Coaching with a DASH diet improves albuminuria

Among Black adults with hypertension and advanced chronic kidney disease, nutritional coaching alongside a food allowance was superior to food allowance alone for improvements in diet quality overall, and for decreasing albuminuria in participants with severe albuminuria [1].

Black Americans are disproportionately affected by hypertension and chronic kidney disease, with suboptimal healthy-diet access and knowledge being a potential contributing factor, according to Prof. Diedre C. Crews (Johns Hopkins University School of Medicine Equity, MD, USA). The Dietary Approaches to Stop Hypertension (DASH) diet is associated with better cardiovascular and kidney health, especially in Black Americans. In the 1-year, Five, Plus Nuts and Beans for Kidneys Trial (NCT03299816), 150 Black adults (≥21 years) with hypertension, UACR 30 to <1,000 mg/g, and eGFR ≥30 mL/min/1.73m² were randomised (1:1) to either a Self-Shopping DASH (S-DASH) diet (US$30/week food allowance without nutritional advice for 4 months only) or to a Coaching DASH (C-DASH) diet (US$30/week food allowance with advice on buying high-potassium foods for 4 months, followed by advice without food allowance for 8 months).

The primary outcome was percent change in UACR at 4 months; secondary outcomes were change in systolic blood pressure at 4 months and UACR at 1 year. Participants had a mean age of 60 years, mean BMI 34 kg/m², and 44% had self-reported diabetes. There was a higher percentage of male participants in the S-DASH group (44%) versus the C-DASH group (29%); other baseline characteristics were well balanced between groups. The mean systolic blood pressure was 129 mmHg and eGFR was 75 ml/min/1.73m². The 4-month results showed a 28.6% decline in UACR in the C-DASH group (n=67) versus a −5.6% decline in the S-DASH group (n=72). The decrease in diastolic blood pressure was −2.1 mmHg in the C-DASH group versus −0.3% in the S-DASH group; the urine potassium decline was 7.0% versus 0.4%, respectively. In the subgroup of patients with severely increased UACR, the C-DASH group showed a 73% decrease in UACR and the S-DASH group a 21% increase (P=0.01). Statistically significant greater increases were observed in potassium and fruit and vegetable consumption in the C-DASH group versus the S-DASH group. There was also a suggestion of benefit for those with diabetes (P=0.09). “Regarding safety, only 1 C-DASH participant had potassium >5.5 mmol/L; no glucose values >400 were observed and no hospitalisations deemed related to the study protocol. Further dietary interventions that incorporate coaching/health education along with healthy foods provision may better address kidney health inequities,” said Prof. Crews [1].

1. Crews DC, et al. Dietary Intervention Trial for Hypertensive Black Adults With CKD. FR-OR64, ASN Kidney Week 2022, 3–6 Nov.

 

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Posted on 8 December 202217 May 2024