Chronic kidney disease (CKD) affects approximately 12 to 15% of adults worldwide, with an increasing incidence expected. Major causes include diabetic nephropathy, hypertension, and various glomerulonephritis. Proteinuria is a key factor in identifying and assessing the risk of CKD progression.
The precise pathophysiology of CKD is not fully understood, but recent research highlights metabolic alterations, particularly in lipid and glucose metabolism. CKD progression is influenced by diet, as evidenced by recent studies. Interventions such as the ketogenic diet and time-restricted feeding show promising results in improving metabolism and may have beneficial effects on CKD.
Our study aims to evaluate the impact of time-restricted eating (TRE) on proteinuria, the decline in glomerular filtration rate, and weight loss in patients with moderate CKD with albuminuria (KDIGO stage 2-3). This will allow us to better understand the efficacy of this dietary approach tailored to the individual habits of participants.
The primary outcome measure will be albuminuria before and after the 12-week intervention. Secondary outcome measures will include the impact of fasting on blood pressure as assessed by 24-hour ambulatory monitoring, body composition evaluated by DXA and BIA, continuous glucose monitoring, and blood hormone profiles. Additionally, the feasibility and safety of TRE in this population will be assessed.
Clinical criteria
Adult men and women
Chronic Kidney Disease with KDIGO stage G2 and G3 defined by a Glomerular Filtration Rate between 30 and 90 mL/min/1.73m2
Albuminuria stage A2 or A3, but without nephrotic-range proteinuria: 3 to 200 mg/mmol
Clinical criteria
Pregnant and breastfeeding women, plans for maternity during the study
Eating disorder(s)
Other diets: low-carb, ketogenic diet, hypocaloric diets (eviction for food intolerances, vegan/vegetarian diet are not excluded)
Parallel
Time-restricted eating
BehavioralParticipants will be advised to consume meals and calorie-containing drinks only during a window of 8 hours, to be self-selected by the participant and advised by the investigators based on their daily routine and eating habits during the run-in phase.
Active control
BehavioralParticipants will be advised to keep the same eating rhythm and timing of meals per day during the intervention.
Change in urine albumin/creatinine ratio (UACR)
Measured by 24h urine collection
Change in creatinine- and cystatin-estimated glomerular filtration rate (eGFR)
Measured in clinical chemistry
Change in blood pressure
Measured by 24h ambulatory blood pressure monitoring (ABPM)
Change in systolic and diastolic blood pressure
Measured with an arm cuff in the sitting position
Change in body fat mass and regional distribution
Measured by dual-energy X-ray absorptiometry (DXA)
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de Seigneux Sophie
Lead sponsor
University Hospital, Geneva
Sponsor institution
University Hospital, Geneva
Collaborator
