Abstract
Dietary sodium intake can increase risk of hypertension, a leading cause of kidney
failure in individuals with chronic kidney disease. The objective of this systematic
review was to examine the effect of sodium-specific medical nutrition therapy provided
by a registered dietitian nutritionist or international equivalent on blood pressure
and urinary sodium excretion in individuals with chronic kidney disease, stages 2
through 5, receiving maintenance dialysis and posttransplant. Medline, the Cumulative
Index to Nursing and Allied Health Literature, Cochrane Cochrane Central Register
of Controlled Trials, and other databases were searched to identify eligible controlled
trials published in the English language from January 2000 until June 2020 that addressed
the research question. Risk of bias was assessed using the RoB 2.0 tool and quality
of evidence was examined by outcome using the Grading of Recommendations Assessment,
Development, and Evaluation method. Of the 5,642 articles identified, eight studies
were included in the final analyses. Six studies targeted clients who were not dialyzed,
including one with clients who were posttransplantation, and two studies with clients
receiving maintenance hemodialysis. Sodium-specific medical nutrition therapy from
a registered dietitian nutritionist significantly reduced clinic systolic blood pressure
(mean difference –6.7, 95% CI –11.0 to –2.4 mm Hg; I2 = 51%) and diastolic blood pressure (mean difference –4.8, 95% CI, –7.1 to –2.4 mm
Hg; I2 = 23%) as well as urinary sodium excretion (mean difference –67.6, 95% CI –91.6 to
–43.6 mmol/day; I2 = 84.1%). Efficacy was limited to individuals who were not dialyzed, including posttransplantation,
but the intervention did not significantly improve blood pressure in individuals receiving
maintenance hemodialysis. Adults with chronic kidney disease should begin to work
with registered dietitian nutritionist early in the course of disease to receive individualized,
effective counseling to improve risk factors and, ultimately, health outcomes.
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Biography
M. Rozga is a nutrition researcher, Academy of Nutrition and Dietetics Evidence Analysis Center, Chicago, IL.
Biography
J. D. Burrowes is a professor of nutrition, Long Island University (Post), Greenvale, NY.
Biography
L. D. Byham-Gray is a professor and vice chair of research, Rutgers University, Newark, NJ.
Biography
D. Handu is a senior scientific director, Academy of Nutrition and Dietetics Evidence Analysis Center, Chicago, IL.
Article info
Publication history
Published online: May 01, 2021
Accepted:
March 25,
2021
Received:
November 19,
2020
Footnotes
Supplementary materials: Table 2 and Figure 4 are available at www.jandonline.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This systematic review was funded by the Academy of Nutrition and Dietetics.
This systematic review was registered at PROSPERO (CRD42020157835) and at Open Science Framework.
Identification
Copyright
© 2022 by the Academy of Nutrition and Dietetics.
