[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"trial:NCT04911491":3,"trial-entities:NCT04911491":121,"trial-summary:NCT04911491":125},{"id":4,"nct_id":4,"org_study_id":5,"brief_title":6,"official_title":7,"overall_status":8,"completion_date":9,"status_verified_date":10,"last_update_date":11,"start_date":12,"sponsor_name":13,"lead_sponsor_class":14,"has_dmc":15,"brief_summary":16,"detailed_description":17,"conditions":18,"keywords":23,"study_type":24,"primary_purpose":25,"phases":26,"enrollment_info":28,"interventions":31,"primary_outcomes":42,"secondary_outcomes":47,"sex":54,"minimum_age":55,"maximum_age":56,"healthy_volunteers":57,"eligibility_criteria":58,"std_ages":79,"locations":82,"central_contacts":106,"overall_officials":109,"references":112,"see_also_links":120},"NCT04911491","21-3000","Inspiratory Muscle Strength Training in Chronic Kidney Disease","Inspiratory Muscle Strength Training for Lowering Systolic Blood Pressure in Midlife and Older Adults With Chronic Kidney Disease","RECRUITING","2026-07-01","2025-04","2025-05-02","2022-03-01","University of Colorado, Denver","OTHER",true,"More than 80% of individuals with chronic kidney disease have concomitant hypertension and the majority fail to achieve blood pressure control \\\u003C130\u002F80 mmHg, leading to high risk of cardiovascular diseases and end-stage kidney disease. A stepwise combination of lifestyle modifications and drug therapy is recommended to lower blood pressure; however, adherence to time-intensive lifestyle interventions such as aerobic exercise in patients with chronic kidney disease is poor. This clinical trial seeks to establish the efficacy of high-resistance inspiratory muscle strength training, a novel time-efficient lifestyle intervention, for lowering systolic blood pressure and improving endothelial function in midlife and older adults with moderate-to-severe chronic kidney disease and inadequately controlled hypertension, and to use innovate translational assessments to understand the mechanisms involved.","Chronic kidney disease (CKD) is a major public health concern that has reached epidemic proportions. Hypertension is a leading modifiable risk factor for cardiovascular disease (CVD) and end-stage kidney disease, yet 50-70% of adults with CKD fail to achieve blood pressure (BP) control to \\\u003C130\u002F80 mmHg. A key process linking high systolic BP (SBP) to CVD is vascular endothelial dysfunction, which is due in part to increased reactive oxygen species and decreased nitric oxide. Nitric oxide is also critical in the regulation of renal blood flow, which is intimately related to blood pressure and vascular function. High-resistance inspiratory muscle strength training (IMST) is a novel lifestyle intervention involving repeated inhalations against a resistive load using a hand-held device. This study will test whether high-resistance IMST (75% of maximal inspiratory pressure \\[75% PImax\\]; 30 breaths \\[5 min\\]\u002Fday, 6 days \\[30 min\\]\u002Fweek) vs. Sham training (15% PImax) reduces resting systolic blood pressure in midlife and older adults (\\>50 years) with moderate-to-severe CKD and inadequately controlled hypertension. Changes in 24-hr systolic blood pressure and endothelial function (brachial artery flow-mediated dilation) are secondary outcomes. Innovative translational techniques will be used to provide mechanistic insight, including serum incubation in endothelial cell culture, metabolomics analysis, endothelial cell collections, and assessment of renal blood flow by magnetic resonance imaging. Changes and cerebrovascular and cognitive function will be assessed as part of a sub-study.",[19,20,21,22],"Chronic Kidney Diseases","Hypertension","Aging","Blood Pressure",[],"INTERVENTIONAL","TREATMENT",[27],"NA",{"count":29,"type":30},108,"ESTIMATED",[32,37],{"type":33,"name":34,"description":35,"armGroupLabels":36},"DEVICE","IMST","Inspiratory muscle strength training (IMST) is a form of physical training that utilizes the diaphragm and accessory respiratory muscles to repeatedly inhale against resistance using a handheld device.",[34],{"type":33,"name":38,"description":39,"armGroupLabels":40},"Sham Training","Repeated inhalations against a low resistance will be performed using a handheld