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

Jelmer Humalda, Gerald Klaassen*, Hanne de Vries, Yvette Meuleman, Lara C. Verschuur, Elisabeth J. M. Straathof, Gozewijn Laverman, Willem Jan W. Bos, Paul J. M. van der Boog, Karin Vermeulen, O. A. Blanson Henkemans, Wilma Otten, Martin Borst, de, Sandra van Dijk, Gerjan Navis

*Corresponding author for this work

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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 m2) 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 m2. During the intervention period, sodium excretion decreased in the intervention group from 188 ± 8 (SE) to 148 ± 8 mmol/d (P < 0.001), but did not change significantly in the control group. At 3 months, mean sodium excretion was 24.8 (95% CI, 0.1-49.6) mmol/d lower in the intervention group (P = 0.049). At 3 months, systolic blood pressure (SBP) decreased in the intervention group from 140 ± 3 to 132 ± 3 mm Hg (P < 0.001), but was unchanged in the control group. Mean difference in SBP across groups was −4.7 (95% CI, −10.7 to 1.3) mm Hg (P = 0.1). During the maintenance phase, sodium excretion increased in the intervention group, but remained lower than at baseline at 160 ± 8 mmol/d (P = 0.01), while it decreased in the control group from 174 ± 9 at the end of the intervention period to 154 ± 9 mmol/d (P = 0.001). Consequently, no difference in sodium excretion between groups was observed after the maintenance phase. There was no difference in SBP between groups after the maintenance phase. 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. Funding: Grant funding from the Netherlands Organization for Health Research and Development and the Dutch Kidney Foundation. Trial registration: Registered at ClinicalTrials.gov with study number NCT02132013.

Original languageEnglish
Pages (from-to)847-856
Number of pages10
JournalAmerican Journal of Kidney Diseases
Issue number6
Early online date16-Jan-2020
Publication statusPublished - Jun-2020


  • Sodium
  • behavioral intervention
  • blood pressure (BP)
  • chronic kidney disease (CKD)
  • co-creation
  • dietary modification
  • hypertension
  • lifestyle
  • modifiable risk factor
  • randomized controlled trial (RCT)
  • self-regulation
  • sodium intake
  • transplantation

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