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Phosphorus Additives and Albuminuria in Early Stages of CKD: A Randomized Controlled Trial.

ABSTRACT: Little is known about the effects of phosphorus additives on patients with kidney disease.Randomized, double-blind, crossover trial.31 adults with early stages of presumed chronic kidney disease (estimated glomerular filtration rate ? 45mL/min/1.73m2; urine albumin-creatinine ratio sex-specific cutoff points: men ? 17mg/g, women ? 25mg/g).Higher versus lower phosphorus intake for 3 weeks. Higher phosphorus intake was achieved by the addition of commercially available diet beverages and breakfast bars to diet.Change in 24-hour urine albumin excretion and plasma fibroblast growth factor 23 level.Two 24-hour urine collections and a single fasting blood draw at the end of each period.Mean baseline values for phosphorus intake, 24-hour urine phosphorus excretion, and estimated glomerular filtration rate were 1,113±549 (SD) mg/d, 688±300mg/d, and 74.6±22.0mL/min/1.73m2. Median urine albumin excretion of 82.7 (IQR, 39.6-174.1) mg/d. Although phosphorus intake from study products increased by 993mg/d (P<0.001) during the higher compared to lower phosphorus additive period, background phosphorus intake decreased by 151mg/d (P=0.004). Higher phosphorus additive consumption increased 24-hour urine phosphorus excretion by 505 (95% CI, 381 to 629) mg/d (P<0.001), but did not significantly increase albuminuria (higher vs lower: 14.3%; 95% CI, -2.5% to 34.0%; P=0.1) or fibroblast growth factor 23 level (higher vs lower: 3.4%; 95% CI, -5.9% to 13.6%; P=0.4).Small sample size, short duration of intervention, changes in background diet during the intervention.A 3-week consumption of higher phosphorus food additives did not significantly increase albuminuria. Further studies are needed to confirm these results.

SUBMITTER: Chang AR

PROVIDER: S-EPMC5263092 | biostudies-literature | 2017 Feb

REPOSITORIES: biostudies-literature

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Phosphorus Additives and Albuminuria in Early Stages of CKD: A Randomized Controlled Trial.

Chang Alex R AR Miller Edgar R ER Anderson Cheryl A CA Juraschek Stephen P SP Moser Melissa M White Karen K Henry Bobbie B Krekel Caitlin C Oh Susan S Charleston Jeanne J Appel Lawrence J LJ

American journal of kidney diseases : the official journal of the National Kidney Foundation 20161116 2

<h4>Background</h4>Little is known about the effects of phosphorus additives on patients with kidney disease.<h4>Study design</h4>Randomized, double-blind, crossover trial.<h4>Setting & participants</h4>31 adults with early stages of presumed chronic kidney disease (estimated glomerular filtration rate ≥ 45mL/min/1.73m<sup>2</sup>; urine albumin-creatinine ratio sex-specific cutoff points: men ≥ 17mg/g, women ≥ 25mg/g).<h4>Intervention</h4>Higher versus lower phosphorus intake for 3 weeks. Highe ...[more]

PMID: 27865566

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Project description:The stepped-care approach, where people with early symptoms of depression are stepped up from low-intensity interventions to higher-level interventions as needed, has the potential to assist many people with mild depressive symptoms. Self-monitoring techniques assist people to understand their mental health symptoms by increasing their emotional self-awareness (ESA) and can be easily distributed on mobile phones at low cost. Increasing ESA is an important first step in psychotherapy and has the potential to intervene before mild depressive symptoms progress to major depressive disorder. In this secondary analysis we examined a mobile phone self-monitoring tool used by young people experiencing mild or more depressive symptoms to investigate the relationships between self-monitoring, ESA, and depression.We tested two main hypotheses: (1) people who monitored their mood, stress, and coping strategies would have increased ESA from pretest to 6-week follow-up compared with an attention comparison group, and (2) an increase in ESA would predict a decrease in depressive symptoms.We recruited patients aged 14 to 24 years from rural and metropolitan general practices. Eligible participants were identified as having mild or more mental health concerns by their general practitioner. Participants were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored), and both groups self-monitored for 2 to 4 weeks. Randomization was carried out electronically via random seed generation, by an in-house computer programmer; therefore, general practitioners, participants, and researchers were blinded to group allocation at randomization. Participants completed pretest, posttest, and 6-week follow-up measures of the Depression Anxiety Stress Scale and the ESA Scale. We estimated a parallel process latent growth curve model (LGCM) using Mplus to test the indirect effect of the intervention on depressive symptoms via the mediator ESA, and calculated 95% bias-corrected bootstrapping confidence intervals (CIs).Of the 163 participants assessed for eligibility, 118 were randomly assigned and 114 were included in analyses (68 in the intervention group and 46 in the comparison group). A parallel process LGCM estimated the indirect effect of the intervention on depressive symptoms via ESA and was shown to be statistically significant based on the 95% bias-corrected bootstrapping CIs not containing zero (-6.366 to -0.029). The proportion of the maximum possible indirect effect estimated was ?(2 )=.54 (95% CI .426-.640).This study supported the hypothesis that self-monitoring increases ESA, which in turn decreases depressive symptoms for young people with mild or more depressive symptoms. Mobile phone self-monitoring programs are ideally suited to first-step intervention programs for depression in the stepped-care approach, particularly when ESA is targeted as a mediating factor.ClinicalTrials.gov NCT00794222; http://clinicaltrials.gov/ct2/show/NCT00794222 (Archived by WebCite at http://www.webcitation.org/65lldW34k).

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Dataset Information

Phosphorus Additives and Albuminuria in Early Stages of CKD: A Randomized Controlled Trial.

Publications

Phosphorus Additives and Albuminuria in Early Stages of CKD: A Randomized Controlled Trial.

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