Very Low Protein Diet and Renal Death in Chronic Kidney Disease (CKD)-ERIKA Study

NCT ID: NCT00323713

Last Updated: 2011-06-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

360 participants

Study Classification

INTERVENTIONAL

Study Start Date

2005-02-28

Study Completion Date

2012-12-31

Brief Summary

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The purpose of this study is to determine whether the use of a very low protein diet is effective in delaying the start of chronic dialysis treatment in patients affected by chronic kidney disease (CKD).

Detailed Description

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The prevalence of chronic dialysis patients is increasing worldwide because of the rising incidence of end stage renal disease, it is burdened by high cardiovascular risk, it is associated with a very high morbidity and mortality and it determines enormous costs for the community.

The improvement in the management of metabolic and cardiovascular complication associated to chronic kidney disease (CKD) since the early stages of the disease becomes mandatory in order to delay the start of dialysis and to ameliorate the whole patient outcome.

Dietary protein restriction represents a basic therapeutic approach in CKD, by reducing the accumulation of nitrogen catabolic substances, the phosphorus retention and the consequent hyperparathyroidism, the metabolic acidosis, the salt intake and the consequent hypertension, the proteinuria, and by improving the anemia and the glycemic tolerance, but the effects of the low protein diet on renal failure progression rate have not been definitely demonstrated.

Dietary effective reduction of just 0.2 g/kg/day of proteins is effective in ameliorating blood urea nitrogen, metabolic acidosis and hyperphosphoremia, and the very low protein diet (VLPD) allows a further improving of the metabolic control of uremia, it is safe, not affecting the nutritional status, and it is cost saving. VLPD has been suggested to delay the start of renal replacement therapy with respect to standard low protein diet, by mean of either secondary analysis of clinical trials or retrospective analysis.

Large randomized clinical trials (RCT) on this issue lack, and the effect of VLPD on renal death remain to be addressed. As well, information on patients' compliance to VLPD prescription and on the impact of VLPD on the quality of life are needed. Finally, also the effects of VLPD on both cardiovascular risk factors and mortality remain to be completely evaluated.

The primary aim of this study is to evaluate, by mean of a RCT, the effect of the very low protein diet on the renal death in renal patients affected by chronic renal insufficiency of moderate to advanced degree (CKD stages 4 and 5). Secondary aims are to evaluate the effect of VLPD on cardiovascular risk factors, morbidity and mortality, the adherence to VLPD, and the relationship between VLPD and quality of life.

Conditions

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Chronic Renal Insufficiency

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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VLPD diet

Adavnced CKD patients (stage 4-5) on a very low protein diet

Group Type EXPERIMENTAL

Very low protein diet

Intervention Type BEHAVIORAL

0.3 g of proteins per kilo of body weight per day, supplemented with a mixture of essential aminoacids and chetoacids

LPD diet

Adavnced CKD patients (stage 4-5) on a low protein diet

Group Type ACTIVE_COMPARATOR

Low protein diet

Intervention Type BEHAVIORAL

0.6 g of protein per kilo of body weight per day

Interventions

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Very low protein diet

0.3 g of proteins per kilo of body weight per day, supplemented with a mixture of essential aminoacids and chetoacids

Intervention Type BEHAVIORAL

Low protein diet

0.6 g of protein per kilo of body weight per day

Intervention Type BEHAVIORAL

Other Intervention Names

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VLPD LPD

Eligibility Criteria

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Inclusion Criteria

* Patients with chronic renal insufficiency in stage CKD 4 and 5 (GFR \< 30 ml/min/1.73m2, estimated by the 24-hours creatinine clearance) receiving conservative treatment for CKD
* Incident patients with chronic renal insufficiency in stage CKD 4 and 5 (GFR \< 30 ml/min/1.73m2, estimated by the 24-hours creatinine clearance), provided stable renal function determined by two 24-hour measurements of creatinine clearance 2 weeks a part

Exclusion Criteria

* Patients already on very low protein diet
* Change of creatinine clearance \> 30% within the last 3 months
* Severe undernutrition as indicated by :

1. BMI \< 20 kg/m2 in presence of serum albumin \< 3.0 g/dl, or BMI \< 17.5 kg/m2 whatever albumin value
2. body weight reduction \> 7.5% within the last 3 months
* Severe obesity as indicated by BMI \> 35 kg/m2
* Pregnancy or feeding
* Chronic treatment with steroid or cytotoxic drugs
* Fast progressing glomerulonephritis
* Active SLE and vasculitis
* Cardiac failure stage IV NYHA
* Advanced liver cirrhosis
* Active cancer diseases
* Severe encephalopathy associated with lack of spontaneous feeding
* Chronic obstructive respiratory diseases needing oxygen treatment
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Azienda Sanitaria ASL Avellino 2

