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Clinical Trial
. 2012 Oct 19:13:137.
doi: 10.1186/1471-2369-13-137.

The effect of lowering salt intake on ambulatory blood pressure to reduce cardiovascular risk in chronic kidney disease (LowSALT CKD study): protocol of a randomized trial

Emma J McMahon  1 , Judith D Bauer, Carmel M Hawley, Nicole M Isbel, Michael Stowasser, David W Johnson, Rachael E Hale, Katrina L Campbell
Affiliations
Clinical Trial

The effect of lowering salt intake on ambulatory blood pressure to reduce cardiovascular risk in chronic kidney disease (LowSALT CKD study): protocol of a randomized trial

Emma J McMahon et al. BMC Nephrol. .

Abstract

Background: Despite evidence implicating dietary sodium in the pathogenesis of cardiovascular disease (CVD) in chronic kidney disease (CKD), quality intervention trials in CKD patients are lacking. This study aims to investigate the effect of reducing sodium intake on blood pressure, risk factors for progression of CKD and other cardiovascular risk factors in CKD.

Methods/design: The LowSALT CKD study is a six week randomized-crossover trial assessing the effect of a moderate (180 mmol/day) compared with a low (60 mmol/day) sodium intake on cardiovascular risk factors and risk factors for kidney function decline in mild-moderate CKD (stage III-IV). The primary outcome of interest is 24-hour ambulatory blood pressure, with secondary outcomes including arterial stiffness (pulse wave velocity), proteinuria and fluid status. The randomized crossover trial (Phase 1) is supported by an ancillary trial (Phase 2) of longitudinal-observational design to assess the longer term effectiveness of sodium restriction. Phase 2 will continue measurement of outcomes as per Phase 1, with the addition of patient-centered outcomes, such as dietary adherence to sodium restriction (degree of adherence and barriers/enablers), quality of life and taste assessment.

Discussion: The LowSALT CKD study is an investigator-initiated study specifically designed to assess the proof-of-concept and efficacy of sodium restriction in patients with established CKD. Phase 2 will assess the longer term effectiveness of sodium restriction in the same participants, enhancing the translation of Phase 1 results into practice. This trial will provide much-needed insight into sodium restriction as a treatment option to reduce risk of CVD and CKD progression in CKD patients.

Trial registration: Universal Trial Number: U1111-1125-2149. Australian New Zealand Clinical Trials Registry Number: ACTRN12611001097932.

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Figures

Figure 1
Figure 1
Simplified diagram of the relationship between excess sodium, kidney damage and risk of CVD. Excess sodium in CKD is caused by decreased sodium excretion & high sodium intake (*influenced by food supply and preference – potentially mediated by taste sensitivity). This increases cardiovascular risk not only via altered extracellular volume & blood pressure (BP) but also through direct toxic effects on blood vessels.
Figure 2
Figure 2
LowSALT CKD study flowchart.
Figure 3
Figure 3
LowSALT CKD study data collection schedule.
See this image and copyright information in PMC

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