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CompletedNCT03299816Updated Jun 22, 2023Results posted

Five, Plus Nuts and Beans for Kidneys

An interventional study of Coaching DASH group (C-DASH) and Self-Shopping DASH group (S-DASH) in Chronic Kidney Disease and Hypertension, sponsored by Johns Hopkins University. Completed at 1 site in United States. Open to participants aged 21 Years to 100 Years. Per ClinicalTrials.gov, last updated 2023-06-22.

Sponsored by Johns Hopkins University · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
142
Allocation
Randomized
Ages
21 Years to 100 Years
Sex
All
01

Study summary

This Five, Plus Nuts and Beans for Kidneys Study is a single center, randomized controlled trial with 2 parallel arms testing the hypothesis that delivery of nutritional advice to adopt a Dietary Approaches to Stop Hypertension (DASH)-like diet and $30/week worth of fruits, vegetables, nuts and beans tailored to personal choices and availability in neighborhood stores, will reduce kidney damage in African Americans with hypertension and chronic kidney disease.

Read the detailed description

This study will test the effectiveness of dietary advice delivered by a study coach and assistance with weekly online ordering of $30/week worth of potassium rich foods delivered by a local grocer to a community location for reducing urinary albumin excretion among African Americans with hypertension and chronic kidney disease. Participants will be recruited from primary care clinics in Baltimore, MD.

150 African American adults diagnosed with hypertension and with mild/moderate chronic kidney disease based on the presence of albuminuria will be randomly assigned to one of two arms for 12 months. There are 2 phases of the study. In Phase 1 (months 1-4), one study arm will consist of minimal guidance from the study team and a weekly allowance of $30 dollars to purchase food and drinks of their choosing from a local grocer. During Phase 1, the second arm of the study will receive dietary guidance from the study coach and assistance with ordering and purchasing $30/week worth of high potassium foods from the same local grocer. In Phase 2 (months 5-12) neither study arm will receive a food allowance, however the second arm will receive telephonic visits and dietary advice from the study coach.

02

Conditions studied

  • Chronic Kidney Disease
  • Hypertension

Keywords

  • Chronic Kidney Disease
  • Hypertension
  • Albuminuria
  • African Americans
03

Who can participate

Ages eligible
21 Years to 100 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Self-identified African American race
  • Age 21 years or older
  • Clinical diagnosis of hypertension and have a urine Albumin-Creatinine Ratio (ACR) of ≥30 mg/g with or without estimated Glomerular Filtration Rate (GFR) 30-59 ml/min/1.73m2.
  • Must be under regular care with their Johns Hopkins Community Physicians (JHCP) or Johns Hopkins Outpatient Center (JHOC) physician (seen within the past 12 months).
  • Must have a systolic blood pressure of \<=160 mmHg and a diastolic blood pressure of \<=100 mmHg (average of two visits)
  • Be on stable doses of antihypertensive medications for a minimum of two months prior to randomization.

Exclusion criteria

Exclusion Criteria:

  • Cardiovascular (CV) event within 6 months
  • Chronic disease that might interfere with trial participation (e.g. stage 4 or 5 Chronic Kidney Disease, Estimated Glomerular Filtration Rate \<30 ml/min/1.73m2)
  • Unwillingness or inability to adopt a DASH-like diet
  • Consumes over 14 alcoholic drinks per week
  • Poorly controlled diabetes (Hemoglobin A1c >9%).
  • Patients with a serum potassium >4.6 milliequivalent (mEq) /L45
  • Urine ACR ≥ 1,000 mg/g
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
142 participants (actual)

Study arms

  • Active comparator
    Self-Shopping DASH group (S-DASH)

    The Self-Shopping DASH group will receive printed patient-centered materials on the DASH diet and chronic kidney disease. Participants will also receive $30/week allowance for the purchase of food and drinks of their choosing from a local grocer (Klein's ShopRite stores of Maryland) during the first four months. During the remainder of the study (months 5-12), the participants in this group will be asked to continue to follow the dietary advice provided but will not receive the food allowance.

    Behavioral: Self-Shopping DASH group (S-DASH)

  • Experimental
    Coaching DASH group (C-DASH)

    The C-DASH group intervention will be a patient-tailored program, delivered by a study coach that is trained by a dietitian, which emphasizes key self-management behaviors - diet and self-monitoring. This group will receive advice from the study coach and purchase $30 worth of fresh fruits, vegetables, nuts and beans that are high in potassium on a weekly basis for the first four months.

    Behavioral: Coaching DASH group (C-DASH)

Interventions

  • BehavioralCoaching DASH group (C-DASH)

    Participants assigned to the C-DASH diet advice group will be provided $30/week worth of fruits, vegetables, nuts and beans ordered through the study coach and delivered to a community location to reach a certain goal of potassium intake (months 0-4). During phase 2 of the study (months 5-12), a study coach will continue telephonic contact with the participants to set goals for following a DASH-like diet without the weekly food allowance.

    Also known as: Coaching DASH diet advice group (C-DASH)

  • BehavioralSelf-Shopping DASH group (S-DASH)

    Participants will be given a brochure containing information about the DASH diet which will be reviewed with a study team member. In months 1-4, participants will receive a gift card equivalent to a weekly allowance of $30 to Klein's ShopRite stores of Maryland for purchases of food and beverages of their choice. During phase two (months 5-12), they will be asked to continue following a DASH-like diet but will not receive a gift card for purchases.

    Also known as: Self-Shopping DASH diet advice Group (S-DASH)

05

What researchers measure

Primary outcomes

  1. Change in Urinary Albumin Excretion From Baseline to 4 Months

    Urine samples will be collected for ACR (albumin-to-creatinine ratio).

    Time frame: Baseline, 4 months

Secondary outcomes

  1. Change in Systolic Blood Pressure From Baseline to 4 Months

    Daytime systolic blood pressure monitoring will be determined using OMRON 907-xl

    Time frame: Baseline,4 months

  2. Change in Systolic Blood Pressure From Baseline to 12 Months

    Daytime systolic blood pressure monitoring will be determined using OMRON 907-xl

    Time frame: Baseline, end of study (approximately 12 months)

  3. Change in Urinary Albumin Excretion From Baseline to 12 Months

    Urine samples will be collected for ACR (albumin-to-creatinine ratio).

    Time frame: Baseline, end of study (approximately 12 months)

Other outcomes

  1. Change in Urinary Albumin Excretion From Baseline to 1 Month

    Urine samples will be collected for ACR (albumin-to-creatinine ratio).

    Time frame: Baseline, 1 month

  2. Change in Systolic Blood Pressure From Baseline to 1 Month

    Daytime systolic blood pressure monitoring will be determined using OMRON 907-xl

    Time frame: Baseline, 1 month

06

Results

Posted Jun 22, 2023
Limitations and caveats
The COVID-19 pandemic restricted in-person research activities for \~6 months, which impacted trial conduct in two ways: (1) 8 of the participants randomized at the onset of the pandemic did not return when restrictions on in person research were lifted. They were excluded from the final sample size. (2) Upon resuming in-person activities, the protocol was modified to Phase 1 only for the 33 participants who were randomized in 2021, so that the trial could be completed within the funding period.

Participant flow

Phase 1: 4-month Intervention Period
Participant flow — Phase 1: 4-month Intervention Period
MilestoneCoaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)
Started7072
Completed6972
Not completed10
Withdrew: Withdrawal by subject10
Phase 2: 12-month Follow-up Period
Participant flow — Phase 2: 12-month Follow-up Period
MilestoneCoaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)
Started5256
Completed4953
Not completed33
Withdrew: Withdrawal by subject10
Withdrew: Lost to follow-up23

Outcome measures

PrimaryChange in Urinary Albumin Excretion From Baseline to 4 Months

Urine samples will be collected for ACR (albumin-to-creatinine ratio).

Time frame:
Baseline, 4 months
Reported as:
Least squares mean · mg/g
Change in Urinary Albumin Excretion From Baseline to 4 Months
mg/gCoaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)
Change in Urinary Albumin Excretion From Baseline to 4 Months-28.6 ± 12.0-5.6 ± 11.6
Statistical analysis
  • Coaching DASH Group (C-DASH) vs Self-Shopping DASH Group (S-DASH) · Mixed effects regression · p = 0.17 (The a priori threshold for statistical significance was \<0.05)Urinary albumin-to-creatinine ratio (ACR) was not normally distributed and was natural log transformed for analyses
SecondaryChange in Systolic Blood Pressure From Baseline to 4 Months

Daytime systolic blood pressure monitoring will be determined using OMRON 907-xl

Time frame:
Baseline,4 months
Reported as:
Least squares mean · mm Hg
Change in Systolic Blood Pressure From Baseline to 4 Months
mm HgCoaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)
Change in Systolic Blood Pressure From Baseline to 4 Months-1.4 ± 1.80.9 ± 1.7
Statistical analysis
  • Coaching DASH Group (C-DASH) vs Self-Shopping DASH Group (S-DASH) · Mixed effects regression · p = 0.36 (The a priori threshold for statistical significance was \<0.05)
SecondaryChange in Systolic Blood Pressure From Baseline to 12 Months

Daytime systolic blood pressure monitoring will be determined using OMRON 907-xl

Time frame:
Baseline, end of study (approximately 12 months)
Reported as:
Least squares mean · mm Hg
Change in Systolic Blood Pressure From Baseline to 12 Months
mm HgCoaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)
Change in Systolic Blood Pressure From Baseline to 12 Months1.5 ± 2.3-1.6 ± 2.3
Statistical analysis
  • Coaching DASH Group (C-DASH) vs Self-Shopping DASH Group (S-DASH) · Mixed effects regression · p = 0.33 (The a priori threshold for statistical significance was \<0.05)
SecondaryChange in Urinary Albumin Excretion From Baseline to 12 Months

Urine samples will be collected for ACR (albumin-to-creatinine ratio).

Time frame:
Baseline, end of study (approximately 12 months)
Reported as:
Least squares mean · mg/g
Change in Urinary Albumin Excretion From Baseline to 12 Months
mg/gCoaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)
Change in Urinary Albumin Excretion From Baseline to 12 Months-11.5 ± 14.1-1.4 ± 13.7
Statistical analysis
  • Coaching DASH Group (C-DASH) vs Self-Shopping DASH Group (S-DASH) · Mixed effects regression · p = 0.61 (The a priori threshold for statistical significance was \<0.05)Urinary albumin-to-creatinine ratio (ACR) was not normally distributed and was natural log transformed for analyses
Other pre-specifiedChange in Urinary Albumin Excretion From Baseline to 1 Month

Urine samples will be collected for ACR (albumin-to-creatinine ratio).

Time frame:
Baseline, 1 month
Reported as:
Least squares mean · mg/g
Change in Urinary Albumin Excretion From Baseline to 1 Month
mg/gCoaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)
Change in Urinary Albumin Excretion From Baseline to 1 Month-14.8 ± 10.1-19.6 ± 9.8
Statistical analysis
  • Coaching DASH Group (C-DASH) vs Self-Shopping DASH Group (S-DASH) · Mixed effects regression · p = 0.73 (The a priori threshold for statistical significance was \<0.05)Urinary albumin-to-creatinine ratio (ACR) was not normally distributed and was natural log transformed for analyses
Other pre-specifiedChange in Systolic Blood Pressure From Baseline to 1 Month

Daytime systolic blood pressure monitoring will be determined using OMRON 907-xl

Time frame:
Baseline, 1 month
Reported as:
Least squares mean · mm Hg
Change in Systolic Blood Pressure From Baseline to 1 Month
mm HgCoaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)
Change in Systolic Blood Pressure From Baseline to 1 Month-1.1 ± 1.6-0.3 ± 1.5
Statistical analysis
  • Coaching DASH Group (C-DASH) vs Self-Shopping DASH Group (S-DASH) · Mixed effects regression · p = 0.75 (The a priori threshold for statistical significance was \<0.05)

Adverse events

Collected over The first 108 randomized participants: 1 year; The remaining 33 randomized participants: 4 months. Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Coaching DASH Group (C-DASH)0/70 (0%)7/70 (10%)10/70 (14.3%)
Self-Shopping DASH Group (S-DASH)0/72 (0%)7/72 (9.7%)16/72 (22.2%)
Most frequent serious events
Showing 10 of 26
Most frequent serious events
EventCoaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)
Abdominal PainGastrointestinal disorders1/700/72
Angioneurotic edemaInjury, poisoning and procedural complications1/700/72
Acute kidney failureRenal and urinary disorders1/700/72
Chronic pancreatitisGastrointestinal disorders1/700/72
COVID-19Infections and infestations1/700/72
Diabetes mellitus with ketoacidosisEndocrine disorders1/700/72
Mechanical complication of ventricular intracranial (communicating) shuntNervous system disorders1/700/72
Moderate persistent asthma with (acute) exacerbationRespiratory, thoracic and mediastinal disorders1/700/72
Acute Kidney InjuryRenal and urinary disorders1/700/72
Angina pectorisVascular disorders1/700/72
Most frequent other events
Most frequent other events
EventCoaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)
Hypertensive UrgencyVascular disorders3/7010/72
HypokalemiaMetabolism and nutrition disorders7/706/72

Baseline characteristics

Age, Continuous
Age, Continuous(years)Coaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)Total
Mean59.7 ± 13.762.7 ± 11.761.1 ± 12.8
Sex: Female, Male
Sex: Female, Male(Participants)Coaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)Total
Female504090
Male203252
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)Coaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)Total
Hispanic or Latino112
Not Hispanic or Latino6971140
Unknown or Not Reported000
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Coaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)Total
American Indian or Alaska Native000
Asian000
Native Hawaiian or Other Pacific Islander000
Black or African American6971140
White000
More than one race112
Unknown or Not Reported000
Region of Enrollment
Region of Enrollment(Participants)Coaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)Total
United States7072142
Baseline Urinary albumin-to-creatine (ACR)
Baseline Urinary albumin-to-creatine (ACR)(mg/g)Coaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)Total
Mean99.8 (49.0 to 234.5)98.8 (47.3 to 236.5)99.5 (4.08 to 234.5)
Systolic Blood Pressure
Systolic Blood Pressure(mmHg)Coaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)Total
Mean128.1 ± 14.4130.8 ± 12.8129.4 ± 13.6
Diastolic Blood Pressure
Diastolic Blood Pressure(mmHg)Coaching DASH Group (C-DASH)Self-Shopping DASH Group (S-DASH)Total
Mean72.3 ± 10.674.4 ± 11.273.3 ± 10.9

2 further baseline measures are reported on the registry.

07

Study locations

1 site
  • East Baltimore Medical Campus
    Baltimore, Maryland 21202, United States
08

References and documents

Study documents

  • Protocol and statistical analysis plan · Apr 24, 2020

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: Yes — Plan to share the Statistical Analysis Plan and Study Protocol.

Supporting information: Study protocol, Sap

09

Registry details

Key details

Study ID
NCT03299816
Lead sponsor
Johns Hopkins University
Collaborators
National Institute on Minority Health and Health Disparities (NIMHD)
Responsible party
Sponsor
First posted
Oct 3, 2017
Start date
Feb 22, 2018
Primary completion
Nov 22, 2021
Completion
Dec 8, 2021
Results posted
Jun 22, 2023
Last update
Jun 22, 2023

Study contacts

Deidra Crews, MD, ScM
principal investigator · Johns Hopkins University

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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