Kidney Week

Abstract: FR-OR64

Dietary Intervention Trial for Hypertensive Black Adults With CKD

Session Information

• High-Impact Clinical Trials
  November 04, 2022 | Location: W415 Valencia, Orange County Convention Center‚ West Building
  Abstract Time: 11:15 AM - 11:30 AM

Category: Diversity and Equity in Kidney Health

• 800 Diversity and Equity in Kidney Health

Authors

• Crews, Deidra C., Johns Hopkins University, Baltimore, Maryland, United States

Deidra C. Crews,

• Dalcin, Arlene Taylor, Johns Hopkins University, Baltimore, Maryland, United States

Arlene Taylor Dalcin,

• Carson, Kathryn A., Johns Hopkins University, Baltimore, Maryland, United States

Kathryn A. Carson,

• Charleston, Jeanne, Johns Hopkins University, Baltimore, Maryland, United States

Jeanne Charleston,

• Stephens, Mary Ann Chutuape, Johns Hopkins University, Baltimore, Maryland, United States

Mary Ann Chutuape Stephens,

• Cooper, Lisa A., Johns Hopkins University, Baltimore, Maryland, United States

Lisa A. Cooper,

• Hines, Anika L., Virginia Commonwealth University, Richmond, Virginia, United States

Anika L. Hines,

• Albert, Michael C., Johns Hopkins University, Baltimore, Maryland, United States

Michael C. Albert,

• Yeh, Hsin-Chieh, Johns Hopkins University, Baltimore, Maryland, United States

Hsin-Chieh Yeh,

• Appel, Lawrence J., Johns Hopkins University, Baltimore, Maryland, United States

Lawrence J. Appel,

• Miller, Edgar R., Johns Hopkins University, Baltimore, Maryland, United States

Edgar R. Miller,

Group or Team Name

• Five Plus Nuts and Beans for Kidneys Investigators

Background

Black Americans are disproportionately affected by hypertension and advanced CKD. Inequitable access to healthy foods and knowledge gaps about healthy eating may be key drivers of these disparities.

Methods

Black adults with hypertension, urine albumin-to-creatinine ratio (ACR) ≥30 and <1000 mg/g, and eGFR ≥30 ml/min/1.73m² were randomized in a 1:1 ratio to: 1) Self-Shopping Dietary Approaches to Stop Hypertension (S-DASH) diet with a $30/week grocery allowance for 4 months (m) but no guidance on purchases, followed by no grocery allowance for 8m; or 2) Coaching (C-DASH) diet advice group with a $30/week food allowance and assistance in purchasing high potassium (K) foods for 4m, followed by coaching without food allowance for 8m. Primary outcome was percent change in urine ACR at 4m; secondary outcomes were change in systolic BP at 4m and ACR at 12m. We present 4m outcomes using mixed effects regression models.

Results

A total of 150 participants were randomized (Feb 2018-Aug 2021); 142 remained after COVID restrictions. Mean age was 61yrs; 37% were male; 44% had diabetes; mean systolic BP was 129 mmHg, eGFR was 75 ml/min/1.73m². Majority (64%) were taking a RAAS blocker and 26% were food insecure. Characteristics were balanced across study arms, except male sex (29% C-DASH, 44% S-DASH). C-DASH group had greater increases in dietary K and fruit/veg consumption than S-DASH (p<0.01); and C-DASH group had declines in ACR that did not differ statistically from S-DASH (p=0.17) (Figure), except among the subgroup with urine ACR ≥300 (n=26), where C-DASH group had a 73.3% decrease in ACR, and S-DASH had a 20.5% increase, p=0.01. There was also a suggestion of benefit for those with diabetes (p=0.09). Hyperkalemia (>5.5 mEq/L) occurred in 1 C-DASH participant, and no S-DASH participants.

Conclusion

Among Black adults with hypertension and CKD, a dietary intervention led to improvements in diet quality and a suggestion of benefits for albuminuria lowering, particularly among persons with severely increased albuminuria and those with diabetes.

Funding

• Other NIH Support –