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

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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
Volume69
Issue number5
DOIs
Publication statusPublished - 1 May 2017

Cite this

Meuleman, Yvette ; Hoekstra, Tiny ; Dekker, Friedo W. ; Navis, Gerjan ; Vogt, Liffert ; van der Boog, Paul J.M. ; Bos, Willem Jan W. ; van Montfrans, Gert A. ; van Dijk, Sandra ; ESMO study group. / Sodium Restriction in Patients With CKD : A Randomized Controlled Trial of Self-management Support. In: American Journal of Kidney Diseases. 2017 ; Vol. 69, No. 5. pp. 576-586.
@article{1882683c92d14597bbd8e77ac27d59b1,
title = "Sodium Restriction in Patients With CKD: A Randomized Controlled Trial of Self-management Support",
abstract = "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.",
keywords = "Behavior change, blood pressure, chronic kidney disease (CKD), dietary sodium intake, disease progression, health-related quality of life (HRQoL), hypertension, kidney function, lifestyle interventions, modifiable risk factor, nutrition, protein excretion, randomized controlled trial, self-efficacy, self-managment support",
author = "Yvette Meuleman and Tiny Hoekstra and Dekker, {Friedo W.} and Gerjan Navis and Liffert Vogt and {van der Boog}, {Paul J.M.} and Bos, {Willem Jan W.} and {van Montfrans}, {Gert A.} and {van Dijk}, Sandra and Boeschoten, {Elisabeth W.} and Marion Verduijn and {ten Brinke}, Lucia and Anke Spijker and Kwakernaak, {Arjan J.} and Humalda, {Jelmer K.} and {van Hirtum}, Tonnie and Robin Bokelaar and Loos, {Marie Louise} and Anke Bakker-Edink and Charlotte Poot and Yvette Ciere and Sophie Zwaard and Glenn Veldscholte and Lara Heuveling and Marjolein Storm and Karen Prantl and {ESMO study group}",
year = "2017",
month = "5",
day = "1",
doi = "10.1053/j.ajkd.2016.08.042",
language = "English",
volume = "69",
pages = "576--586",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "5",

}

Meuleman, Y, Hoekstra, T, Dekker, FW, Navis, G, Vogt, L, van der Boog, PJM, Bos, WJW, van Montfrans, GA, van Dijk, S & ESMO study group 2017, 'Sodium Restriction in Patients With CKD: A Randomized Controlled Trial of Self-management Support' American Journal of Kidney Diseases, vol. 69, no. 5, pp. 576-586. https://doi.org/10.1053/j.ajkd.2016.08.042

Sodium Restriction in Patients With CKD : A Randomized Controlled Trial of Self-management Support. / Meuleman, Yvette; Hoekstra, Tiny; Dekker, Friedo W.; Navis, Gerjan; Vogt, Liffert; van der Boog, Paul J.M.; Bos, Willem Jan W.; van Montfrans, Gert A.; van Dijk, Sandra; ESMO study group.

In: American Journal of Kidney Diseases, Vol. 69, No. 5, 01.05.2017, p. 576-586.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Sodium Restriction in Patients With CKD

T2 - A Randomized Controlled Trial of Self-management Support

AU - Meuleman, Yvette

AU - Hoekstra, Tiny

AU - Dekker, Friedo W.

AU - Navis, Gerjan

AU - Vogt, Liffert

AU - van der Boog, Paul J.M.

AU - Bos, Willem Jan W.

AU - van Montfrans, Gert A.

AU - van Dijk, Sandra

AU - Boeschoten, Elisabeth W.

AU - Verduijn, Marion

AU - ten Brinke, Lucia

AU - Spijker, Anke

AU - Kwakernaak, Arjan J.

AU - Humalda, Jelmer K.

AU - van Hirtum, Tonnie

AU - Bokelaar, Robin

AU - Loos, Marie Louise

AU - Bakker-Edink, Anke

AU - Poot, Charlotte

AU - Ciere, Yvette

AU - Zwaard, Sophie

AU - Veldscholte, Glenn

AU - Heuveling, Lara

AU - Storm, Marjolein

AU - Prantl, Karen

AU - ESMO study group

PY - 2017/5/1

Y1 - 2017/5/1

N2 - 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.

AB - 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.

KW - Behavior change

KW - blood pressure

KW - chronic kidney disease (CKD)

KW - dietary sodium intake

KW - disease progression

KW - health-related quality of life (HRQoL)

KW - hypertension

KW - kidney function

KW - lifestyle interventions

KW - modifiable risk factor

KW - nutrition

KW - protein excretion

KW - randomized controlled trial

KW - self-efficacy

KW - self-managment support

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U2 - 10.1053/j.ajkd.2016.08.042

DO - 10.1053/j.ajkd.2016.08.042

M3 - Article

VL - 69

SP - 576

EP - 586

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 5

ER -