Resistance Training and Diet in Patients With Chronic Renal Failure
Condition: Kidney Failure, Chronic
MeSH terms: Renal Insufficiency; Kidney Failure, Chronic
Study type: Interventional

Summary: 
      This study will examine the effects of long-term adherence to a low protein diet (LPD) of 0.6
      g/kg-1/d-1 with and without progressive resistance exercise training in patients with
      impaired renal function on body composition, renal function (glomerular filtration rate),
      nitrogen balance, muscle strength and size, and functional capacity. The hypothesis is that
      adherence to a LPD will result in a reduction in skeletal muscle mass and reduced strength
      and functional capacity while those patients who adhere to the LPD and exercise will
      demonstrate a similar preservation of renal function but will have greater fat free mass,
      muscle mass and strength. The intervention trial will last 18 months in which patients with
      moderate renal failure will be randomly assigned to one of 4 interventions: standard care,
      standard care + exercise, LPD, and LPD with exercise. In this way the independent and
      combined effects of diet and exercise on the progression of renal disease and body
      composition will be monitored. This study will have important implications for the treatment
      of patients with chronic renal failure. New strategies of combining exercise with
      recommendations of a low protein diet may slow the progression of renal disease and improve
      strength and functional capacity in these at-risk patients.
    

Detailed description: 
      Management of dietary protein intake of the CRF patient represents a critical balance between
      providing adequate protein to meet nutritional requirements, and limiting protein intake in
      the hope of slowing or abating the progression of CRF. A number of studies have demonstrated
      that reduced dietary protein intake can slow the progression of chronic renal failure.
      Finding effective ways to increase nitrogen retention and decrease urinary nitrogen excretion
      may help CRF patients maintain a more positive nitrogen balance and lessen the nitrogen load
      on the kidneys for a given dietary protein intake. Our laboratory has demonstrated that in
      older men and women, the consequence of adherence to a low protein diet is an accommodation
      that results in decreased muscle mass, strength,and compromised immune function. We have also
      demonstrated that when healthy, free living older men and women consume a weight maintenance
      diet providing the RDA for protein of 0.8 g/kg-1/day-1 for 15 weeks they lose skeletal muscle
      mass. These data clearly indicate that elderly people have an increased need for dietary
      protein (compared to young people). Data has also demonstrated that progressive resistance
      exercise improves nitrogen balance in older healthy individuals as well as in patients with
      mild to moderate chronic renal failure.
    

Intervention name(s): low protein diet; resistance training; combination of diet control and exercise
Intervention type(s): Behavioral; Behavioral; Behavioral
Allocation: Randomized
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Diet; exercise