Urinary proteomics combined with home blood pressure telemonitoring for health care reform trial: rational and protocol

Abstract

Background: Hypertension and diabetes cause chronic kidney disease (CKD) and diastolic left ventricular dysfunction (DVD) as forerunners of disability and death. Home blood pressure telemonitoring (HTM) and urinary peptidomic profiling (UPP) are technologies enabling prevention.

Methods: UPRIGHT-HTM (Urinary Proteomics Combined with Home Blood Pressure Telemonitoring for Health Care Reform [NCT04299529]) is an investigator-initiated 5-year clinical trial with patient-centred design, which will randomise 1148 patients to be recruited in Europe, sub-Saharan Africa and South America. During the whole study, HTM data will be collected and freely accessible for patients and caregivers. The UPP, measured at enrolment only, will be communicated early during follow-up to 50% of patients and their caregivers (intervention), but only at trial closure in 50% (control). The hypothesis is that early knowledge of the UPP risk profile will lead to more rigorous risk factor management and result in benefit. Eligible patients, aged 55-75 years old, are asymptomatic, but have ≥5 CKD- or DVD-related risk factors, preferably including hypertension, type-2 diabetes, or both. The primary endpoint is a composite of new-onset intermediate and hard cardiovascular and renal outcomes. Demonstrating that combining UPP with HTM is feasible in a multicultural context and defining the molecular signatures of early CKD and DVD are secondary endpoints.

Expected outcomes: The expected outcome is that application of UPP on top of HTM will be superior to HTM alone in the prevention of CKD and DVD and associated complications and that UPP allows shifting emphasis from treating to preventing disease, thereby empowering patients.

Keywords: Chronic kidney disease; diabetic nephropathy; home blood pressure telemonitoring; hypertension; left ventricular function; type-2 diabetes mellitus.

Figure 1.

UPRIGHT-HTM design. eCRF: electronic report forms completed by investigators; EP: absence (−)/incidence (+) of the components of the primary endpoint during the run-in/follow-up periods, respectively; IC: written informed consent; pINF: patients received the UPRIGHT-HTM information sheet and were familiarised with operating the blood pressure monitoring devices; pQ: patient-administered questionnaires; R: randomisation after stratification for centre and sex; S: initial screening; UPP: urinary proteomic profiling (mandatory prior to randomisation – optional at the end of follow-up).

Figure 2.

Proposal for the clinical application of HF1 over a 5-year horizon. In a random population sample, 25% of participants combined three major risk factors for diastolic left ventricular dysfunction. Modified and reproduced with permission from reference [32].