Osama W Amro1, Jessica K Paulus2, Farzad Noubary2, Ronald D Perrone3. 1. Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA; Tufts University School of Medicine, Boston, MA. 2. Tufts University School of Medicine, Boston, MA; The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA. 3. Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA; Tufts University School of Medicine, Boston, MA. Electronic address: rperrone@tuftsmedicalcenter.org.
Abstract
BACKGROUND:Autosomal dominant polycystic kidney disease (ADPKD) affects millions of people worldwide. Vasopressin promotes disease progression. STUDY DESIGN: A randomized controlled trial with equal (1:1) allocation. SETTING & PARTICIPANTS: This trial examined the effect of combining a low-osmolar (low-sodium [1,500mg/d], low-protein [0.8g per kilogram of body weight]) diet and adjusted water intake on vasopressin secretion in 34 patients with ADPKD. INTERVENTION: Participants were randomly assigned to receive a low-osmolar diet followed by adjusted water intake to achieve urine osmolality ≤ 280mOsm/kg water versus no intervention for 2 weeks. OUTCOME: The primary outcome of the study was change (delta) in copeptin levels and urine osmolality between the intervention and control groups from baseline to 2 weeks. MEASUREMENTS: Fasting plasma copeptin level, 24-hour urine osmolality, and total solute intake. RESULTS: Baseline characteristics of the 2 groups were similar. Mean plasma copeptin levels and urine osmolality declined from 6.2±3.05 (SD) to 5.3±2.5pmol/L (P=0.02) and from 426±193 to 258±117mOsm/kg water (P=0.01), respectively, in the intervention group compared to a nonsignificant change in the control group (from 4.7±3.6 to 5.07±4pmol/L [P=0.2] and 329±159 to 349±139mOsm/kg water [P=0.3], respectively). The change in copeptin levels (primary outcome) and urine osmolality was statistically significant between the intervention and control groups (delta copeptin, -0.86±1.3 vs +0.39±1.2pmol/L [P=0.009]; delta urine osmolality, -167±264 vs +20±80mOsm/kg water [P=0.007], respectively). Total urinary solute decreased in only the intervention group and significantly differed between groups at week 1 (P=0.03), reducing mean water prescription from 3.2 to 2.6L/d. LIMITATIONS: Small sample size and short follow-up. CONCLUSIONS: We developed a stepwise dietary intervention that led to a significant reduction in vasopressin secretion in patients with ADPKD. Furthermore, this intervention led to a reduction in water required for vasopressin reduction.
RCT Entities:
BACKGROUND:Autosomal dominant polycystic kidney disease (ADPKD) affects millions of people worldwide. Vasopressin promotes disease progression. STUDY DESIGN: A randomized controlled trial with equal (1:1) allocation. SETTING & PARTICIPANTS: This trial examined the effect of combining a low-osmolar (low-sodium [1,500mg/d], low-protein [0.8g per kilogram of body weight]) diet and adjusted water intake on vasopressin secretion in 34 patients with ADPKD. INTERVENTION: Participants were randomly assigned to receive a low-osmolar diet followed by adjusted water intake to achieve urine osmolality ≤ 280mOsm/kg water versus no intervention for 2 weeks. OUTCOME: The primary outcome of the study was change (delta) in copeptin levels and urine osmolality between the intervention and control groups from baseline to 2 weeks. MEASUREMENTS: Fasting plasma copeptin level, 24-hour urine osmolality, and total solute intake. RESULTS: Baseline characteristics of the 2 groups were similar. Mean plasma copeptin levels and urine osmolality declined from 6.2±3.05 (SD) to 5.3±2.5pmol/L (P=0.02) and from 426±193 to 258±117mOsm/kg water (P=0.01), respectively, in the intervention group compared to a nonsignificant change in the control group (from 4.7±3.6 to 5.07±4pmol/L [P=0.2] and 329±159 to 349±139mOsm/kg water [P=0.3], respectively). The change in copeptin levels (primary outcome) and urine osmolality was statistically significant between the intervention and control groups (delta copeptin, -0.86±1.3 vs +0.39±1.2pmol/L [P=0.009]; delta urine osmolality, -167±264 vs +20±80mOsm/kg water [P=0.007], respectively). Total urinary solute decreased in only the intervention group and significantly differed between groups at week 1 (P=0.03), reducing mean water prescription from 3.2 to 2.6L/d. LIMITATIONS: Small sample size and short follow-up. CONCLUSIONS: We developed a stepwise dietary intervention that led to a significant reduction in vasopressin secretion in patients with ADPKD. Furthermore, this intervention led to a reduction in water required for vasopressin reduction.
Authors: Sandrina Balanescu; Peter Kopp; Mary Beth Gaskill; Nils G Morgenthaler; Christian Schindler; Jonas Rutishauser Journal: J Clin Endocrinol Metab Date: 2011-02-02 Impact factor: 5.958
Authors: P A Gabow; W D Kaehny; A M Johnson; I T Duley; M Manco-Johnson; D C Lezotte; R W Schrier Journal: Kidney Int Date: 1989-02 Impact factor: 10.612
Authors: Xiaofang Wang; Yanhong Wu; Christopher J Ward; Peter C Harris; Vicente E Torres Journal: J Am Soc Nephrol Date: 2007-11-21 Impact factor: 10.121
Authors: Fouad T Chebib; Ronald D Perrone; Arlene B Chapman; Neera K Dahl; Peter C Harris; Michal Mrug; Reem A Mustafa; Anjay Rastogi; Terry Watnick; Alan S L Yu; Vicente E Torres Journal: J Am Soc Nephrol Date: 2018-09-18 Impact factor: 10.121
Authors: Annette T Y Wong; Carly Mannix; Jared J Grantham; Margaret Allman-Farinelli; Sunil V Badve; Neil Boudville; Karen Byth; Jessie Chan; Susan Coulshed; Marie E Edwards; Bradley J Erickson; Mangalee Fernando; Sheryl Foster; Imad Haloob; David C H Harris; Carmel M Hawley; Julie Hill; Kirsten Howard; Martin Howell; Simon H Jiang; David W Johnson; Timothy L Kline; Karthik Kumar; Vincent W Lee; Maureen Lonergan; Jun Mai; Philip McCloud; Anthony Peduto; Anna Rangan; Simon D Roger; Kamal Sud; Vincent Torres; Eswari Vilayur; Gopala K Rangan Journal: BMJ Open Date: 2018-01-21 Impact factor: 2.692
Authors: Ragada El-Damanawi; Michael Lee; Tess Harris; Laura B Mader; Simon Bond; Holly Pavey; Richard N Sandford; Ian B Wilkinson; Alison Burrows; Przemyslaw Woznowski; Yoav Ben-Shlomo; Fiona E Karet Frankl; Thomas F Hiemstra Journal: BMJ Open Date: 2018-05-09 Impact factor: 2.692
Authors: Steven Soroka; Ahsan Alam; Micheli Bevilacqua; Louis-Philippe Girard; Paul Komenda; Rolf Loertscher; Philip McFarlane; Sanjaya Pandeya; Paul Tam; Daniel G Bichet Journal: Can J Kidney Health Dis Date: 2018-10-12