OTHER

Sponsor Role lead

Responsible Party

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ASL_AV 2 - Avellino - Italy

Principal Investigators

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Vincenzo Bellizzi, MD, PhD

Role: STUDY_CHAIR

Nephrology Unit "A. Landolfi" Hospital, Solofra (AV) Italy

Giuseppe Conte, MD

Role: STUDY_CHAIR

Division of Nephrology, Medical School, Second University of Naples, Naples, Italy

Ciro Gallo, MD

Role: STUDY_CHAIR

Biostatistics Unit, Medical School, Second University of Naples, Naples, Italy

Locations

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Nephrology Unit, "Moscati" Hospital

Avellino, AV, Italy

Site Status

Nephrology Unit, S. Angelo dei Lombardi Hospital

Sant'Angelo dei Lombardi, AV, Italy

Site Status

Nephrology Unit "A. Landolfi" Hospital

Solofra, AV, Italy

Site Status

Nephrology Division, Medical School, University of Bari

Bari, BA, Italy

Site Status

Nephrology Unit, Brindisi Hospital

Brindisi, BR, Italy

Site Status

Nephrology Unit, Piedimonte Matese Hospital

Piedimonte Matese, CE, Italy

Site Status

Nephrology Unit, S. Felice a Cancello Hospital

San Felice A Cancello, CE, Italy

Site Status

Nephrology Division, Medical School, University of Catanzaro

Catanzaro, CZ, Italy

Site Status

Nephrology Division, Medical School, University of Foggia

Foggia, FG, Italy

Site Status

Nephrology Unit, Foggia Hospital

Foggia, FG, Italy

Site Status

Nephrology Unit, San Severo Hospital

San Severo, FG, Italy

Site Status

Nephrology Unit, Galatina Hospital

Galatina, LE, Italy

Site Status

Nephrology Division, "San Carlo" Hospital

Potenza, PZ, Italy

Site Status

Nephrology Unit, "Curto" Hospital

Polla, SA, Italy

Site Status

Nephrology Unit, Castellammare Hospital

Castellammare di Stabia, , Italy

Site Status

Nephrology Division, Medical School, University "Federico II" of Naples

Napoli, , Italy

Site Status

Nephrology Division, Medical School, Second University of Naples

Napoli, , Italy

Site Status

Countries

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Italy

References

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Di Iorio BR, Minutolo R, De Nicola L, Bellizzi V, Catapano F, Iodice C, Rubino R, Conte G. Supplemented very low protein diet ameliorates responsiveness to erythropoietin in chronic renal failure. Kidney Int. 2003 Nov;64(5):1822-8. doi: 10.1046/j.1523-1755.2003.00282.x.

Reference Type BACKGROUND
PMID: 14531817 (View on PubMed)

Di Iorio BR, Bellizzi V, Minutolo R, De Nicola L, Iodice C, Conte G. Supplemented very low-protein diet in advanced CRF: is it money saving? Kidney Int. 2004 Feb;65(2):742. doi: 10.1111/j.1523-1755.2004.404_2.x. No abstract available.

Reference Type BACKGROUND
PMID: 14717953 (View on PubMed)

Bellizzi V, Di Iorio BR, De Nicola L, Minutolo R, Zamboli P, Trucillo P, Catapano F, Cristofano C, Scalfi L, Conte G; ERIKA Study-group. Very low protein diet supplemented with ketoanalogs improves blood pressure control in chronic kidney disease. Kidney Int. 2007 Feb;71(3):245-51. doi: 10.1038/sj.ki.5001955. Epub 2006 Oct 11.

Reference Type BACKGROUND
PMID: 17035939 (View on PubMed)

Hahn D, Hodson EM, Fouque D. Low protein diets for non-diabetic adults with chronic kidney disease. Cochrane Database Syst Rev. 2020 Oct 29;10(10):CD001892. doi: 10.1002/14651858.CD001892.pub5.

Reference Type DERIVED
PMID: 33118160 (View on PubMed)

Other Identifiers

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KA1-1425

Identifier Type: -

Identifier Source: org_study_id

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