Effect of Coaching to Increase Water Intake on Kidney Function Decline in Adults With Chronic Kidney Disease: The CKD WIT Randomized Clinical Trial
Clark WF, Sontrop JM, Huang SH, Gallo K, Moist L, House AA, Cuerden MS, Weir MA, Bagga A, Brimble S, Burke A, Muirhead N, Pandeya S, Garg AX
JAMA · 68 citations
How it was studied
- Design
- Randomized controlled trial (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Independent funding
- Government
- Canadian Institutes of Health Research
- Government
- CIHR
Based on 2 listed funder(s).
Publication
- Published
- 2018-05-08 · JAMA · vol. 319 · issue 18 · p. 1870
- Publisher
- American Medical Association
- Cited
- 99 citations · more than 99% of similar papers · 9.1× the field average
- Impact
- Top 10% most cited in its field
- References
- 48 works
- Access
- Free to read
- Research areas
- Dialysis and Renal Disease Management · Chronic Kidney Disease and Diabetes · Sodium Intake and Health
- Keywords
- Medicine, Renal function, Kidney disease, Kidney, Coaching, Internal medicine, Disease, Water intake, Physiology
- MeSH
- urine, humans, disease progression, water, glomerular filtration rate, health behavior, drinking, osmolar concentration, aged, middle aged, female, male, renal insufficiency, chronic, patient education as topic, mentoring
14 authors
From CA
- William F. Clark · correspondingWestern University; London Health Sciences Centre
- Jessica M. SontropWestern University; London Health Sciences Centre
- Shih‐Han Susan HuangWestern University; London Health Sciences Centre
- Kerri GalloLondon Health Sciences Centre
- Louise M. MOISTWestern University; London Health Sciences Centre
- Andrew A. HouseWestern University; London Health Sciences Centre
Abstract
Importance
In observational studies, increased water intake is associated with better kidney function.
Objective
To determine the effect of coaching to increase water intake on kidney function in adults with chronic kidney disease.
Design, setting, and participants
The CKD WIT (Chronic Kidney Disease Water Intake Trial) randomized clinical trial was conducted in 9 centers in Ontario, Canada, from 2013 until 2017 (last day of follow-up, May 25, 2017). Patients had stage 3 chronic kidney disease (estimated glomerular filtration rate [eGFR] 30-60 mL/min/1.73 m2 and microalbuminuria or macroalbuminuria) and a 24-hour urine volume of less than 3.0 L.
Interventions
Patients in the hydration group (n = 316) were coached to drink more water, and those in the control group (n = 315) were coached to maintain usual intake.
Main outcomes and measures
The primary outcome was change in kidney function (eGFR from baseline to 12 months). Secondary outcomes included 1-year change in plasma copeptin concentration, creatinine clearance, 24-hour urine albumin, and patient-reported overall quality of health (0 [worst possible] to 10 [best possible]).
Results
Of 631 randomized patients (mean age, 65.0 years; men, 63.4%; mean eGFR, 43 mL/min/1.73 m2; median urine albumin, 123 mg/d), 12 died (hydration group [n = 5]; control group [n = 7]). Among 590 survivors with 1-year follow-up measurements (95% of 619), the mean change in 24-hour urine volume was 0.6 L per day higher in the hydration group (95% CI, 0.5 to 0.7; P < .001). The mean change in eGFR was -2.2 mL/min/1.73 m2 in the hydration group and -1.9 mL/min/1.73 m2 in the control group (adjusted between-group difference, -0.3 mL/min/1.73 m2 [95% CI, -1.8 to 1.2; P = .74]). The mean between-group differences (hydration vs control) in secondary outcomes were as follows: plasma copeptin, -2.2 pmol/L (95% CI, -3.9 to -0.5; P = .01); creatinine clearance, 3.6 mL/min/1.73 m2 (95% CI, 0.8 to 6.4; P = .01); urine albumin, 7 mg per day (95% CI, -4 to 51; P = .11); and quality of health, 0.2 points (95% CI, -0.3 to 0.3; P = .22).
Conclusions and relevance
Among adults with chronic kidney disease, coaching to increase water intake compared with coaching to maintain the same water intake did not significantly slow the decline in kidney function after 1 year. However, the study may have been underpowered to detect a clinically important difference.
Trial registration
clinicaltrials.gov Identifier: NCT01766687.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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