The chronic kidney disease Water Intake Trial (WIT): results from the pilot randomised controlled trial

William F Clark, Jessica M Sontrop, Shih-Han Huang, Kerri Gallo, Louise Moist, Andrew A House, Matthew A Weir, Amit X Garg, William F Clark, Jessica M Sontrop, Shih-Han Huang, Kerri Gallo, Louise Moist, Andrew A House, Matthew A Weir, Amit X Garg

Abstract

Background and objectives: Increased water intake may benefit kidney function. Prior to initiating a larger randomised controlled trial (RCT), we examined the safety and feasibility of asking adults with chronic kidney disease (CKD) to increase their water intake.

Design, setting, participants and measurements: Beginning in October 2012, we randomly assigned 29 adults with stage 3 CKD (estimated glomerular filtration rate (eGFR) 30-60 mL/min/1.73 m(2) and albuminuria) to one of the two groups of water intake: hydration (n=18) or standard (n=11). We asked the hydration group to increase their water intake by 1.0-1.5 L/day (in addition to usual intake, depending on sex and weight) for 6 weeks, while the control group carried on with their usual intake. Participants collected a 24 h urine sample at baseline and at 2 and 6 weeks after randomisation. Our primary outcome was the between-group difference in change in 24 h urine volume from baseline to 6 weeks.

Results: (63%)of participants were men, 81% were Caucasians and the average age was 61 years (SD 14 years). The average baseline eGFR was 40 mL/min/1.73 m(2) (SD 11 mL/min/1.73 m(2)); the median albumin to creatinine ratio was 19 mg/mmol (IQR 6-74 mg/mmol). Between baseline and 6-week follow-up, the hydration group's average 24 h urine volume increased by 0.7 L/day (from 2.3 to 3.0 L/day) and the control group's 24 h urine decreased by 0.3 L/day (from 2.0 to 1.7 L/day; between-group difference in change: 0.9 L/day (95% CI 0.4 to 1.5; p=0.002)). We found no significant changes in urine, serum osmolality or electrolyte concentrations, or eGFR. No serious adverse events or changes in quality of life were reported.

Conclusions: A pilot RCT indicates adults with stage 3 CKD can successfully and safely increase water intake by up to 0.7 L/day in addition to usual fluid intake. TRIAL REGISTRATION REGISTERED WITH CLINICAL TRIALSGOVERNMENT IDENTIFIER: NCT01753466.

Keywords: EPIDEMIOLOGY; INTERNAL MEDICINE.

Figures

Figure 1
Figure 1
Flow diagram of participant selection and follow-up.
Figure 2
Figure 2
Change in 24 h urine volume after randomisation to hydration or control intervention.
Figure 3
Figure 3
Correlation between 24 h urine volume and self-reported fluid intake 2 weeks after randomisation (r=Pearson's correlation coefficient).

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