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

Yvette Meuleman, Tiny Hoekstra, Friedo W. Dekker, Gerjan Navis, Liffert Vogt, Paul J.M. van der Boog, Willem Jan W. Bos, Gert A. van Montfrans, Sandra van Dijk, ESMO study group

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Background To evaluate the effectiveness and sustainability of self-managed sodium restriction in patients with chronic kidney disease. Study Design Open randomized controlled trial. Setting & Participants Patients with moderately decreased kidney function from 4 hospitals in the Netherlands. Intervention Regular care was compared with regular care plus an intervention comprising education, motivational interviewing, coaching, and self-monitoring of blood pressure (BP) and sodium. Outcomes Primary outcomes were sodium excretion and BP after the 3-month intervention and at 6-month follow-up. Secondary outcomes were protein excretion, kidney function, antihypertensive medication, self-efficacy, and health-related quality of life (HRQoL). Results At baseline, mean sodium excretion rate was 163.6 ± 64.9 (SD) mmol/24 h; mean estimated glomerular filtration rate was 49.7 ± 25.6 mL/min/1.73 m2; median protein excretion rate was 0.8 (IQR, 0.4-1.7) g/24 h; and mean 24-hour ambulatory systolic and diastolic BPs were 129 ± 15 and 76 ± 9 mm Hg, respectively. Compared to regular care only (n = 71), at 3 months, the intervention group (n = 67) showed reduced sodium excretion rate (mean change, −30.3 [95% CI, −54.7 to −5.9] mmol/24 h), daytime ambulatory diastolic BP (mean change, −3.4 [95% CI, −6.3 to −0.6] mm Hg), diastolic office BP (mean change, −5.2 [95% CI, −8.4 to −2.1] mm Hg), protein excretion (mean change, −0.4 [95% CI, −0.7 to −0.1] g/24h), and improved self-efficacy (mean change, 0.5 [95% CI, 0.1 to 0.9]). At 6 months, differences in sodium excretion rates and ambulatory BPs between the groups were not significant, but differences were detected in systolic and diastolic office BPs (mean changes of −7.3 [95% CI, −12.7 to −1.9] and −3.8 [95% CI, −6.9 to −0.6] mm Hg, respectively), protein excretion (mean changes, −0.3 [95% CI, −0.6 to −0.1] g/24h), and self-efficacy (mean change, 0.5 [95% CI, 0.0 to 0.9]). No differences in kidney function, medication, and HRQoL were observed. Limitations Nonblinding, relatively low response rate, and missing data. Conclusions Compared to regular care only, this self-management intervention modestly improved outcomes, although effects on sodium excretion and ambulatory BP diminish over time.

Original languageEnglish
Pages (from-to)576-586
Number of pages11
JournalAmerican Journal of Kidney Diseases
Issue number5
Publication statusPublished - 1 May 2017

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