Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effect of Dietary Sodium Reduction in Kidney Disease Patients With Albuminuria
Brief Summary: The proposed randomized controlled trial will test the effect of dietary sodium reduction on albuminuria in patients with proteinuric chronic kidney disease. Results from this study will clarify the role of dietary sodium reduction in management of patients with proteinuric chronic kidney disease and its potential to halt the progression of chronic kidney disease.


Options:
A: Inclusion Criteria:

Individuals eligible to participate in this study must meet all of the following criteria:

* Willing and able to provide written, signed informed consent after the nature of the study has been explained, and prior to any research-related procedures.
* Age ≥ 18 years and ≤ 85 years.
* Willing and able to comply with all study procedures.
* Patients with eGFR of 20 to 60 ml/min/173m2 by the abbreviated (4-variable) MDRD equation and a relatively stable clinical course.
* Sitting systolic blood pressure ≥ 100 mmHg prior to study entry (to exclude people at risk from hypotension from dietary salt reduction).

Exclusion Criteria:

Individuals who meet any of the following exclusion criteria will not be eligible to participate in the study:

* Recent acute illness (≤1 month). Minor ailments such as a recovered common cold or allergic rhinitis would not be considered as exclusion criteria but would be left to the site PI's discretion.
* Recent hospitalization (≤1 month) unless clearly for a minor elective procedure unlikely to interfere with BIA measurements. The final decision will be left to the site PI's discretion.
* Any psychological condition (including alcoholism) that could interfere with the patient's ability to comply with the study protocol.
* Subjects with baseline 24-hour urinary sodium excretion ≤100 mmol/day.
* Amputation of a limb other than fingers or toes.
* Pacemaker, defibrillator, implantable pump, artificial joint, pins, plates or other types of metal objects in the body (other than dental fillings).
* Coronary stents or metal suture material in the heart.
* Use of any investigational product or investigational medical device within 30 days prior to screening, or requirement for any investigational agent prior to completion of all scheduled study assessments.
* Weight over 300 pounds (limitation for examination table).
* Pregnancy or lactation.
* Patients with kidney diseases known to be associated with salt wasting (see above).
* Patients with atrial fibrillation as ambulatory blood pressure measurements may not be accurate in this setting.
* Any condition that, in the view of the PI, places the subject at high risk of poor treatment compliance or of not completing the study.
B: Inclusion Criteria:

* Men or women at least 21 years of age: The lower age limit was chosen based on the National Institutes of Health (NIH) definition of adults for participation in research
* Any race or ethnicity: The investigators expect to recruit 50-60% African American and 40-50% non-African American (White, Hispanic, and Asian Americans), with the vast majority of the latter being non-Hispanic Whites.
* eGFR \< 90 mL/min/1.73m2 but \> 30 mL/min/1.73m2. The upper limit for eGFR was chosen to include participants with a clinically significant decrease in renal function. The investigators chose an upper eGFR limit slightly higher than the Kidney Disease Outcomes Quality Initiative (KDOQI) definition of moderately reduced glomerular filtration rate (GFR) to be more inclusive of patients with mild reduction in GFR but significant proteinuria. The lower eGFR limit was set to exclude patients with advanced CKD, where the potential effects of dietary sodium reduction on proteinuria may not be apparent or greatly alter CKD progression. The eGFR to define eligibility will be calculated using calibrated serum creatinine values and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimating equation.
* Albumin-to-creatinine ratio \> 30mg/g

Exclusion Criteria:

* Albuminuria ≥1.5 g/g or kidney structural change
* Prior kidney transplant based on self-report
* Immunosuppression or other immunotherapy within the past six months prior to enrollment based on patient self-report
* History of cancer other than non-melanoma skin cancer within two years prior to enrollment based on patient self-report
* History of polycystic kidney disease
* Currently receiving dialysis treatment
* History of human immunodeficiency virus (HIV)
* Current pregnancy, breastfeeding or plans to become pregnant during the study
* Consumption of ≥14 alcoholic drinks/week or consumption of ≥6 drinks/occasion
* Current participation in another lifestyle intervention trial
* Current residence or planned residence make it difficult to meet trial requirements
* Other concerns regarding ability to meet trial requirements, at the discretion of the principal investigator
C: Inclusion Criteria:

* Participant is willing and able to give informed consent for participation in the study.
* Male or Female, aged 18 years or above.
* Diagnosed with CKD and an eGFR ≥ 20 ml/min/1.73m2
* Participant has clinically acceptable laboratory data available to confirm the diagnosis.
* Able (in the opinion of the Investigators) and willing to comply with all study requirements.
* Willing to allow his or her General Practitioner and consultant, if appropriate, to be notified of participation in the study

Exclusion Criteria:

* Female participants who is pregnant, lactating or planning pregnancy during the course of the study.
* Any other significant disease or disorder which, in the opinion of the Investigator, may either put the participants at risk because of participation in the study, or may influence the result of the study, or the participant's ability to participate in the study.
* Inability to understand English or special communication needs because the interventions will use English and is not funded to deal with special communication needs.
* Known salt losing nephropathy
D: 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.

Answer: B