Protein Intake, Nutrition and Cardiovascular Diseases in Stage V CKD
This trial is active, not recruiting.
|Conditions||hemodialysis, end stage renal disease|
|Sponsor||University of Utah|
|Collaborator||National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)|
|Start date||September 2007|
|End date||December 2013|
|Trial size||150 participants|
|Trial identifier||NCT00566670, 1 R01 DK077298, IRB_00024816, R01DK077298|
We do not know whether consumption of high amounts of protein in dialysis patients is beneficial or harmful. We will assess how much of protein patients take over three days and how that correlates with their muscle mass and arterial stiffness.
|United States||No locations recruiting|
|Other countries||No locations recruiting|
Chronic hemodialysis patients
We will assess in our patients how the amount of their protein intake correlates with their muscle mass and arterial stiffness.
time frame: Baseline,6 months,12 months,18 months
Evidence of clinically definite arterial stiffness and cardio vascular disease confirmed by a MRI/BIA test/PWV test
time frame: 18 months
Male or female participants at least 18 years old.
Inclusion Criteria: - The study will be comprised of adult (≥18 years) chronic hemodialysis patients. - Appetite often change with initiation of dialysis and kidney function recover sometimes from acute renal failure; hence only patients on dialysis at least for three months will be included. - As urinary losses of urea could affect the estimation of protein intake from the urea kinetic modeling, we initially planned to exclude patients with urine output > 200 ml/day. However, this might exclude many potential participants. Therefore, we plan to include those participants with UPO > 200 ml/day but willing to collect 44-hr urine collection between dialysis treatments for measurement of urinary urea. Exclusion Criteria: - Patients with persistent volume overload (substantial pedal edema) despite attempts at achieving dry weight will be excluded as hydration status might affect estimation of muscle mass. - - patients with inability to walk or those who use wheel-chair might have reduced mid-thigh muscle mass despite good protein intake because of disuse, and hence these patients will be excluded. - Persons with pacemakers and cochlear implants are excluded because of the magnetic field of MRI. Certain types of materials used in breast augmentation could be affected by the strong magnetic field and hence breast augmentation is an exclusion criteria. Artificial hips could interfere with mid-thigh muscle mass measurements whereas lumbar spine hardware could interfere with visceral fat measurements and hence, individuals with these will be excluded.- - Persons > 300 lbs will be excluded because of the weight limit of the MRI table. Atrial fibrillation could interfere with measurement of PWV. - Patients who are unlikely or unable (in the opinion of the nephrologists, nurses or dieticians taking care of the patient) to comply with research protocol will be excluded. - Patients with symptomatic heart failure, current active malignancy (excluding squamous and basal cell skin cancers), active AIDS, chronic lung disease requiring supplemental oxygen therapy and cirrhosis will be excluded. - Patients enrolled in interventional trials will be excluded.
|Official title||Protein Intake, Nutrition and Cardiovascular Disease in Stage V CKD on Hemodialysis|
|Principal investigator||Srinivasan Beddhu, M.D|
|Description||Even though the National Kidney Foundation guidelines recommend a dietary protein intake of 1.2 g/kg/d in hemodialysis patients, it remains unclear whether high protein intake has beneficial or harmful nutritional and cardiovascular effects in this population. We hypothesize that in the dialysis population overall: (1) Protein intake is a major determinant of muscle mass while inflammation, oxidative stress and metabolic acidosis play a lesser role; (2) Malnutrition is not an uremic cardiovascular risk factor hence low protein intake does not cause cardiovascular disease; and (3) In the other extreme, high protein intake is also not a major cause of cardiovascular disease since high serum phosphorus associated with high protein intake can usually be controlled by the use of phosphorus binders in routine clinical practice. The specific aims of this proposal are to examine in a prospective cohort of hemodialysis patients the longitudinal associations of absolute total protein intake (TPI in g/day) or dietary protein intake normalized to body weight (DPI in g/kg/day) with 1. Nutritional status (mid-thigh muscle mass as measured by Magnetic Resonance Imaging ) and functional status (6-min walk) and 2. Arterial stiffness (aortic pulse wave velocity) Understanding the relationship between protein intake with body composition (muscle mass) and intermediate CV outcomes (arterial stiffness) in stage V CKD patients in hemodialysis is of great scientific and practical significance|
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