device.",[41],"Control",[43],{"measure":44,"description":45,"timeFrame":46},"Change in Casual Systolic Blood Pressure","Casual (resting) measures of systolic blood pressure (mmHg) will be measured in triplicate over the brachial artery of the non-dominant arm after 5 minutes of quiet rest, with 1 minute of recovery between each measure, using an automated oscillometric sphygmomanometer.","Baseline, 3 months",[48,51],{"measure":49,"description":50,"timeFrame":46},"Change in 24-Hour Ambulatory Systolic Blood Pressure","Brachial artery systolic blood pressure (mmHg) will be measured automatically every 20 minutes for a 24-hour period by an ambulatory blood pressure monitor and will be averaged over the entire 24-hour period.",{"measure":52,"description":53,"timeFrame":46},"Change in Brachial Artery Flow-Mediated Dilation","Flow-mediated dilation of the brachial artery will be performed using ultrasonography and analyzed with a commercially available software package as percent change in diameter from baseline following reactive hyperemia.","ALL","50 Years",null,false,{"inclusion":59,"exclusion":65,"raw_text":78},[60,61,62,63,64],"Aged 50 years or older; women must be post-menopausal","Chronic kidney disease stage 3 or 4 (estimated glomerular filtration rate with the 4 CKD-EPI 2021 race-free equation: 20-59 mL\u002Fmin\u002F1.73m\\^2; stable renal function in the past 3 months)","History of inadequately controlled hypertension (systolic blood pressure 120-159 mmHg on two separate days) and on a stable antihypertensive regimen for the past 6 weeks","Weight stable in the prior 3 months (\\\u003C2 kg weight change) and willing to remain weight stable throughout the study. Participants using glucagon-like peptide-1 receptor agonists or planning to start them during the study are excluded unless they have achieved weight stability for at least 3 months prior to enrollment.","Ability to provide informed consent",[66,67,68,69,70,71,72,73,74,75,76,77],"Patients with advanced chronic kidney disease requiring chronic dialysis","Significant pulmonary disorders including: chronic obstructive pulmonary disease, interstitial lung disease, cystic fibrosis, or uncontrolled asthma","History of spontaneous pneumothorax, collapsed lung due to traumatic injury that has not fully healed, burst eardrum that has not fully healed, or other conditions of the eardrum","Significant co-morbid conditions with a life expectancy of \\\u003C 1 year","History of severe congestive heart failure (i.e., ejection fraction \\\u003C35%)","History of hospitalization within the last month","Albuminuria (albumin to creatinine ratio \\> 2200 mg\u002Fg","Current smoker","Immunosuppressant agents taken in the past 12 months. Steroids used for the treatment of gout are acceptable; however, patients should not be using steroids within 2 weeks (or 14 days) prior to the vascular testing (rationale: may confound vascular testing)","Known malignancy","Inability to cooperate with or clinical contraindication for magnetic resonance imaging including: severe claustrophobia, implants, devices, or non-removable body piercings (these individuals can participate in the study but are excluded from the MRI procedure)","Illicit drug use or alcohol dependence\u002Fabuse, which in the opinion of the investigators, would prohibit compliance with the study intervention","Inclusion Criteria:\n\n* Aged 50 years or older; women must be post-menopausal\n* Chronic kidney disease stage 3 or 4 (estimated glomerular filtration rate with the 4 CKD-EPI 2021 race-free equation: 20-59 mL\u002Fmin\u002F1.73m\\^2; stable renal function in the past 3 months)\n* History of inadequately controlled hypertension (systolic blood pressure 120-159 mmHg on two separate days) and on a stable antihypertensive regimen for the past 6 weeks\n* Weight stable in the prior 3 months (\\\u003C2 kg weight change) and willing to remain weight stable throughout the study. Participants using glucagon-like peptide-1 receptor agonists or planning to start them during the study are excluded unless they have achieved weight stability for at least 3 months prior to enrollment.