Association of Diuretics With Change in Extracellular Volume, Natriuretic Peptides, Symptoms, and Cardiovascular Outcomes in CKD

Description

Almost 15% of Americans have chronic kidney disease (CKD), with an even higher rate in Veterans due to common risk factors such as high blood pressure and diabetes. People with CKD have a high risk of cardiovascular (CV) diseases, such as heart attacks, heart failure, and strokes. Extra fluid in the body, called volume overload, may lead to CV disease in people with CKD. It is unknown if volume overload develops in the earliest stages of CKD, when treating it with common, inexpensive medicines called diuretics may improve long-term CV outcomes. This study will lay important groundwork to answer this question in Veterans with early CKD by comparing two ways to measure volume overload and studying the change in common symptoms like fatigue and short-term CV function after treatment with diuretic medicines.The investigators previously showed that brain natriuretic peptide (BNP) and N-terminal-pro-BNP (NT-pro-BNP), measures of ventricular stretch, are associated with death and cardiovascul

Trial Eligibility

Inclusion Criteria: * Male or female Veterans age 18 years or older. There will be no upper age limit. * The presence of CKD stages 1, 2, or 3, as defined below by Kidney Disease Improving Global Outcomes guidelines, for a period of at least 3 months. * Stage 1: eGFR 90 mL/min/1.73 m2 and spot urine albumin-to-creatinine ratio 30 mg/g. * Stage 2: eGFR 60-89 mL/min/1.73 m2 and spot urine albumin-to-creatinine ratio 30 mg/g. * Stage 3: eGFR 30-59 mL/min/1.73 m2. * Measured blood pressure either \>140 mmHg systolic or \>90 mmHg diastolic at the two most recent clinic visits. * Able to understand and sign informed consent after the nature of the study has been fully explained. Exclusion Criteria: * Unable to understand or provide informed consent. * Unwilling or unable to participate in the protocol or comply with any of its components. * CKD stages 4-5, defined as eGFR \<30 mL/min/1.73 m2. * Receiving chronic hemodialysis or peritoneal dialysis. * Recipient of a kidney transplant. * Serum potassium \<3.5 mEq/L at baseline. * Known left ventricular ejection fraction \<40% on visual estimate based on chart review of available echocardiogram data. * Known hepatic cirrhosis. * Major limb amputation. * Known pregnancy. * Presence of a pacemaker or defibrillator.

Study Info

Interventions

Locations Recruiting

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