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ISN-ACT Trial List: May 2018
ISN Academy. ISN-ACT . May 16, 2018; 218490
Topic: General Nephrology
Disclosure(s): The ISN-Advancing Clinical Trials is a new initiative of the ISN intended to leverage existing infrastructures within ISN, in order to improve global nephrology community participation in clinical trial research. As part of its activities, the ISN-ACT highlights and sometimes analyzes important recent nephrology trials from latest medical literature every month through the ISN-ACT Trial-list. Editors of the ISN-ACT Trial-List also select clinical trials of particular impact, and collaborate with the @ISNeducation social media learning team to represent these trials visually. Join the ISN-ACT To generate more high-quality clinical trials and studies in nephrology, ISN-ACT is calling on investigators and interested individuals. If you are an ISN member interested to join this great initiative, submit your application online. Use the button below (download PDF) to download this month's edition of the list.
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Once a month, the ISN-ACT (Advancing Clinical Trials) team collects and publishes a list of important nephrology trials from the latest medical literature. Each trial is reviewed in context and their risk of bias in seven key areas assessed. This month, we looked at the following trials: 

Hypertension gets a short-back-and-sides in community-based treatment program
A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops
Victor, et al. N Eng J Med. 2018;378:1291-1301
The worldwide burden of hypertension continues to grow and strategies to ensure that evidence-based treatment is provided to disadvantaged populations are urgently needed. In a novel approach to this problem, Victor, et al. enrolled 319 African-American males with hypertension from 52 African-American owned barbershops in Los Angeles, USA. All barbers were trained to provide their clients with lifestyle advice and encouragement to see their doctor. Barbershops were then cluster-randomized to an intervention – in which barbers facilitated meetings at their shop where a pharmacist was able to prescribe and direct hypertension management (in collaboration with patients’ doctors) – or to control (barber training only). At 6 months, the mean difference in systolic blood pressure reduction was 21.6mmHg (95% CI 14.7-28.4; P<0.001) in favour of the intervention and 63.6% of the intervention group achieved target blood pressure (<130/80mmHg) versus 11.7% in the control arm (P<0.001). Follow up was 95% complete in both arms. While admitting that the short duration of follow up and volunteer bias inherent in enrolling participants to this type of intervention may place limits on generalisability, this trial serves as another potent reminder of the potential value of taking primary care out of the clinic and into the community.

Automated reminders help maintain medication adherence in young transplant recipients
A Randomized Trial of a Multicomponent Intervention to Promote Medication Adherence: The Teen Adherence in Kidney Transplant Effectiveness of Intervention Trial (TAKE-IT)
Foster, et al. Am J Kidney Dis. 2018; doi: 10.1053/j.ajkd.2017.12.012
Poor medication adherence is an important cause of graft failure, especially in younger recipients. Foster, et al., enrolled 169 participants aged 11-24 years from two countries who were at least 3 months post-transplant. They randomized them to either a control group which received medication adherence monitoring and 3-monthly coaching or to an intervention group in which participants also received a personalised suite of regular text messages or reminder emails to take their anti-rejection medications. Each participant received an electronic pillbox that stored all their medications and permitted monitoring of dose timing and adherence. Over a 12-month period, those in the intervention group took all of their medications for the day 78% of the time versus 68% of the time in the control group (OR 1.66, 95% confidence interval 1.15-2.39; P=0.006). This effect did not seem to wane with time. Self-reported adherence was over 95% in both groups. There were no significant differences in tacrolimus trough levels or episodes of acute rejection. This interesting study reveals the extent of medication non-adherence in young transplant recipients, but fortunately suggests that structured reminders can make a difference.

A preview of this infographic is available below, and can be downloaded to the left.

A Randomized Trial of a Multicomponent Intervention to Promote Medication Adherence: The Teen Adherence in Kidney Transplant Effectiveness of Intervention Trial (TAKE-IT)
Foster, et al. Am J Kidney Dis. 2018; doi: 10.1053/j.ajkd.2017.12.012

A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops
Victor, et al. N Eng J Med. 2018;378:1291-1301
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