/2015
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Approval date [1]
292540
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14/04/2015
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Ethics approval number [1]
292540
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Submission Code: NZ/1/8297015
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Summary
Brief summary
Hyponatremia is the most common electrolyte disturbance encountered in the hospital setting, and is defined as serum sodium less than 135mmol/L. It is associated with an increase risk of patient mortality as well as a longer length of hospital admission. The Syndrome of Inappropriate ADH secretion (SIADH) is the most common cause of hyponatremia in hospital inpatients. Fluid restriction is widely accepted as the first line therapy for the management of hyponatremia secondary to SIADH. Other proposed treatments include urea, salt tablets and demeclocycline, however the evidence for their use is scarce and often limited to case series. This is a prospective randomised open label trial involving all medical patients admitted to North Shore Hospital from April to July 2015 with hyponatremia secondary to SIADH. Patients will be randomised to one of two management groups: Fluid restriction <800ml alone, or a combination of fluid restriction with urea. The primary end points include time to reach sodium >128, and time to hospital discharge. Using a 2-sided alpha level of 0.05, to detect a 5mmol/L or greater difference in mean serum sodium after one day with 80% power, will require a minimum of 12 subjects per group.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Sonakshi Sharma
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Address
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Endocrinology Registrar
Endocrinology/Diabetes Department
North Shore Hospital
124 Shakespeare Road
Takapuna 0622
Auckland
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Country
55818
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New Zealand
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Phone
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+64212688665
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Sonakshi Sharma
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Address
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Endocrinology Registrar
Endocrinology/Diabetes Department
North Shore Hospital
124 Shakespeare Road
Takapuna 0622
Auckland
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Country
55819
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New Zealand
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Phone
55819
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+64212688665
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Sonakshi Sharma
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Address
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Endocrinology Registrar
Endocrinology/Diabetes Department
North Shore Hospital
124 Shakespeare Road
Takapuna 0622
Auckland
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Country
55820
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New Zealand
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Phone
55820
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+64212688665
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Fax
55820
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Email
55820
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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