***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The effectiveness of salt restriction to lower blood pressure ( BP ) in Bangladeshi patients with chronic kidney disease ( CKD ) is uncertain . Objective To test the hypothesis that a tailored intervention intended to reduce salt intake in addition to st and ard care will achieve a greater reduction in BP in UK Bangladeshi patients with CKD than st and ard care alone . Design A r and omised parallel-group controlled trial conducted over a 6 month period . Setting A tertiary renal unit based in acute care hospital in East London . Participants 56 adult participants of Bangladeshi origin with CKD and BP > 130/80 mm Hg or on antihypertensive medication . Intervention Participants were r and omly allocated to receive a tailored low-salt diet or the st and ard low-salt advice .  BP medication , physical activity and weight were monitored . Main outcome measures The primary outcome was change in ambulatory BP . Adherence to dietary advice was assessed by measurement of 24 h urinary salt excretion . Results Of 56 participants r and omised , six withdrew at the start of the study . During the study , one intervention group participant died , one control group participant moved to Bangladesh . Data were available for the primary endpoint on 48 participants . Compared with control group the intervention urinary sodium excretion fell from 260 mmol/d to 103 mmol/d ( −131 to −76 , p<0.001 ) at 6 months and result ed in mean ( 95 % CI ) falls in 24 h systolic/diastolic BP of −8 mm Hg ( −11 to −5)/2 ( −4 to −2 ) both p<0.001 . Conclusions A tailored intervention can achieve moderate salt restriction in patients with CKD , result ing in clinical ly meaningful falls in BP independent of hypertensive medication . Trial Registration Clinical Trials.gov NCT00702312 Reduction of residual albuminuria during single-agent renin-angiotensin-aldosterone blockade is accompanied by improved cardiorenal outcomes in CKD . We studied the individual and combined effects of the vitamin D receptor activator paricalcitol ( PARI ) and dietary sodium restriction on residual albuminuria in CKD . In a multicenter , r and omized , placebo (PLAC)-controlled , crossover trial , 45 patients with nondiabetic CKD stages 1 - 3 and albuminuria > 300 mg/24 h despite ramipril at 10 mg/d and BP<140/90 mmHg were treated for four 8-week periods with PARI ( 2 μg/d ) or PLAC , each combined with a low-sodium ( LS ) or regular sodium ( RS ) diet . We analyzed the treatment effect by linear mixed effect models for repeated measurements . In the intention-to-treat analysis , albuminuria ( geometric mean ) was 1060 ( 95 % confidence interval , 778 to 1443 ) mg/24 h during RS + PLAC and 990 ( 95 % confidence interval , 755 to 1299 ) mg/24 h during RS + PARI ( P=0.20 versus RS + PLAC ) . LS + PLAC reduced albuminuria to 717 ( 95 % confidence interval , 512 to 1005 ) mg/24 h ( P<0.001 versus RS + PLAC ) , and LS + PARI reduced albuminuria to 683 ( 95 % confidence interval , 502 to 929 ) mg/24 h ( P<0.001 versus RS + PLAC ) . The reduction by PARI beyond the effect of LS was nonsignificant ( P=0.60 ) . In the per- protocol analysis restricted to participants with ≥95 % compliance with study medication , PARI did provide further albuminuria reduction ( P=0.04 LS + PARI versus LS + PLAC ) . Dietary adherence was good as reflected by urinary excretion of 174±64 mmol Na+ per day in the combined RS groups and 108±61 mmol Na+ per day in the LS groups ( P<0.001 ) . In conclusion , moderate dietary sodium restriction substantially reduced residual albuminuria during fixed dose angiotensin-converting enzyme inhibition . The additional effect of PARI was small and nonsignificant BACKGROUND AND OBJECTIVES Patients with chronic kidney disease ( CKD ) are often volume exp and ed and hypertensive . Few controlled studies have assessed the effects of a sodium-restricted diet ( SRD ) in CKD . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS We conducted a r and omized crossover trial to evaluate the effect of SRD ( target < 2 g sodium per day ) versus usual diet on hydration status ( by bioelectrical impedance spectroscopy ) and blood pressure ( BP ) between May of 2009 and May of 2013 . A total of 58 adults with stage 3 - 4 CKD were enrolled from two academic sites : University of Michigan ( n=37 ) and University of North Carolina at Chapel Hill ( n=21 ) ; 60 % were men , 43 % were diabetic , 93 % were hypertensive , and mean age was 61 years . Participants followed SRD or usual diet for 4 weeks , followed by a 2-week washout period and a 4-week crossover phase . During the SRD , dieticians provided counseling every 2 weeks , using motivational interviewing techniques . RESULTS Whole-body extracellular volume and calf intracellular volume decreased by 1.02 L ( 95 % confidence interval [ 95 % CI ] , -1.48 to -0.56 ; P<0.001 ) and -0.06 L ( 95 % CI , -0.12 to -0.01 ; P=0.02 ) , respectively , implying decreased fluid content on the SRD compared with usual diet . Significant reductions in urinary sodium ( -57.3 mEq/24 h ; 95 % CI , -81.8 to -32.9 ) , weight ( -2.3 kg ; 95 % CI , -3.2 to -1.5 ) , and 24-hour systolic BP ( -10.8 mmHg ; 95 % CI , -17.0 to -4.6 ) were also observed ( all P<0.01 ) . Albumin-to-creatinine ratio did not change significantly and mean serum creatinine increased slightly ( 0.1 mg/dl ; 95 % CI , -0.01 to 0.2 ; P=0.06 ) . No period or carryover effects were observed . Results were similar when analyzed from phase 1 only before crossover , although P values were modestly larger because of the loss of power . CONCLUSIONS In this r and omized crossover trial , implementation of SRD in patients with CKD stage 3 - 4 result ed in clinical ly and statistically significant improvement in BP and hydration status . This simple dietary intervention merits a larger trial in CKD to evaluate effects on major clinical outcomes BACKGROUND AND OBJECTIVES The antiproteinuric effect of a renin-angiotensin-aldosterone system blockade can be magnified by dietary salt restriction . This study sought to determine the effect of intensive low-salt diet education on BP and urine albumin excretion in nondiabetic patients with hypertension and albuminuria . