Association of a reduction in central obesity and phosphorus intake with changes in urinary albumin excretion: The PREMIER study


Background: Excess adiposity and dietary factors may be important determinants of urinary albumin excretion (UAE). Study Design: Observational analysis of PREMIER, a randomized trial designed to lower blood pressure using behavioral interventions (counseling on weight loss, healthy diet, and exercise). Setting & Participants: 481 participants with normal kidney function who provided adequate 24-hour urine collections at baseline and 6 months. Predictors: Change in waist circumference; 24-hour urine sodium, potassium, and phosphorus excretion; and protein intake estimated from urea nitrogen. Outcomes & Measurements: The primary outcome was change in log-transformed 24-hour UAE over 6 months. Results: After 6 months, the proportion of individuals with UAE ≥10 mg/d decreased from 18.7% to 12.7% (P < 0.001). Changes in mean waist circumference (-4.2 ± 6.6 [SD] cm), 24-hour excretion of sodium (-28.2 ± 71.7 mmol/d), potassium (+8.4 ± 27.8 mmol/d), phosphorus (-27.7 ± 314.1 mg/d), and protein intake (-1.7 ± 19.4 g/d) were observed. After adjustment for relevant covariates, the following variables were associated significantly with reduction in ln(UAE) in separate models: decrease in waist circumference (P = 0.001), decrease in 24-hour urine phosphorus excretion (P < 0.001), and decrease in protein intake (P = 0.01). In a multivariable model including these 3 predictors, decreases in waist circumference (P = 0.002) and 24-hour urine phosphorus excretion (P = 0.03), but not change in protein intake (P = 0.5), remained associated significantly with reduction in ln(UAE). These associations remained significant even after adjustment for changes in blood pressure and insulin resistance. Baseline UAE and metabolic syndrome modified the relationship of waist circumference with ln(UAE); specifically, individuals with higher UAE and baseline metabolic syndrome experienced greater reductions in ln(UAE) from decreases in waist circumference. Limitations: Observational study with potential for confounding. Conclusions: In adults with normal kidney function, decreases in waist circumference and 24-hour urine phosphorus excretion are associated with reductions in UAE. These findings support the rationale for clinical trials to determine whether reducing dietary phosphorus intake or waist circumference could prevent chronic kidney disease or slow its progression. © 2013 National Kidney Foundation, Inc.






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Publication Info

Chang, Alex, Bryan C Batch, Heather L McGuire, William M Vollmer, Laura P Svetkey, Crystal C Tyson, Anawin Sanguankeo, Cheryl Anderson, et al. (2013). Association of a reduction in central obesity and phosphorus intake with changes in urinary albumin excretion: The PREMIER study. American Journal of Kidney Diseases, 62(5). pp. 900–907. 10.1053/j.ajkd.2013.04.022 Retrieved from

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Bryan Courtney Batch

Professor of Medicine

Type 2 Diabetes, Obesity/Overweight, Behavior change, Non-pharmacologic intervention, Health disparities


Laura Pat Svetkey

Professor of Medicine

Laura P. Svetkey, MD MHS is Professor of Medicine/Nephrology, Vice Chair for Faculty Development and Diversity in the Department of Medicine. She is also the Director of Duke’s CTSA-sponsored internal career development award program (KL2) and the Associate Director of Duke’s REACH Equity Disparities Research Center, in which she also leads the Investigator Development Core.

Dr. Svetkey has over 30 years of experience in the investigation of hypertension, obesity, and related areas, conducting NIH-sponsored clinical research ranging from behavioral intervention trials to metabolomics and genetics, with a consistent focus on prevention, non-pharmacologic intervention, health disparities and minority health. Her research has affected national guidelines, having served on the 2013 national Hypertension Guideline Panel (JNC) and the Lifestyle Guideline Working Group. She is an American Society of Hypertension certified hypertension specialist, and a member of the Association of American Physicians (AAP). She is the Associate Director, Core Director and Project PI of Duke’s NIH-sponsored REACH Equity Disparities Research Center (PI: Kimberly Johnson).

As Department of Medicine Vice Chair for Faculty Development and Diversity, she implements a wide range of programs to enhance the experience and advancement of faculty and trainees, with particular emphasis on those from racial and ethnic groups under-represented in medicine, and women.


Crystal Cenell Tyson

Assistant Professor of Medicine

As a board-certified nephrologist and a certified clinical hypertension specialist (ASH-SCH), I take care of patients with kidney disorders and/or high blood pressure. Patients with chronic kidney disease and high blood pressure have an increased risk for developing complications of cardiovascular disease, such as heart attacks, congestive heart failure, strokes, kidney failure requiring dialysis or a kidney transplant, and a shortened lifespan. My clinical focus is to slow the progression of chronic kidney disease and reduce complications from cardiovascular disease with lifestyle modification. I particularly enjoy treating patients with severe or difficult to control high blood pressure by focusing on finding an effective medication regimen that provides the least side effects, eliminating ineffective medications, simplifying medication schedules, and promoting healthy lifestyle behavior. I see patients 2 days per week in the Duke Nephrology Clinic and the Duke Nephrology Hypertension Clinic.

My research interests are to reduce racial and health disparities among patients with hypertension and chronic kidney disease using lifestyle modifications. My past and current research investigates the effects of diet (i.e., the DASH diet, sodium reduction), exercise, and weight loss on blood pressure and kidney function, as well as the effect of bilateral renal artery denervation on blood pressure.

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