DD-study: Diet or Diuretics for Salt-sensitivity in Chronic Kidney Disease

Study Overview
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Brief Summary
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In this clinical study the anti-hypertensive response to dietary salt restriction is compared with the anti-hypertensive response to the diuretics hydrochlorothiazide/amiloride in adult patients with chronic kidney disease.

Detailed Description
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Patients with chronic kidney disease (CKD) are exquisitely salt-sensitive. Salt-sensitivity in CKD is linked to hypertension and cardiovascular outcomes. Dietary salt restriction is an accepted intervention for salt-sensitivity in CKD. Another strategy, however, could be to block sodium uptake by the kidney pharmacologically by diuretics. Especially diuretics acting on the distal tubule may be effective, because this appears to be the site of increased sodium reabsorption in CKD. It is currently unknown how these two strategies, diet or diuretics, relate. The investigators hypothesize that diuretics are non-inferior to diet.

Official Title
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DD-study: Diet or Diuretics for Salt-sensitivity in Chronic Kidney Disease

Conditions
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Chronic Kidney Disease

Intervention / Treatment
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* Drug: Amiloride
* Drug: Hydrochlorothiazide
* Other: Low-sodium diet


Participation Criteria
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Eligibility Criteria
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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)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Diuretic treatment<br>Patients receive amiloride and hydrochlorothiazide | Drug: Amiloride<br>* Combined with hydrochlorothiazide<br>Drug: Hydrochlorothiazide<br>* Combined with amiloride<br>|
| Active Comparator: Low-sodium diet<br>Patients are put on a low-sodium diet (60 mmol/day) | Other: Low-sodium diet<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 24 hour blood pressure |  | Two weeks after start of each intervention |