Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Randomised Controlled Trial of the Effect of Dietary Salt Reduction on Blood Pressure and Other Cardiovascular Parameters in Kidney Transplant Recipients
Brief Summary: Cardiovascular morbidity and mortality is increased in kidney transplant patients. High blood pressure (BP) contributes significantly to this risk and is also associated with shortened allograft survival. Salt reduction lowers BP in the general population and there is emerging data that salt reduction also effectively lowers BP in chronic kidney disease (CKD). Kidney transplant patients, by definition have CKD, but they differ fundamentally from the general CKD population in that they are on medications which can predispose to high blood pressure, their kidneys are denervated, and they often have reasonable excretory kidney function.

The proposed study will be an eight-week randomised, controlled trial assessing the effect of intensive dietary salt advice on cardiovascular risk factors in kidney transplant patients. The primary outcome is office BP readings, with the effect on 24-hour ambulatory blood pressure, proteinuria, arterial stiffness and endothelial function being studied as secondary outcomes.


Options:
A: Inclusion Criteria:

* Age \> 18 years.
* CKD stage 3 or 4 (MDRD-GFR 15-60 ml/min)
* Use of any anti-hypertensive drugs
* No anti-hypertensive drugs but an average office systolic blood pressure \> 140 mmHg (as measured by datascope)

Exclusion Criteria:

* Salt-wasting CKD
* Nephrotic syndrome
* Pregnant or breastfeeding women
* Life expectancy \< 6 months
* Severe heart failure (NYHA III or IV) or liver cirrhosis with ascites and the inability to withdraw diuretics
* Rapidly declining kidney function with high likelihood of dialysis or kidney transplantation in the coming 4 months
* Kidney transplant recipients
* Use of immunosuppressive drugs
* Use of non-steroidal anti-inflammatory drugs
* Previous intolerance or allergy to hydrochlorothiazide or amiloride
* Serum sodium \< 135 mmol/l
* Serum potassium \< 3.5 mmol/l or \> 5.0 mmol/l
* Inability to adhere to the study protocol (due to language, incapacitated subjects, subjects with intellectual disability)
B: Inclusion Criteria:

* Age eighteen and more
* Clinical diagnoses of diabetes
* Clinical diagnosis of renal disease and an Estimated Glomerular Filtration Rate (eGFR) of less than 60ml/min calculated based on the Chronic Kidney Disease Epidemiology Collaboration (CKD_EPI) formula and /or an Albumin/Creatinine ratio of 30mg/mmol or more.
* Free of cognitive deficit as determined by the recruiting nephrologist based on a normal score on the Short Portable Mental Status Questionnaire.

(The nephrologist will ensure patients' referral or follow-up in the case of a diagnosed cognitive deficit)

* Free of psychomotor skills limitations as determined by the physical examination of the medical doctor recruiting the patient.
* Able to read, write and speak in French

Exclusion Criteria:

* Terminal illness other than chronic kidney disease such as cancer or severe heart failure.
* Planned major surgical procedures.
* Patient on dialysis.
* Patient receiving nursing home care visits for the management of diabetes.
C: Inclusion Criteria:

* Haemodialysis/haemodiafiltration for ESRF for \>3 months
* Clinically stable

Exclusion Criteria:

* Significant intercurrent illness
* Systolic BP \>240 mmHg/diastolic BP \>120 mmHg at enrollment
* Unstable blood pressure whilst on HD
* Sodium profiled haemodialysis/HDF
D: Inclusion Criteria:

* Patients who have received a kidney transplant ≥ 6 months previously who have a BP \>130 mm Hg systolic and/or \>80 mm Hg diastolic, or are receiving treatment for hypertension.

Exclusion Criteria:

* BP \< 120/80 on blood pressure treatment
* BP \>160/100
* Variation in Creatinine \>20% over preceding 2 months
* Secondary hypertension due to a cause other than CKD
* Heart failure (LVEF \<30% or NYHA class II - IV)
* Myocardial Infarction within 6 months
* Stroke within 6 months
* Current diagnosis of cancer
* Liver disease
* Bilateral arterio-venous fistulae
* Evidence of significant active infection
* Females who are pregnant or breastfeeding
* Hyponatremia (Na \<130mmol/L) or Hypernatremia (Na \>150mmol/L)
* Histologically confirmed episode of rejection within 6 months
* Steroids dose change in preceding 2 months
* Patients who are not able to give full informed consent
* Initial 24hr urinary sodium \<80mmol/24hrs

Answer: D