Clinical Research Directory

Inclusion Criteria: * The presence of nephrotic range proteinuria (\> 3 g/d proteinuria by 24hr urine protein, 24hr urine albumin, spot urine protein/creatinine ratio, or spot urine albumin/creatinine ratio) or stage 4 or 5 chronic kidney disease (estimated glomerular filtration rate \< 30 mL/min/1.73 m2 by Modification of Diet in Renal Disease equation) PLUS * Clinical signs of hypervolemia present (lower extremity edema, ascites, or pleural effusions) with an estimated dry weight (defined as edema-free weight without orthostatic hypotension) 5 lbs less than enrollment body weight Exclusion Criteria: * Weight \< 100 lbs or \> 300 lbs. * Autonomic insufficiency resulting in orthostatic hypotension at screening * Hypokalemia at enrollment (defined as serum potassium \< 3.5 mmol/L) * Moderate to severe hyponatremia at enrollment (defined as serum sodium \< 130 mmol/L) * Serum creatinine \> 6 mg/dL or \> 1.5 times baseline * Patients who are unable or unwilling to measure their home blood pressures and weights * Patients without a working phone number and smart phone device * Expectation that the patient will require dialysis initiation within \< 3 months * Expected lifespan of \< 6 months * The presence of a medical condition that would interfere with effectively using the Diuretic Tuner (dementia, illiteracy, or blindness) * Pregnant patients * Prisoners