Chronic Kidney Disease Stage 3B, Chronic Kidney Disease, Stage 4, Proteinuria
Conditions
Keywords
CKD, proteinuria, diet, plant-based diet, vegan, randomized controlled trial
Brief summary
This study will test the hypothesis that lifestyle intervention consisting of a whole food, plant-based (WFPB) diet and group education will favorably impact outcomes germane to individuals with chronic kidney disease (CKD) stage 3b and 4, including blood pressure control, amount of proteinuria (protein in the urine), and preservation of glomerular filtration rate (GFR). In addition, this study will assess weight and body composition, diabetic control in subjects with diabetes as well as CKD, and quality of life. Safety of a WFPB diet in subjects with CKD will be tested with respect to the development of elevated serum potassium and phosphorus, hypoalbuminemia (low blood protein), hypotension (low blood pressure), and hypoglycemia (low blood sugar). An exploratory aim is to test the effects of a WFPB diet on the microbiome of subjects by collecting and analyzing stool samples.
Interventions
OTHERwhole food, plant-based diet
The study diet is whole food, plant based defined as containing no animal products or refined grains or added oils, minimal use of any sweeteners, and, for the purposes of this study, on average containing no more than 15% calories from fat.
Sponsors
University of Rochester
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
The initial phase of the study will be a three month randomized clinical trial of a whole food plant based nutrition program vs. usual care in patients with chronic kidney disease. Subjects randomized to the intervention arm will start the nutrition program as soon as they are able. Subjects assigned to the control arm will be placed on a 'wait-list' to start the nutrition program after they undergo three months of testing during their usual care, which consists of routine CKD care as directed by their primary nephrologist. After a 3 month 'wait', they will start the same plant-based nutrition program as the intervention arm subjects. Both experimental and control group subjects will be followed for a total of 9 months after starting the plant-based dietary intervention. Thus, in addition to the 3-month randomized control trial, there will be data from a 9-month single arm clinical intervention.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age greater than 18 years * Subjects with CKD 3b and 4 (as determined by an estimated glomerular filtration rate of ≥ 15 ml/min but ≤ 45 ml/min for at least three months) * Subjects with proteinuria documented at least twice with the most recent test within the last 6 months as determined by: * Urine albumin excretion rate of \> 300 mg/day or urine albumin to creatinine ratio of \> 300 mg/g of creatinine * Urine protein excretion rate of \> 500 mg/day or urine protein to creatinine ratio of \> 0.5 g/g of creatinine * If using angiotensin converting enzyme inhibitor, angiotensin receptor blockers and/or aldosterone antagonists, on a stable dose of for greater than one month * Fluent in English language * Able and willing to comply with the testing and group education schedules * Able and willing to comply with a whole-food, plant-based diet * Able and willing to give informed consent
Exclusion criteria
* Any kidney disease requiring immunosuppressive therapy * Pregnancy or intent to become pregnant in the next 12 months * Life expectancy \< 12 months * History of solid organ transplant or anticipated solid organ transplant in next 12 months * History of hyperkalemia: Two potassium measurements \> 5.1 Meq/L within the last three months, or history of any intervention for hyperkalemia in the last 6 months * Subjects with malabsorptive syndromes * Subjects with history of bariatric surgery or planned bariatric surgery in the next 12 months * Subjects on warfarin * Subjects with current eating disorders * Subjects with tobacco or illicit substance use * Subjects with alcohol use of \> 7 drinks per week * Allergy or intolerance of a plant-based or plant-derived food (gluten, soy, etc.) * Following a vegan diet in the six months prior to consent * Major surgery within 60 days prior to consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in GFR from baseline | 1, 4, 8, and 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | Serum creatinine (renal function panel) and Cystatin C |
| Change in systolic and diastolic blood pressure from baseline | 4, 8, and 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | — |
| Change in proteinuria from baseline | 4, 8, and 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | Urine total protein:creatinine ratio |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Waist circumference changes from baseline | 4, 8, and 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | — |
| 8-point bioelectrical impedance analysis changes from baseline | 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | Body composition assessment |
| Hemoglobin A1c changes from baseline | 4, 8, and 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | Diabetic control |
| KDQOL-36 changes from baseline | 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | Scoring of this questionnaire consists of 5 scales (symptoms/problem list, effects of kidney disease, burden of kidney disease, SF-12 physical composite, and SF-12 mental composite). The lowest possible score for each scale is 0, indicating the worst outcome, and the best possible score is 100, indicating the best possible outcome. |
| Serum potassium changes from baseline | 1, 4, 8, and 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | — |
| Serum phosphorus changes from baseline | 1, 4, 8, and 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | — |
| Serum albumin changes from baseline | 1, 4, 8, and 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | — |
| Blood glucose level changes from baseline | 1, 4, 8, and 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | Fasting serum levels from all subjects; additionally, whole blood levels measured by glucometer in subjects with comorbid type 1 or type 2 diabetes mellitus |
| Serum magnesium changes from baseline | 1, 4, 8, and 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | — |
| Parathyroid hormone (PTH) changes from baseline | 12 weeks (RCT); 3 and 9 months on intervention diet (all subjects) | — |
| 25-hydroxycholecalciferol changes from baseline | 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | — |
| Fibroblast growth factor-23 changes from baseline | 12 weeks (RCT); 3 and 9 months on intervention diet (all subjects) | — |
| High sensitivity CRP changes from baseline | 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | — |
| CBC with differential changes from baseline | 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | — |
| Changes in nutrient intakes from baseline based on 3 day food diaries | 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | Assess baseline compared to intervention diet and assess compliance of intervention diet over study duration |
| Changes in urinary indicators of dietary intake from baseline | 12 weeks (RCT); 3 and 9 months on intervention diet (all subjects) | 24 hour urine collection, urinary oxidation (urinary 8-isoprostane) |
| Total cholesterol, HDL, LDL, and non-HDL cholesterol level changes from baseline | 1, 4, and 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | Fasting lipid panel |
| Weight changes from baseline | 4, 8, and 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | — |
| BMI changes from baseline | 4, 8, and 12 weeks (RCT); 3, 6, and 9 months on intervention diet (all subjects) | — |
Other
| Measure | Time frame | Description |
|---|---|---|
| Exploratory stool microbiome evaluation | 12 weeks (RCT) | Changes in microbiome from baseline |
Countries
United States
Outcome results
None listed