Dietary and Dialysate Sodium Reduction on Body Fluid Volume and Inflammatory State in Hemodialysis Patients
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Purpose
Objective: To evaluate the influence of dietary sodium reduction on body fluid volume and inflammatory state in hemodialysis (HD) patients.
Design: Prospective controlled randomized study. Setting: Dialysis Unit of Botucatu Medical School Hospital, Sao Paulo State University, Brazil.
Patients: Adult patients on HD for at least 30 days and C-reactive protein (CRP) ≥ 0.7 mg/dl were randomly allocated into two groups: Group A: 21 patients treated with a 2g sodium restriction in their habitual diet, and Group B: 18 controls. Inflammatory, biochemical, hematological and nutritional markers, as well as dialysis dosage were assessed at baseline and after 8 and 16 weeks.
| Condition | Intervention | Phase |
|---|---|---|
|
Chronic Kidney Diseases Stage 5 |
Other: Dietary sodium restriction Other: Dialysate sodium concentration reduction |
Phase 4 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Effects of Dietary and Dialysate Sodium Reduction on Body Fluid Volume and Inflammatory State in Hemodialysis Patients. A Prospective Randomized Controlled Study |
- C-reactive protein [ Time Frame: up to 16 weeks ] [ Designated as safety issue: Yes ]The outcome will be evaluates each eight weeks
- interleukin-6 [ Time Frame: up to 16 weeks ] [ Designated as safety issue: Yes ]The outcome will be evaluates each eight weeks
- alpha tumor necrosis serum concetrations [ Time Frame: up to 16 weeks ] [ Designated as safety issue: Yes ]The outcome will be evaluates each eight weeks
| Enrollment: | 59 |
| Study Start Date: | April 2007 |
| Study Completion Date: | February 2009 |
| Primary Completion Date: | February 2009 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Group A
Composed by 21 patients treated with reduction of 2 grams of sodium reduction in their habitual diet.
|
Other: Dietary sodium restriction
Restriction of 2 grams on daily sodium diet intake.
Other Name: Dietary prescription
|
|
Experimental: Group B
Composed by 20 patients treated by reduction of dialysate concentration from 138 to 135 mEq/L
|
Other: Dialysate sodium concentration reduction
Reduction of dialysate sodium concentration from 138 to 135 mEq/L
Other Name: Dialysis prescription
|
|
No Intervention: Group C
Composed by 18 patients followed without changes in dialysate sodium concentration or diet sodium amount.
|
Detailed Description:
The prognosis of chronic kidney diseases (CKD) patients is strongly compromised by cardiovascular (CV) complications. Inflammation is established as a major risk factor for CV complications in these patients, occurring in approximately one third of them. Recently, growing evidences have suggested the body water volume expansion is a cause of inflammation in CKD. In a previous study Rodrigues Telini showed that dietary sodium restriction reduced the inflammatory markers levels in hemodialysis (HD) patients. Similar results were observed in patients treated by reduction of HD dialysate sodium concentration. However in both studies no significant reduction in body volume markers was observed. These results could be due to small number of patients or low sensibility of volume markers; on the other hand they could suggest a direct role of sodium as an inflammatory inducer independently of volume. With a larger number of patients and using a more sensitive volume marker as the B-type natriuretic peptide (BNP), this study intends to confirm the hypothesis that sodium mobilization can reduce the body water volume and attenuate the inflammatory in HD patients. A hundred thirty-five patients will be enrolled and divided in three groups with 35 patients: A, treated by reduction of 2 grams in daily sodium intake; B, exposed to reduction of sodium dialysate from 138 to 135 mEq/L and C, control group. The patients will be followed up by 16 weeks and inflammatory markers (CRP, interleukin-6, and tumor necrosis factor) as well as volume markers (Watson formula, electrical bioimpedance measurements and BNP concentration) will be determine each 8 weeks.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- included patients aged ≥ 18 years who had been on hemodialysis for at least 90 days, and were diagnosed with inflammation. Inflammation was defined as C Reactive Protein ≥ 0.7 mg/dL
Exclusion Criteria:
- acute inflammatory processes confirmed by clinical criteria and/or complementary tests
- acute inflammatory diseases
- tuberculosis
- use of antibiotics within the past two months
- chronic inflammatory diseases
- neoplasias
- chronic obstructive pulmonary disease
- use of central venous catheter and positive HIV serology
Contacts and Locations More Information
No publications provided
| Responsible Party: | Lidiane Silva RodriguesTelini, MSC, UPECLIN HC FM Botucatu Unesp |
| ClinicalTrials.gov Identifier: | NCT01458808 History of Changes |
| Other Study ID Numbers: | upeclin/HC/FMB-Unesp-55 |
| Study First Received: | June 14, 2011 |
| Last Updated: | October 24, 2011 |
| Health Authority: | Brazil: National Committee of Ethics in Research |
Keywords provided by UPECLIN HC FM Botucatu Unesp:
|
salt inflammation hypervolemia diet |
Additional relevant MeSH terms:
|
Kidney Diseases Renal Insufficiency, Chronic Kidney Failure, Chronic Urologic Diseases Renal Insufficiency |
ClinicalTrials.gov processed this record on June 17, 2013