Please select the eligibility criteria that correspond to the clinical trial below.
Title: Lifestyle Management of CKD in Obese Diabetic Patients
Brief Summary: The purpose of this randomized clinical trial is to evaluate the efficacy of 3 different technology-supported approaches to engaging 300 individuals with diabetes and concurrent chronic kidney disease in weight loss, dietary sodium restriction, and dietary restriction of inorganic phosphates when compared to usual care. Participants will be randomized to 1 of 4 groups, Usual Care (UC), Social Cognitive Theory-based Group Counseling (SCT), Mobile self-monitoring with tailored feedback and counseling (MONITORING), or a combination of SCT plus MONITORING conditions (COMBINED). Investigators will evaluate the intervention arms primarily in terms of weight reduction, urinary sodium excretion, and serum phosphorus and, secondarily in terms of physical activity, blood pressure, fasting lipids, medication requirements, and pulse wave velocity. Measurements will occur at baseline, 6, and 12 months. The statistical modeling of the baseline, 6 mos and 12 mos outcome variables will be based on logistic generalized linear mixed models (for binary outcomes) linear mixed models (for continuous outcomes), and random effects multinomial models (for outcomes with more than 2 levels, such as changes in medication management). In separate analyses of the intervention arm only, investigators will model self-monitoring adherence and examine possible associations between self-monitoring adherence and outcomes. The mediating effect of self-efficacy on the primary outcomes will be evaluated using structural equation models.


Options:
A: Inclusion Criteria:

* Age ≥ 18 years;
* Informed Consent;
* \>1 year after transplantation
* Medical approvement for participation in the study by the nephrologist.

Exclusion Criteria:

* Psychopathology;
* Severe cognitive disorders;
* Negative advice of the nephrologist and/or cardiologist.
B: Inclusion Criteria:

* Stages 3-4 CKD patients (GFR 20-60 mL/min)
* Male or female
* BMI 35-45 kg/m2
* Aged \>18 years
* Previously attempted weight loss
* Fit or anesthesia and surgery
* Written informed consent

Exclusion Criteria:

* Pregnancy
* History of chronic liver disease
* Previous gastric surgery or large hiatus hernia
* Previous bariatric surgery
* Psychiatric illness, including anxiety, mood and untreated eating disorders
* Malnutrition (assessed by subjective global assessment)
* Infection or course of antibiotics within the last month
* Unwilling to consider surgical treatment
* Previous kidney transplant
C: Inclusion Criteria:

* 15 obese men (BMI\>30), aged 18 to 55, with glomerular hyperfiltration (creatinine clearance\>130 ml/min)) and 10 normal body weight men (BMI\<25), aged 18 to 55.

Exclusion Criteria:

* Heart failure, CKD, COPD
* Known allergy to furosemide, acetazolamide, inulin or amino-hippurate
* Pharmacologic treatment for hypertension, cardiac disease, diabetes mellitus
* Treatment with corticosteroids, antiepileptics or NSAID
D: Inclusion Criteria:

* In order to be eligible for the study, the individual must be 40 years of age or older
* Have a DRG Code of T2DM, GFR of 15-89 ml/min/1.73m2 and a BMI \>30 kg/m2.
* The participant's physician of record will have verified that his/her patient can safely participant in an intervention study that involves weight loss and a goal of 150 minutes/week of moderate physical activity comparable to brisk walking.

Exclusion Criteria:

* Investigators will exclude from participation those with the following characteristics:

  1. unable or unwilling to provide informed consent
  2. unable to participate meaningfully in an intervention that involves group sessions (e.g., due to uncorrected hearing impairment, non-English-speaking)
  3. unable to read or otherwise use an iPad to monitor dietary intake, physical activity, and weight (e.g., blind, illiterate)
  4. unwilling to accept randomization assignment
  5. pregnant, or plans to become pregnant in the next 12 months, less than 3 months postpartum, or nursing or within 6 weeks of having completed nursing
  6. weight loss of \> 10% in the past 6 months except for postpartum weight loss
  7. unable to walk 0.25 miles in 10 minutes
  8. a major psychiatric disorder
  9. planning gastric bypass surgery in the next 12 months
  10. individuals who are institutionalized (e.g., in a nursing home or personal care facility, or those who are incarcerated and have no control over their diet).
* Investigators will exclude from the study those with underlying diseases that would increase the risk of participating in an intervention involving caloric restriction and physical activity.
* Such individuals would include those requiring treatment for cancer, exclusive of skin cancer other than melanoma, in the past 2 years; infectious diseases including untreated AIDS and active tuberculosis; uncontrolled hypertension of \>190 mmHg SBP or \>105 mmHg DBP despite treatment; stroke or TIA in the past 6 months; conditions requiring the use of home oxygen; or other chronic disease or condition likely to limit life span to \< 1 year.
* Because of the dietary requirements of a pregnant woman, and the nature of weight loss and gain with pregnancy, inclusion of pregnant women in the study would confound the study results. Those who become pregnant during the study will be withdrawn from the study.

Answer: D