Clinical trial NCT03878277: Evaluation of Coffee Therapy for Improvement of Renal Oxygenation
Official title: Coffee, Renal Oxygenation, Blood Flow and Glomerular Filtration Rate in Early Diabetic Kidney Disease.
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Type1diabetes
Type1 Diabetes Mellitus
Diabetic Kidney Disease
Juvenile Diabetes
Diabetic Nephropathies
Diabetes Complications
Diabetes, Autoimmune
Lead sponsor: University of Colorado, Denver
Sponsor class: OTHER
Collaborators: name: Johns Hopkins University
First posted: 2019-03-18
Enrollment: 10
Sex: ALL
Minimum age (years): 12
Maximum age (years): 21
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: Over 1.25 million Americans have Type 1 Diabetes (T1D), increasing risk for early death from cardiovascular disease (CVD). Despite advances in glycemic and blood pressure control, a child diagnosed with T1D is expected to live up to 17 years less than non-diabetic peers. The strongest risk factor for CVD and mortality in T1D is diabetic kidney disease (DKD). Current treatments, such as control of hyperglycemia and hypertension, are beneficial, but only partially protect against DKD. This limited progress may relate to a narrow focus on clinical manifestations of disease, rather than on the initial metabolic derangements underlying the initiation of DKD. Renal hypoxia, stemming from a potential metabolic mismatch between increased renal energy expenditure and impaired substrate utilization, is increasingly proposed as a unifying early pathway in the development of DKD. T1D is impacted by several mechanisms which increase renal adenosine triphosphate (ATP) consumption and decrease ATP generation.

Caffeine, a methylxanthine, is known to alter kidney function by several mechanisms including natriuresis, hemodynamics and renin-angiotensin-aldosterone system. In contrast, to other natriuretic agents, caffeine is thought to fully inhibit the local tubuloglomerular feedback (TGF) response to increased distal sodium delivery. This observation has broad-ranging implications as caffeine can reduce renal oxygen (O2) consumption without impairing effective renal plasma flow (ERPF) and glomerular filtration rate (GFR).

There are also data suggesting that chemicals in coffee besides caffeine may provide important cardio-renal protection. Yet, there are no data examining the impact of coffee-induced natriuresis on intrarenal hemodynamic function and renal energetics in youth-onset T1D. Our overarching hypothesis in the proposed pilot and feasibility trial is that coffee drinking improves renal oxygenation by reducing renal O2 consumption without impairing GFR and ERPF. To address these hypotheses, we will measure GFR, ERPF, renal perfusion and oxygenation in response to 7 days of cold brew coffee (one Starbucks® Cold brew 325ml bottle daily \[205mg caffeine\]) in an open-label pilot and feasibility trial in 10 adolescents with T1D already enrolled in the CASPER Study (PI: Bjornstad).


Eligibility criteria: Inclusion Criteria:

* Youth with T1D (antibody +) with \<10 year duration
* Age 12-21 years
* Weight \>57 lbs and \<350 lbs
* BMI \>5th %ile
* HbA1c \<12%
* Previous exposure to caffeine

Exclusion Criteria:

* Anemia
* Allergy to shellfish or iodine
* Severe illness, recent diabetic ketoacidosis (DKA)
* Tachyarrhythmias, Attention-deficit/hyperactivity disorder (ADHD), tremors, tics, Tourette's, arrythmias, insomnia, overactive bladder
* Estimated Glomerular Filtration Rate (eGFR) \<60 ml/min/1.73 m2 or creatinine \> 1.5 mg/dl or history of albumin-to-creatinine ratio (ACR) \>300 mg/g
* MRI Scanning contraindications (claustrophobia, implantable metal devices that are non-MRI compatible, \>350 lbs)
* Pregnancy or nursing
* (Angiotensin-converting enzyme) ACE inhibitors, angiotensin receptor blockers (ARBs), diuretics, sodium-glucose co-transport (SGLT) 2 or 1 blockers, daily NSAIDs or aspirin, sulfonamides, thiazolsulfone or probenecid, atypical antipsychotics, steroids

Primary outcomes:
measure: Renal Oxygenation
timeFrame: 1 hour
measure: Renal Perfusion
timeFrame: 1 hour
Secondary outcomes:
measure: Glomerular Filtration Rate
timeFrame: 4 hours
measure: Effective Renal Plasma Flow
timeFrame: 4 hours
measure: Tubular Injury Markers
timeFrame: 4 hours
Other outcomes:
Locations:
city: Aurora
country: United States
facility: Children's Hospital Colorado
state: Colorado
Study officials:
affiliation: University of Colorado Denver | Anschutz
name: Petter Bjornstad, MD
role: PRINCIPAL_INVESTIGATOR
References: