- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03290716
Diet, ExerCIse and carDiovascular hEalth (DECIDE) - Salt Reduction Strategies for the Elderly in Nursing Homes in China (DECIDE-Salt)
Diet, Exercise and Cardiovascular Health - Effect of Salt Substitute and Stepwise Salt Supply Control in Reducing Blood Pressure in the Elderly in Nursing Homes in China: a Factorial Cluster-randomized Controlled Trial
The DECIDE - Salt in Elderly (Diet, ExerCIse and carDiovascular hEalth - Salt Reduction Strategies for the Elderly in Nursing Homes in China) is to evaluate the effects, safety and cost-effectiveness of salt substitution (SS) and stepwise salt supply control (SSSC) in reducing blood pressure in Chinese elderly in nursing homes. The study will recruit over 960 old people from 48 nursing homes in northern China. The 48 nursing homes will be randomised into the following 4 groups.
- salt substitute (SS) and stepwise salt supply control (SSSC);
- SS only;
- SSSC only; and
- no SS and no SSSC (control).
The intervention will last over 2 years. The randomization will be conducted centrally after the baseline survey completed. Primary outcome will be the change in systolic blood pressure. The secondary outcomes include: the changes in diastolic blood pressure, 24hr urinary sodium, potassium and microalbumin, and incidence of hyperkalemia, hypokalemia, hyponatremia, cardiovascular events, and all causes death, and incremental cost-effectiveness ratio.
Study Overview
Detailed Description
The DECIDE - Salt in Elderly (Diet, ExerCIse and carDiovascular hEalth - Salt Reduction Strategies for the Elderly in Nursing Homes in China) is a study in the DECIDE project, which includes five studies. The others are DECIDE - Diet, DECIDE - Exercise, DECIDE - Obesity in Children, and DECIDE - Smart Living. The DECIDE - Salt in Elderly study is to evaluate the effects, safety and cost-effectiveness of salt substitution (SS) and kitchen-based stepwise salt supply control (SSSC) in reducing blood pressure in Chinese elderly in nursing homes. Specifically, the study aims include:
- to test if a stepwise salt supply control strategy could significantly reduce systolic blood pressure among elderly living in nursing homes;
- to test if replacing regular salt with the market available salt substitute could significantly reduce systolic blood pressure among elderly living in nursing homes; and
- to test if the joint effect of the two strategies is larger than that from one of each.
The corresponding null hypotheses that will be tested are:
- the mean change from the baseline in systolic blood pressure of elderly residents in nursing homes that are supplied with SS is equal to the mean change from the baseline in systolic blood pressure of elderly residents in nursing homes that are supplied with regular salt;
- the mean change from the baseline in systolic blood pressure of elderly residents in nursing homes that apply SSSC is equal to the mean change from the baseline in systolic blood pressure of elderly residents in nursing homes that do not apply SSSC;
- There is no interaction between the two interventions above.
The study will recruit over 960 old people from 48 nursing homes in northern China, where the mean salt intake is generally higher than 12 g/day. A 2x2 factorial cluster-randomized trial will be used to test two independent salt reduction strategies: 1) using salt substitute to replace the regular salt in the kitchen of nursing homes; and 2) training the nursing manager to control/reduce, step by step, the amount of salt supplied to the kitchen of nursing homes. The 48 nursing homes will be randomized to the following 4 groups.
- salt substitute (SS) and stepwise salt supply control (SSSC);
- SS only;
- SSSC only; and
- no SS and no SSSC (control).
A brief health education on salt and health will be applied to all four groups. The salt substitute (NaCl 62.5% and KCl 25%) will be centrally provided. And the Train-the-trainers model will be used to train the nursing home managers how to implement the SSSC.
The intervention will last over 2 years. The baseline examination including three blood pressure measurements and one 24-hr urine collection will be conducted for all participants. Fasting blood samples will be drawn for measurement of serum potassium and detect hyperkalemia, hypokalemia, hyponatremia and renal dysfunction.
The randomization will be conducted centrally by the study coordinating center at Peking University Clinical Research Institute, after the baseline survey completed.
All participants will be followed up for blood pressure measurements at 6, 12, 18 and 24 months, for serum potassium at 12 and 24 months, and for 24-hr urine collection at 24 months.
Study outcomes:
Primary outcome: The change in systolic blood pressure from baseline to follow-up.
Secondary outcomes: The incidence of hyponatremia, hyperkalemia, hypokalemia and renal dysfunction from the baseline to 24 months. The change in 24-hr urinary sodium, potassium and microalbumin from the baseline to 24 months. The change in diastolic blood pressure from baseline to follow-up. The incremental cost-effectiveness ratio (ICER). The incidence of cardiovascular events and all causes death during follow up.
Power analysis:
On the assumptions of a 20% dropout rate, an intraclass correlation of 0.02, the number of clusters of 48 and at least 20 elderly people in each nursing home, and an α value of 0.05, the study to detect a mean 3.0 mmHg reduction in systolic blood pressure (SD, 18 mm Hg) between the intervention groups would have a power of 0.81. To detect a 4.0 mmHg reduction in systolic blood pressure (SD, 18 mm Hg), the power of the same sample size would be 0.96.
