A Self-management Approach for Dietary Sodium Restriction in Patients With CKD: A Randomized Controlled Trial

摘要

Rationale Objective: Patients with chronic kidney disease (CKD) are particularly sensitive to dietary sodium. We evaluated a self-management approach for dietary sodium restriction in patients with CKD.Study Design: Randomized controlled trial.Setting Participants: Nephrology outpatient clinics in 4 Dutch hospitals. 99 adults with CKD stages 1 to 4 or a functioning (estimated glomerular filtration rate >= 25 mL/min/1.73 m(2)) kidney transplant, hypertension, and sodium intake >130 mmol/d.Intervention: Routine care was compared with routine care plus a web-based self-management intervention including individual e-coaching and group meetings implemented over a 3-month intervention period, followed by e-coaching over a 6-month maintenance period.Outcomes: Primary outcomes were sodium excretion after the 3-month intervention and after the 6-month maintenance period. Secondary outcomes were blood pressure, proteinuria, costs, quality of life, self-management skills, and barriers and facilitators for implementation.Results: Baseline estimated glomerular filtration rate was 55.0 +/- 22.0 mL/min/1.73 m(2). During the intervention period, sodium excretion decreased in the intervention group from 188 +/- 8 (SE) to 148 +/- 8 mmol/d (P Limitations: Limited power, postrandomization loss to follow-up, Hawthorne effect, lack of dietary data, short-term follow-up.Conclusions: A coaching intervention reduced sodium intake at 3 months. Efficacy during the maintenance phase was diminished, possibly due to inadvertent adoption of the intervention by the control group.