Protein Intake, Nutrition and Cardiovascular Diseases in Stage V CKD
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Purpose
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.
| Condition |
|---|
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Hemodialysis End Stage Renal Disease |
| Study Type: | Observational |
| Study Design: | Observational Model: Cohort Time Perspective: Prospective |
| Official Title: | Protein Intake, Nutrition and Cardiovascular Disease in Stage V CKD on Hemodialysis |
- 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 ] [ Designated as safety issue: No ]
- Evidence of clinically definite arterial stiffness and cardio vascular disease confirmed by a MRI/BIA test/PWV test [ Time Frame: 18 months ] [ Designated as safety issue: No ]
Biospecimen Retention: Samples With DNA
We will draw 30 ml of blood four times (months 1, 6, 12 and 18) for plasma/serum/DNA samples.Urine Collection: If patients are making more than ½ cup (200 ml) of urine a day.
| Estimated Enrollment: | 150 |
| Study Start Date: | September 2007 |
| Estimated Study Completion Date: | December 2013 |
| Estimated Primary Completion Date: | December 2013 (Final data collection date for primary outcome measure) |
| Groups/Cohorts |
|---|
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Observation (all participants)
Chronic hemodialysis patients
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Detailed 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
- Nutritional status (mid-thigh muscle mass as measured by Magnetic Resonance Imaging ) and functional status (6-min walk) and
- 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
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Non-Probability Sample |
115 patients from different dialysis centers in Utah and 35 patients from Vanderbilt University.
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.
Contacts and LocationsPlease refer to this study by its ClinicalTrials.gov identifier: NCT00566670
| United States, Tennessee | |
| Vanderbilt University Medical Centet | |
| Nashville, Tennessee, United States, 37232-2372 | |
| United States, Utah | |
| University of Utah | |
| Salt Lake City, Utah, United States, 84112 | |
| Principal Investigator: | Srinivasan Beddhu, M.D | University of Utah |
More Information
No publications provided
| Responsible Party: | Srinvasan Beddhu, MD, University of Utah |
| ClinicalTrials.gov Identifier: | NCT00566670 History of Changes |
| Other Study ID Numbers: | IRB_00024816, R01DK077298, 1 R01 DK077298 |
| Study First Received: | November 29, 2007 |
| Last Updated: | December 9, 2013 |
| Health Authority: | United States: Federal Government |
Additional relevant MeSH terms:
|
Cardiovascular Diseases Kidney Failure, Chronic Kidney Diseases |
Renal Insufficiency Renal Insufficiency, Chronic Urologic Diseases |
ClinicalTrials.gov processed this record on February 27, 2015