Statistical analysis: Linear models adjusted for clustering based on participants with available measures were used to assess continuous outcomes. Frailty survival models that account for clustering based upon all randomised participants were used for analysis of the effects on cardiovascular and mortality outcomes. Generalized linear mixed model were used for analysis of effects on hyperkalemia, hypokalemia, hyponatremia and renal dysfunction..
Ethical considerations:
The study will be submitted to and approved by the Peking University IRB, which has the full accreditation from AAHRRP. The study salt substitute is the product available on Chinese market and has been approved manufactured according to the product standards issued by the ministry of health. The SSSC approach will take every step for 3 months and the biggest step of salt reduction will be just 10% of the original amount of use. And the study will ensure an interview will be conducted to collect the feedback before every next step will take place. The SSSC intervention will stop at any time that elderly people feel unlike the foods.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Shanxi
-
Jincheng, Shanxi, China
- Mishan Nursing Home
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Eligibility of nursing homes:
- To be eligible, the nursing home must has not participated in any salt reduction or other intervention trials, has at least 20 residents and has agreed to participate in the study.
Eligibility of individual elderly:
Inclusion Criteria:
- Living in the nursing home permanently or expectedly for the coming two years
- Age less than 55 years.
- Life expectancy over six months.
- Provide written informed content.
Exclusion Criteria:
- Clinically confirmed hyperkalemia
Study Plan
How is the study designed?
Design Details
- Primary Purpose: PREVENTION
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: SINGLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: SS+SSSC
Salt substitute plus stepwise salt supply control
|
Replace regular salt with market available potassium-enriched salt substitute in kitchens of nursing homes.
Other Names:
A stepwise approach to reduce salt used in the kitchen of nursing homes by controlling the supply of salt.
Other Names:
|
EXPERIMENTAL: SS only
Salt substitute only
|
Replace regular salt with market available potassium-enriched salt substitute in kitchens of nursing homes.
Other Names:
|
EXPERIMENTAL: SSSC only
Stepwise salt supply control only
|
A stepwise approach to reduce salt used in the kitchen of nursing homes by controlling the supply of salt.
Other Names:
|
NO_INTERVENTION: control
No salt substitute and no stepwise salt supply control
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The change in systolic blood pressure from baseline to follow-up
Time Frame: baseline、6 month、12 month、18 month and 24-month follow-up
|
mmHg
|
baseline、6 month、12 month、18 month and 24-month follow-up
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The incidence of hyperkalemia
Time Frame: throughout 24 months of follow-up
|
A new case of hyperkalemia is defined as having serum potassium >5.5 mmol/L at either month 12 or 24 among participants with normal serum potassium at the baseline, regardless of clinical manifestations.
|
throughout 24 months of follow-up
|
The incidence of hypokalemia
Time Frame: throughout 24 months of follow-up
|
A new case of hypokalemia is defined as having serum potassium <3.5 mmol/L at either month 12 or 24 among participants with normal serum potassium at the baseline, regardless of clinical manifestations.
|
throughout 24 months of follow-up
|
The change in 24-hour urinary sodium and potassium
Time Frame: baseline and 24-month follow-up
|
mmol/d
|
baseline and 24-month follow-up
|
The change in 24-hour urinary microalbumin
Time Frame: baseline and 24-month follow-up
|
mg/day
|
baseline and 24-month follow-up
|
The change in diastolic blood pressure from baseline to follow-up
Time Frame: baseline、6 month、12 month、18 month and 24-month follow-up
|
mmHg
|
baseline、6 month、12 month、18 month and 24-month follow-up
|
ICER
Time Frame: throughout 24 months of follow-up
|
Incremental cost-effectiveness ratio, defined by the difference in the cost for every unit of gain in the pertained effectiveness outcome
|
throughout 24 months of follow-up
|
Cardiovascular events
Time Frame: throughout 24 months of follow-up
|
fatal and nonfatal stroke, fatal and nonfatal myocardial infarction, hospitalization for congestive heart failure
|
throughout 24 months of follow-up
|
Death
Time Frame: throughout 24 months of follow-up
|
all causes death
|
throughout 24 months of follow-up
|
The incidence of hyponatremia
Time Frame: throughout 24 months of follow-up
|
A new case of hyponatremia is defined as having serum sodium <135 mmol/L at either 12 or 24 months with normal serum sodium at the baseline, regardless of clinical manifestations.
|
throughout 24 months of follow-up
|
The incidence of renal dysfunction
Time Frame: throughout 24 months of follow-up
|
A new case of renal dysfunction is defined as having eGFR <60 at either 12 or 24 months with normal eGFR at the baseline, regardless of clinical manifestations.
|
throughout 24 months of follow-up
|
Collaborators and Investigators
Publications and helpful links
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- 2016YFC130020302
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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