Advertisement
From the Academy| Volume 122, ISSUE 2, P445-460.e19, February 2022

Download started.

Ok

Effects of Sodium-Specific Medical Nutrition Therapy from a Registered Dietitian Nutritionist in Individuals with Chronic Kidney Disease: An Evidence Analysis Center Systematic Review and Meta-Analysis

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ikizler T.A.C.L.
        • Burrowes J.
        • Byham-Gray L.
        • Campbell K.
        • Carrero J.J.
        • et al.
        Clinical practice guideline for nutrition in chronic kidney disease: 2020 update.
        Am J Kidney Dis. 2020; 76: S1-S107
        • Sarafidis P.A.
        • Li S.
        • Chen S.C.
        • et al.
        Hypertension awareness, treatment, and control in chronic kidney disease.
        Am J Med. 2008; 121: 332-340
        • Sarafidis P.A.
        • Sharpe C.C.
        • Wood E.
        • et al.
        Prevalence, patterns of treatment, and control of hypertension in predialysis patients with chronic kidney disease.
        Nephron Clin Pract. 2012; 120: c147-c155
        • US Renal Data System
        US Renal Data System 2019 annual data report: epidemiology of kidney disease in the United States.
        (Published 2019. Accessed April 20, 2020)
        • Klahr S.
        • Levey A.S.
        • Beck G.J.
        • et al.
        The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group.
        N Engl J Med. 1994; 330: 877-884
        • Arnett D.K.
        • Blumenthal R.S.
        • Albert M.A.
        • et al.
        2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
        Circulation. 2019; 140: e563-e595
        • He F.J.
        • Li J.
        • Macgregor G.A.
        Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials.
        BMJ. 2013; 346: f1325
        • Juraschek S.P.
        • Miller 3rd, E.R.
        • Weaver C.M.
        • Appel L.J.
        Effects of sodium reduction and the DASH diet in relation to baseline blood pressure.
        J Am Coll Cardiol. 2017; 70: 2841-2848
        • Centers for Disease Control and Prevention
        Get the facts: sodium and the dietary guidelines.
      1. Schünemann H, Guyatt G, Oxman A, editors. GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group, 2013. https://gdt.gradepro.org/app/handbook/handbook.html. Accessed November 11, 2020.

        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        J Clin Epidemiol. 2009; 62: 1006-1012
        • Rozga M.
        Effect of medical nutrition therapy on primary outcomes for individuals with chronic kidney disease.
        • Rozga M.
        Effects of sodium-specific medical nutrition therapy in individuals with chronic kidney disease: a systematic review.
        http://osf.io/5j3e7
        Date accessed: June 25, 2020
        • Academy of Nutrition and Dietetics Evidence Analysis Library
        "What is the effect of MNT provided by a dietitian on nutrition outcomes in adults with CKD 1-5D and post-transplant?.
        • Ouzzani M.
        • Hammady H.
        • Fedorowicz Z.
        • Elmagarmid A.
        Rayyan—a web and mobile app for systematic reviews.
        Syst Rev. 2016; 5: 210
        • Sterne J.A.C.
        • Savovic J.
        • Page M.J.
        • et al.
        RoB 2: a revised tool for assessing risk of bias in randomised trials.
        BMJ. 2019; 366: l4898
        • McGuinness L.A.
        Risk-of-bias VISualization (robvis): An R package and web application for visualising risk-of-bias assessments.
        Res Synth Methods. 2021; 12: 55-61
      2. R: A language and environment for statistical computing. [computer program]. R Foundation for Statistical Computing, Vienna, Austria2010
        • Guyatt G.
        • Oxman A.D.
        • Akl E.A.
        • et al.
        GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables.
        J Clin Epidemiol. 2011; 64: 383-394
        • Guyatt G.
        • Oxman A.D.
        • Sultan S.
        • et al.
        GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes.
        J Clin Epidemiol. 2013; 66: 151-157
        • Ahn S.Y.
        • Kim D.K.
        • Park J.H.
        • et al.
        Long-term effects of intensive low-salt diet education on deterioration of glomerular filtration rate among non-diabetic hypertensive patients with chronic kidney disease.
        Kidney Blood Press Res. 2019; 44: 1101-1114
        • Hwang J.H.
        • Chin H.J.
        • Kim S.
        • et al.
        Effects of intensive low-salt diet education on albuminuria among nondiabetic patients with hypertension treated with olmesartan: a single-blinded randomized, controlled trial.
        Clin J Am Soc Nephrol. 2014; 9: 2059-2069
        • de Brito-Ashurst I.
        • Perry L.
        • Sanders T.A.
        • et al.
        The role of salt intake and salt sensitivity in the management of hypertension in South Asian people with chronic kidney disease: a randomised controlled trial.
        Heart. 2013; 99: 1256-1260
        • Saran R.
        • Padilla R.L.
        • Gillespie B.W.
        • et al.
        A randomized crossover trial of dietary sodium restriction in stage 3-4 CKD.
        Clin J Am Soc Nephrol. 2017; 12: 399-407
        • Kwakernaak A.J.
        • Waanders F.
        • Slagman M.C.J.
        • et al.
        Sodium restriction on top of renin-angiotensin-aldosterone system blockade increases circulating levels of N-acetyl-seryl-aspartyl-lysyl-proline in chronic kidney disease patients.
        J Hypertens. 2013; 31: 2425-2432
        • Slagman M.C.J.
        • Waanders F.
        • Hemmelder M.H.
        • et al.
        Moderate dietary sodium restriction added to angiotensin converting enzyme inhibition compared with dual blockade in lowering proteinuria and blood pressure: randomised controlled trial.
        BMJ. 2011; : 343
        • Meuleman Y.
        • Hoekstra T.
        • Dekker F.W.
        • et al.
        Sodium restriction in patients with CKD: a randomized controlled trial of self-management support.
        Am J Kidney Dis. 2017; 69: 576-586
        • Rodrigues Telini L.S.
        • de Carvalho Beduschi G.
        • Caramori J.C.
        • Castro J.H.
        • Martin L.C.
        • Barretti P.
        Effect of dietary sodium restriction on body water, blood pressure, and inflammation in hemodialysis patients: a prospective randomized controlled study.
        Int Urol Nephrol. 2014; 46: 91-97
        • Keven K.
        • Yalcin S.
        • Canbakan B.
        • et al.
        The impact of daily sodium intake on posttransplant hypertension in kidney allograft recipients.
        Transplant Proc. 2006; 38: 1323-1326
        • Brito de Freitas A.
        • Nicoletto B.B.
        • Machado d'Almeida K.S.
        • Romano de Medeiros Bastos N.M.
        • Manfro R.C.
        • Souza G.C.
        Effects of dietary counseling on sodium restriction in patients with chronic kidney disease on hemodialysis: a randomized clinical trial.
        Saudi J Kidney Dis Transpl. 2020; 31: 604-613
        • Garofalo C.
        • Borrelli S.
        • Provenzano M.
        • et al.
        Dietary salt restriction in chronic kidney disease: a meta-analysis of randomized clinical trials.
        Nutrients. 2018; 10: 732
        • McMahon E.J.
        • Campbell K.L.
        • Bauer J.D.
        • Mudge D.W.
        Altered dietary salt intake for people with chronic kidney disease.
        Cochrane Database Syst Rev. 2015; 2: CD010070
        • Wen X.
        • