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.
  
  
  METHODS
  Open randomized controlled trial.
  
  
  METHODS
  Patients with moderately decreased kidney function from 4 hospitals in the Netherlands.
  
  
  METHODS
  Regular care was compared with regular care plus an intervention comprising education, motivational interviewing, coaching, and self-monitoring of blood pressure (BP) and sodium.
  
  
  RESULTS
  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±25.6mL/min/1.73m2; 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±9mmHg, 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] mmHg), diastolic office BP (mean change, -5.2 [95% CI, -8.4 to -2.1] mmHg), 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] mmHg, 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Health, Medical, and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands; Department of Medical Psychology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: meulemany@fsw.leidenuniv.nl.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Meuleman
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Nephrology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Tiny
authors.initials: T
authors.lastname: Hoekstra
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.affiliation: Department of Nephrology, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Gerjan
authors.initials: G
authors.lastname: Navis
authors.affiliation: Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Liffert
authors.initials: L
authors.lastname: Vogt
authors.affiliation: Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Paul J M
authors.initials: PJM
authors.lastname: van der Boog
authors.affiliation: Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Willem Jan W
authors.initials: WJW
authors.lastname: Bos
authors.affiliation: Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Gert A
authors.initials: GA
authors.lastname: van Montfrans
authors.affiliation: Department of Health, Medical, and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands; Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dijk
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D004039:Diet, Sodium-Restricted / Q000379:methods*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D009426:Netherlands; D010353:Patient Education as Topic / Q000379:methods*; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy*; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy; D012964:Sodium / Q000652:urine
chemical_list: D000959:Antihypertensive Agents; D012964:Sodium
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