Sodium Restriction in Patients With CKD: A Randomized Controlled Trial of Self-management Support

Factors influencing low sodium intake in people with non-dialysis dependent chronic kidney disease. Journal of Renal Care 46(2), 95-105. S U M M A R Y Objective: To evaluate dietary sodium intake in people with chronic kidney disease (CKD) and identify contributing factors to low sodium intake by applying the Theory of Planned Behaviour (TPB) framework. Design and Methods: Non-dialysed people with CKD completed a 24-hour urinary sodium excretion test and Scored Salt Questionnaire (SSQ). A survey including socio-demographic information, Brief Illness Perception Questionnaire, Short Sodium Knowledge Survey and Dietary Sodium Restriction Questionnaire based on TPB measured the factors contributing to dietary adherence. Results: Sixty-three people [age: 71 (IQR: 64-77); 27% female] participated with 80% having high urinary sodium excretion [median: 134 mmol/day (111; 183)] but only 40% reported high sodium intake [SSQ score = 53 (39 ; 75)]. Overall sodium knowledge was high in 57% of participants although only 33% had seen a dietitian. There was a positive correlation between attitude towards a low-sodium diet and subjective norm (social expectations), r = 0.44, p < 0.01; urinary sodium and the extent of perceived consequences of CKD (r = 0.26, p < 0.05); and the extent to which willpower was perceived as a barrier to adherence to dietary sodium restriction (r = 0.27, p < 0.05). Multiple regression analysis revealed taste of low-salt foods (β = 8.9, p < 0.01) explained 26.4% of variance in dietary sodium intake (R 2 = 0.264, F(12, 34), p < 0.01). Conclusion: TPB successfully identified barriers to follow a low-sodium diet in non-dialysed people with CKD. Taste preferences, willpower, meeting social expectations and disease concern were identified as key contributing factors to adherence. K E Y W O R D S Chronic kidney disease ⦁ Dietary adherance ⦁ Salt intake ⦁ Theory of planned behaviour

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“…; Meuleman et al . ). In the current study, only a third of participants had seen a dietitian before.…”

Section: Discussionmentioning

confidence: 97%

Factors Influencing Low Sodium Intake in People with Non‐Dialysis Dependent Chronic Kidney Disease

Wright

Kickbusch

Swanepoel

et al. 2019

Journal of Renal Care

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“…We could only get a 24 h-ABPM in a small subset of patients followed only by PCPs and our statement about similar BP control in the two groups should be accepted with caution. Although we recommend dietary advice in our guidelines, no real emphasis was put on low-protein diets supplemented with ketoanalogues or very low-sodium diet and these interventions have been proven powerful on the short-term to delay progression to ESRD [39,40].…”

Section: Discussionmentioning

confidence: 99%

Impact of superimposed nephrological care to guidelines-directed management by primary care physicians of patients with stable chronic kidney disease: a randomized controlled trial

et al. 2020

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Background: Optimal clinical care of patients with chronic kidney disease (CKD) requires collaboration between primary care physicians (PCPs) and nephrologists. We undertook a randomised trial to determine the impact of superimposed nephrologist care compared to guidelines-directed management by PCPs in CKD patients after hospital discharge. Methods: Stage 3b-4 CKD patients were enrolled during a hospitalization and randomised in two arms: Comanagement by PCPs and nephrologists (interventional arm) versus management by PCPs with written instructions and consultations by nephrologists on demand (standard care). Our primary outcome was death or rehospitalisation within the 2 years post-randomisation. Secondary outcomes were: urgent renal replacement therapy (RRT), decline of renal function and decrease of quality of life at 2 years. Results: From November 2009 to the end of June 2013, we randomised 242 patients. Mean follow-up was 51 + 20 months. Survival without rehospitalisation, GFR decline and elective dialysis initiation did not differ between the two arms. Quality of life was also similar in both groups. Compared to randomised patients, those who either declined to participate in the study or were previously known by nephrologists had a worse survival. Conclusion: These results do not demonstrate a benefit of a regular renal care compared to guided PCPs care in terms of survival or dialysis initiation in CKD patients. Increased awareness of renal disease management among PCPs may be as effective as a co-management by PCPs and nephrologists in order to improve the prognosis of moderate-to-severe CKD. Trial registration: This study was registered on June 29, 2009 in clinicaltrials.gov (NCT00929760) and adheres to CONSORT 2010 guidelines.

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“…In the cross-over study of Saran et al [45], in which 58 patients were advised to reduce sodium intake for 4 weeks; a decrease of 1.3 g sodium resulted in a decrease of 10.8 mm Hg in systolic BP, without impacting albuminuria. Meuleman et al [46] compared patients in regular follow-up for over 6 months with those who received additional intervention with a focus on education, motivational interview, coaching and self-monitoring of BP and sodium consumption. They found modest improvement in outcomes after the first 3 months (sodium excretion, BP, and proteinuria), which decreased the follow-up time [46].…”

Section: Impact Of Sodium Intake Lowering and CV And Kidney Disease Riskmentioning

confidence: 99%

“…Meuleman et al [46] compared patients in regular follow-up for over 6 months with those who received additional intervention with a focus on education, motivational interview, coaching and self-monitoring of BP and sodium consumption. They found modest improvement in outcomes after the first 3 months (sodium excretion, BP, and proteinuria), which decreased the follow-up time [46]. Thus, although effective in improving the control of risk factors for renal and cardiovascular outcomes in short periods, the clinical practice also shows that the adherence to a low-sodium diet for longer periods is a huge challenge for medical staff and patients.…”

Section: Impact Of Sodium Intake Lowering and CV And Kidney Disease Riskmentioning

confidence: 99%

Sodium Intake and Blood Pressure in Patients with Chronic Kidney Disease: A Salty Relationship

Nerbass¹,

Calice‐Silva²,

Pécoits-Filho³

2018

Blood Purif

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Background: Hypertension affects almost all chronic kidney disease patients and is related to poor outcomes. Sodium intake is closely related to blood pressure (BP) levels in this population and decreasing its intake consistently improves the BP control particularly in short-term controlled trials. However, most patients struggle in following a controlled diet on sodium according to the guidelines recommendation due to several factors and barriers discussed in this article. Summary: This review article summarizes the current knowledge related to the associations between sodium consumption, BP, and the risk of cardiovascular disease and chronic kidney disease (CKD); it also provides recommendations of how to achieve sodium intake lowering. Key Messages: Evidences support the benefits in decreasing sodium intake on markers of cardiovascular and renal outcomes in CKD. Trials had shorter follow-up and to maintain long-term sodium intake control is a major challenge. Larger studies with longer follow-up looking at hard endpoints will be important to drive future recommendations.

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Sodium Restriction in Patients With CKD: A Randomized Controlled Trial of Self-management Support

Abstract: Compared to regular care only, this self-management intervention modestly improved outcomes, although effects on sodium excretion and ambulatory BP diminish over time.

Cited by 90 publications

References 38 publications

Factors Influencing Low Sodium Intake in People with Non‐Dialysis Dependent Chronic Kidney Disease

Factors Influencing Low Sodium Intake in People with Non‐Dialysis Dependent Chronic Kidney Disease

Impact of superimposed nephrological care to guidelines-directed management by primary care physicians of patients with stable chronic kidney disease: a randomized controlled trial

Sodium Intake and Blood Pressure in Patients with Chronic Kidney Disease: A Salty Relationship

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