\n* Ability to provide informed consent\n\nExclusion Criteria:\n\n* Patients with advanced chronic kidney disease requiring chronic dialysis\n* Significant pulmonary disorders including: chronic obstructive pulmonary disease, interstitial lung disease, cystic fibrosis, or uncontrolled asthma\n* History of spontaneous pneumothorax, collapsed lung due to traumatic injury that has not fully healed, burst eardrum that has not fully healed, or other conditions of the eardrum\n* Significant co-morbid conditions with a life expectancy of \\\u003C 1 year\n* History of severe congestive heart failure (i.e., ejection fraction \\\u003C35%)\n* History of hospitalization within the last month\n* Albuminuria (albumin to creatinine ratio \\> 2200 mg\u002Fg\n* Current smoker\n* Immunosuppressant agents taken in the past 12 months. Steroids used for the treatment of gout are acceptable; however, patients should not be using steroids within 2 weeks (or 14 days) prior to the vascular testing (rationale: may confound vascular testing)\n* Known malignancy\n* Inability to cooperate with or clinical contraindication for magnetic resonance imaging including: severe claustrophobia, implants, devices, or non-removable body piercings (these individuals can participate in the study but are excluded from the MRI procedure)\n* Illicit drug use or alcohol dependence\u002Fabuse, which in the opinion of the investigators, would prohibit compliance with the study intervention",[80,81],"ADULT","OLDER_ADULT",[83],{"facility":84,"status":8,"city":85,"state":86,"zip":87,"country":88,"contacts":89,"geoPoint":103},"University of Colorado - Anschutz Medical Campus","Aurora","Colorado","80045","United States",[90,95,99,101],{"name":91,"role":92,"phone":93,"email":94},"Kristen Nowak, PhD, MPH","CONTACT","303-724-4842","Kristen.Nowak@cuanschutz.edu",{"name":96,"role":92,"phone":97,"email":98},"Emily Andrews","303-724-7790","Emily.S.Andrews@cuanschutz.edu",{"name":91,"role":100},"PRINCIPAL_INVESTIGATOR",{"name":102,"role":100},"Michel Chonchol, MD",{"lat":104,"lon":105},39.72943,-104.83192,[107,108],{"name":91,"role":92,"phone":93,"email":94},{"name":96,"role":92,"phone":97},[110,111],{"name":91,"affiliation":13,"role":100},{"name":102,"affiliation":13,"role":100},[113,117],{"pmid":114,"type":115,"citation":116},"41264372","DERIVED","Oh ES, Opoku G, Darvish S, Craighead DH, Ostrow A, Rossman MJ, Steele CN, Struemph T, You Z, Seals DR, Chonchol M, Nowak KL. Sex Differences in Dementia and Mild Cognitive Impairment in Nondialysis CKD. Clin J Am Soc Nephrol. 2026 Mar 1;21(3):389-400. doi: 10.2215\u002FCJN.0000000922. Epub 2025 Nov 20.",{"pmid":118,"type":115,"citation":119},"40504623","Kistler BM, Kirkman DL, Kusni D, Martin Alemany G, Ribeiro HS, Tarca B, Thompson S, Viana JL, Wilkinson TJ, Wilund KR. Physical Activity and Exercise for Cardiometabolic Health and Fitness in CKD: An Overview by Exercise Type. Clin J Am Soc Nephrol. 2026 Jan 1;21(1):144-153. doi: 10.2215\u002FCJN.0000000784. Epub 2025 Jun 12.",[],{"nct_id":4,"conditions":122,"biomarkers":124},[123,20],"Chronic Kidney Disease",[],{"nct_id":4,"found":15,"summary":126,"prompt_version":136},{"design":127,"status":128,"heading":129,"summary":130,"follow_up":131,"word_count":132,"commitments":133,"compensation":134,"drugs_mentioned":135},"This interventional study plans to enroll 108 participants. It compares Inspiratory Muscle Strength Training (IMST) to Sham Training.","completed","Inspiratory Muscle Strength Training for Chronic Kidney Disease and High Blood Pressure","This study is looking at whether Inspiratory Muscle Strength Training (IMST) can help lower high blood pressure in people with chronic kidney disease (CKD). IMST uses a handheld device to strengthen breathing muscles. You might be able to join if you are 50 or older, a woman who has gone through menopause, have moderate to severe CKD, and have high blood pressure that isn't well-controlled. The study will measure changes in your casual systolic blood pressure (the top number in a blood pressure reading) after 3 months to see if IMST is effective. The current recruitment status is unclear.","The primary outcome is measured at 3 months, indicating a follow-up period of at least that duration.",99,"Participants will perform IMST or Sham Training using a handheld device for 30 minutes per week (5 minutes a day, 6 days a week). Blood pressure will be measured at the start and after 3 months.","Not stated in the trial record.",[34],"v2"]