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS This study was conducted between March of 2012 and March of 2013 as an open-label , r and omized , controlled trial . After a run-in period of 8 weeks , all patients received the angiotensin II receptor blocker olmesartan ( 40 mg daily ) . Patients were then divided into two groups . One group was treated for another 8 weeks with angiotensin II receptor blocker plus conventional low-salt diet education , and the other group was treated for 8 weeks with angiotensin II receptor blocker plus intensive low-salt diet education . The final analyses was performed with 245 completed patients . RESULTS The amount of daily albuminuria was significantly decreased from 0 ( 566.0 [ 25.0 - 5398.6 ] mg/d ) to 8 weeks ( 282.5 [ 16.1 - 4898.5 ] mg/d ; P<0.001 ) . From 8 to 16 weeks , the 24-hour urinary sodium excretion was decreased by 36.0±5.9 mmol/d in the intensive education group and 8.8±4.9 mmol/d in the conventional education group ( interaction P<0.001 ) . Patients who completed intensive low-salt diet education exhibited greater decreases in urinary albumin excretion than the control group ( change in albuminuria from 8 to 16 weeks , -154.0 versus 0.4 mg/d ; P=0.01 ) . Urinary albumin excretion tended to decrease as the 24-hour urinary sodium excretion amount decreased ( R=0.32 ; 95 % confidence interval , 0.20 to 0.43 ; P<0.001 ) . CONCLUSIONS The 24-hour urinary albumin excretion was decreased more in patients in the intensive low-salt diet education group than patients in the conventional education group . Weekly intensive education on a low-salt diet would be a suitable method for clinical practice Summary Information is limited regarding the efficacy of antihypertensive drugs in patients with hypertension associated with renal insufficiency . To address this question , a group of 14 out patients with essential hypertension and mild renal insufficiency received slow release verapamil 240 mg/day for 14 days after a 4-week washout period . Patients were r and omly assigned to a low ( 4 g/ day ) or high ( 11 g/day ) salt diet , and crossed over to the alternative diet after 7 days .  24-Hour blood pressure monitoring was performed at the end of the washout period and after 7 and 14 days during verapamil treatment . Verapamil induced a significant fall in mean 24-hour blood pressure that was similar for patients on both diets ( p < 0.01 ) . As expected , natriuresis increased significantly during high sodium intake ( p < 0.01 ) , and bodyweight fell significantly when sodium intake was reduced ( p < 0.05 ) . Meanwhile , serum creatinine and creatinine clearance remained stable . These results indicate that the antihypertensive effect of verapamil is independent of sodium intake even in the presence of mild renal insufficiency Objective To compare the effects on proteinuria and blood pressure of addition of dietary sodium restriction or angiotensin receptor blockade at maximum dose , or their combination , in patients with non-diabetic nephropathy receiving background treatment with angiotensin converting enzyme ( ACE ) inhibition at maximum dose . Design Multicentre crossover r and omised controlled trial . Setting Outpatient clinics in the Netherl and s. Participants 52 patients with non-diabetic nephropathy . Interventions All patients were treated during four 6 week periods , in r and om order , with angiotensin receptor blockade ( valsartan 320 mg/day ) or placebo , each combined with , consecutively , a low sodium diet ( target 50 mmol Na+/day ) and a regular sodium diet ( target 200 mmol Na+/day ) , with a background of ACE inhibition ( lisinopril 40 mg/day ) during the entire study . The drug interventions were double blind ; the dietary interventions were open label . Main outcome measures The primary outcome measure was proteinuria ; the secondary outcome measure was blood pressure . Results Mean urinary sodium excretion , a measure of dietary sodium intake , was 106 ( SE 5 ) mmol Na+/day during a low sodium diet and 184 ( 6 ) mmol Na+/day during a regular sodium diet ( P<0.001 ) . Geometric mean residual proteinuria was 1.68 ( 95 % confidence interval 1.31 to 2.14 ) g/day during ACE inhibition plus a regular sodium diet . Addition of angiotensin receptor blockade to ACE inhibition reduced proteinuria to 1.44 ( 1.07 to 1.93 ) g/day ( P=0.003 ) , addition of a low sodium diet reduced it to 0.85 ( 0.66 to 1.10 ) g/day ( P<0.001 ) , and addition of angiotensin receptor blockade plus a low sodium diet reduced it to 0.67 ( 0.50 to 0.91 ) g/day ( P<0.001 ) . The reduction of proteinuria by the addition of a low sodium diet to ACE inhibition ( 51 % , 95 % confidence interval 43 % to 58 % ) was significantly larger ( P<0.001 ) than the reduction of proteinuria by the addition of angiotensin receptor blockade to ACE inhibition ( 21 % , ( 8 % to 32 % ) and was comparable ( P=0.009 , not significant after Bonferroni correction ) to the reduction of proteinuria by the addition of both angiotensin receptor blockade and a low sodium diet to ACE inhibition ( 62 % , 53 % to 70 % ) . Mean systol 
    Output:
    
Moderate salt restriction significantly reduces BP and proteinuria/albuminuria  in patients with CKD ( Stage 1–4 )