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Pilot study to reduce interdialytic weight gain by provision of low‐sodium, home‐delivered meals in hemodialysis patients
Author(s) -
Perez Luis M.,
Fang HsinYu,
Ashrafi SadiaAnjum,
Burrows Brett T.,
King Alexis C.,
Larsen Ryan J.,
Sutton Bradley P.,
Wilund Kenneth R.
Publication year - 2021
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12902
Subject(s) - medicine , thirst , blood pressure , sodium , hemodialysis , meal , weight gain , body mass index , confidence interval , low sodium , body weight , chemistry , organic chemistry
Patients with kidney failure undergoing maintenance hemodialysis (HD) therapy are routinely counseled to reduce dietary sodium intake to ameliorate sodium retention, volume overload, and hypertension. However, low‐sodium diet trials in HD are sparse and indicate that dietary education and behavioral counseling are ineffective in reducing sodium intake. This study aimed to determine whether 4 weeks of low‐sodium, home‐delivered meals in HD patients reduces interdialytic weight gain (IDWG). Secondary outcomes included changes in dietary sodium intake, thirst, xerostomia, blood pressure, volume overload, and muscle sodium concentration. Methods Twenty HD patients (55 ± 12 years, body mass index [BMI] 40.7 ± 16.6 kg/m 2 ) were enrolled in this study. Participants followed a usual (control) diet for the first 4 weeks followed by 4 weeks of three low‐sodium, home‐delivered meals per day. We measured IDWG, hydration status (bioimpedance), standardized blood pressure (BP), food intake (3‐day dietary recall), and muscle sodium (magnetic resonance imaging) at baseline (0 M), after the 4‐week period of usual diet (1 M), and after the meal intervention (2 M). Findings The low‐sodium meal intervention significantly reduced IDWG when compared to the control period (−0.82 ± 0.14 kg; 95% confidence interval, −0.55 to −1.08 kg; P < 0.001). There were also 1 month (1 M) to 2 month (2 M) reductions in dietary sodium intake (−1687 ± 297 mg; P < 0.001); thirst score (−4.4 ± 1.3; P = 0.003), xerostomia score (−6.7 ± 1.9; P = 0.002), SBP (−18.0 ± 3.6 mmHg; P < 0.001), DBP (−5.9 ± 2.0 mmHg; P = 0.008), and plasma phosphorus −1.55 ± 0.21 mg/dL; P = 0.005), as well as a 0 M to 2 M reduction in absolute volume overload (−1.08 ± 0.33 L; P = 0.025). However, there were no significant changes in serum or tissue sodium (all P > 0.05). Discussion Low‐sodium, home‐meal delivery appears to be an effective method for improving volume control and blood pressure in HD patients. Future studies with larger sample sizes are needed to examine the long‐term effects of home‐delivered meals on these outcomes and to assess cost‐effectiveness.