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Background Little is known about the effects of phosphorus additives on patients with kidney disease. Study Design Randomized, double-blind, cross-over trial Setting & Participants 31 adults with early stages of presumed chronic kidney disease (estimated glomerular filtration rate [eGFR] ≥ 45 ml/min/1.73m2; urine albumin-creatinine ratio [ACR] sex-specific cut points: men ≥ 17 mg/g, women ≥ 25 mg/g). Intervention Higher vs lower phosphorus intake for 3 weeks. Higher phosphorus intake was achieved by addition of commercially available diet beverages and breakfast bars to diet. Outcomes Change in 24-hour urine albumin excretion and plasma fibroblast growth factor 23 Measurements Two 24-hour urine collections and a single fasting blood draw at the end of each period. Results Mean baseline values of phosphorus intake, 24-hour urine phosphorus excretion, and eGFR were 1113 ± 549 (SD) mg/d, 688 ± 300 mg/d, and 74.6 ± 22.0 ml/min/1.73m2. Median albuminuria was 82.7 (IQR, 39.6–174.1) mg/d. While phosphorus intake from study products increased by 993 mg/d (p<0.001) during the higher compared to lower phosphorus additive period, background phosphorus intake decreased by 151 mg/d (p=0.004). Higher phosphorus additive consumption increased 24-hour urine phosphorus excretion by 505 (95% CI, 381–629) mg/d (p<0.001), but did not significantly increase albuminuria (higher vs lower: 14.3%; 95% CI, −2.5% to 34.0%; p=0.1) or fibroblast growth factor 23 (higher vs lower: 3.4%; 95% CI, −5.9% to 13.6%; p=0.4). Limitations Small sample size, short duration of intervention, changes in background diet during the intervention Conclusions A 3-week consumption of higher phosphorus food additives did not significantly increase albuminuria. Further studies are needed to confirm these results.

Background: Despite the importance of healthy diet for cardiovascular (CVD) health, the vast majority of patients with chronic kidney disease (CKD) do not receive dietitian counseling or make dietary modifications. Evidence for using dietary apps and tele-counseling to improve CVD risk factors is limited. Methods: We examined the effects of dietary app-supported tele-counseling on sodium intake and diet quality in 44 patients with type 2 diabetes and stage 1-3a CKD. Patients recorded and shared dietary data via MyFitnessPal with registered dietitians, who used motivational interviewing to provide telephone counseling weekly for 8 weeks. Outcomes included 24-hour urine sodium (2 collections per timepoint), Healthy Eating Index (HEI) 2015 score (multiple 24-hour dietary recalls per timepoint), 24-hour systolic blood pressure (SBP), and 24-hour urine albumin excretion. We report interim results for patients who completed 8-week and 6-month data collection; final outcome data at 12 months will be completed in November 2018. Results: Out of 44 consented patients (mean age 60.3 ± 11.9 y, 43% female, 93% white, 20% <$25,000 annual income, 84% hypertension), 32 (73%) completed 8-week follow-up and 29 (66%) completed 6-month follow-up. While 78% owned a smartphone, 52% entered dietary data using a computer. Among patients who completed 6-month follow-up, sodium excretion did not significantly decrease from baseline to 8 weeks (-345 mg/d, 95% CI: -865, 175) or 6 months: (-182 mg/d, CI: -460, 97) (Table) . However, HEI-2015 score improved by 3.19 (CI: 0.51-5.87) at 8 weeks and 7.21 (CI: 3.07, 11.3) at 6 months; 24-hour SBP improved by -3.7 (CI: -7.4, 0.1) at 8 weeks and by -4.9 (CI: -8.8, -0.9) at 6 months. Conclusions: An app-supported tele-counseling program with a registered dietitian appears to be a feasible strategy to improve dietary quality and blood pressure, even in patients with diabetes and early CKD. Sodium is ubiquitous in the food supply and hard to change at the individual level. Studies to demonstrate efficacy are needed.

Background: Prader-Willi Syndrome (PWS) is the most common genetic cause of obesity. Various dietary strategies have been used for weight management for people with PWS. Methods: This was a clinical feasibility study to test the use of the Modified Atkins Diet (low carbohydrate and high fat) for children with PWS ages 6-12 years who were overweight/obese. Participants went on the Modified Atkins Diet for 4 months and then returned to have anthropometry repeated including repeat labs and behavior questionnaires. Results: Seven children (ages 6-12) were enrolled in the study. Four participants completed the 4-month diet trial; two were unable to comply with the diet and stopped prematurely. One patient lost 2.9 kg; the others maintained their weight. Adverse effects were increases in LDL (expected based on larger studies) and hypercalciuria (with no renal stones) for one patient. Positive effects on hyperphagia and behavior were noted subjectively by families. Conclusion: The Modified Atkins Diet can be a feasible low carbohydrate option for children with Prader-Willi Syndrome for weight management. Long-term use of the diet in patients with Prader-Willi Syndrome needs to be studied further.

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