Журнал "Почки" том 10, №2

Òåìà íîìåðà / Cover Story
Materials and methods
We analyzed the data of CKD WIT, CKD-REIN [3, 5],
and ECIWIC [4] trials for CKD 1–2, adding the data of a
randomized clinical parallel-group trial of CKD WIT conducted
in patients with CKD G3 and HYD45 conducted
in patients with CKD G4–5 during 12 months. All patients
at each stage were divided into two groups: 1) coaching to
increase water intake, 2) coaching to maintain water intake.
The primary outcome was the change in kidney function
by eGFR from baseline to 12 months. The secondary
outcome was a 1-year change in urine RFR. The subjective
assessment of the quality of health (QH) has been estimated.
CIWI aimed to achieve the diuresis of 1.7–2 L.
Overall outcomes were assessed at 0, 6 and 12 months of
the trial. RFR was evaluated using 0.45% sodium chloride
oral solution.
Results and discussion
CIWI may help preserve renal function loss and decline
of eGFR in CKD G1 and G2 but isn’t beneficial in CKD
G3–5 [3–5] (Fig. 1).
Of 124 patients randomized (mean age 53.2 years; men
83 (67 %)), no one died; mean change in 24-hour urine volume
was 0.6 L per day in CKD G1 group with CIWI and
0.5 L in G2.
No statistically significant data on eGFR depending
on CIWI were obtained (Table 1). However, the trend suggests
that CIWI improves eGFR in CKD G1 (from 95 to
96 ml/min/1.73 m 2 ) and preserves eGFR decline in CKD
G2 (78–78). Although coaching to maintain the same water
intake didn’t preserve physiological and pathological eGFR
decreasing in CKD G1–2 (G1 from 96 to 93, G2 from 76 to
73; t = 0.6; p = 0.29; P 0.05 for all groups).
An individual analysis of the RFR has shown that patients
with RFR more than 50 % (G1 — 19 patients (61 %), G2 —
13 patients (42 %)) had reliable preservation of eGFR with its
increase of 1.5 ml/min/1.73 m 2 on CIWI, while patients with
low functional renal reserve had a drop of eGFR at 1.1 ml/
min/1.73 m 2 within 12 months. Patients with low normal serum
sodium levels have shown worse results on CIWI.
The reduction of albumin-to-creatinine ratio does not
depend on the eGFR but strongly correlates with RFR (CC
0.81). Patient-reported overall QH has been insignificantly
higher in CIWI groups.
The randomized clinical parallel-group trial CKD WIT
for CKD stage 3 analyzed 631 patients. Our randomized
Intervention
CKD G1,
n = 62
Figure 1. The effectiveness of CIWI in CKD G1 and G2
Table 1. Changes in eGFR in CKD 1–5 (mL/min/1.73 m 2 )
CKD G2,
n = 62
CKD G3,
n = 631
CKD stage
CKD G4–5,
n = 62
With CIWI +1.2 0 –2.2 –3.3
Without CIWI –3.0 –3.2 –1.9 –2.1
RR G1-G5
1.419
(95% CI 0.619–3.255, NNT 9.5)
0.341
(95% CI 0.136–0.854, NNT 5.0)
Òîì 10, ¹ 2, 2021
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