Original investigation: pathogenesis and treatment of kidney disease and hypertensionHigh urine volume and low urine osmolality are risk factors for faster progression of renal disease1
Section snippets
Methods
The patient population consisted of the study A cohort of the MDRD study (baseline GFR, 25 to 55 mL/min/1.73 m2). Study A was a 2 × 2 factorial design in which patients were randomly assigned to two different levels of blood pressure control: the usual goal (mean arterial pressure [MAP] of 102 to 107 mm Hg) or a low goal (MAP ≤ 92 mm Hg, if tolerated), and two different levels of dietary protein intake: the usual intake (1.3 g/kg of ideal body weight per day) or a low intake (0.6 g/kg of ideal
Results
Table 1 lists baseline characteristics of patients in study A with and without PKD. Patients with PKD comprised approximately 25% of the cohort. Patients with PKD are assumed to have autosomal dominant PKD.
Fig 1, Fig 2 show 24-hour urine volume and Uosm in patients with and without PKD assigned to the usual or low-protein diets during follow-up in the MDRD study, respectively. As shown, the low-protein diet resulted in slightly lower daily urine volumes in patients with and without PKD,
Discussion
The present study used the MDRD study database to examine retrospectively the relationship between fluid intake (reflected by 24-hour urine volume and Uosm) and renal disease progression (decline in GFR). We tested the hypothesis that fluid intake is significantly associated with GFR decline during follow-up in the MDRD study. Patients with and without PKD were analyzed separately because of evidence from experimental models of renal disease that high fluid intake might increase progression in
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Supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases and the Health Care Financing Administration.
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