A Coaching Program to Improve Dietary Intake of Patients with CKD

Abstract

Background and objectivesThe dietary self-management of CKD is challenging. Telehealth interventions may provide an effective delivery method to facilitate sustained dietary change.Design, setting, participants, & measurementsThis pilot, randomized, controlled trial evaluated secondary and exploratory outcomes after a dietitian-led telehealth coaching intervention to improve diet quality in people with stage 3–4 CKD. The intervention group received phone calls every 2 weeks for 3 months (with concurrent, tailored text messages for 3 months), followed by 3 months of tailored text messages without telephone coaching, to encourage a diet consistent with CKD guidelines. The control group received usual care for 3 months, followed by nontailored, educational text messages for 3 months.ResultsEighty participants (64% male), aged 62±12 years, were randomized to the intervention or control group. Telehealth coaching was safe, with no adverse events or changes to serum biochemistry at any time point. At 3 months, the telehealth intervention, compared with the control, had no detectable effect on overall diet quality on the Alternative Health Eating Index (3.2 points, 95% confidence interval, −1.3 to 7.7), nor at 6 months (0.5 points, 95% confidence interval, −4.6 to 5.5). There was no change in clinic BP at any time point in any group. There were significant improvements in several exploratory diet and clinical outcomes, including core food group consumption, vegetable servings, fiber intake, and body weight.ConclusionsTelehealth coaching was safe, but appeared to have no effect on the Alternative Healthy Eating Index or clinic BP. There were clinically significant changes in several exploratory diet and clinical outcomes, which require further investigation.Clinical Trial registry name and registration number: Evaluation of Individualized Telehealth Intensive Coaching to Promote Healthy Eating and Lifestyle in CKD (ENTICE-CKD), ACTRN12616001212448.

Telehealth for Home Dialysis in COVID-19 and Beyond: A Perspective From the American Society of Nephrology COVID-19 Home Dialysis Subcommittee

“…Studies have shown that dietitians using telemedicine platforms can successfully perform coaching programs for dietary counseling in CKD patients as well as diabetes management. [28,29] A regular virtual check-in with the social worker can permit discussions around emotional distress, caregiver burnout, and medical resource acquisition and management. These interdisciplinary visits performed virtually have been successfully performed in CKD programs and can be extended into PD programs.…”

Dietitians Australia position statement on telehealth

“…There is conflicting evidence reported in telephone‐delivered dietetic consultations studies for some diet‐related outcomes, including diet quality 26,28,41‐43 and sodium intake, 30,42,44 and changes in clinical variables including HbA1c, 25,26,28‐30 blood pressure, 25,28,29,34,36,42 lipid profiles 25,28‐30,34,36 and quality of life 26,39,42 . Larger RCTs are needed to confirm the effect of telephone‐delivered dietetic consultations for these outcomes.…”

Telehealth and Nutrition Support During the COVID-19 Pandemic

“…Telehealth visits have been used in multiple diseases to provide nutrition-related interventions. 17 , 18 , 19 Through this type of visit, RDNs can both obtain a thorough history and visualize a patient’s home environment. For example, an RDN providing gluten-free diet education might note that gluten-free flours are directly adjacent to wheat flours.…”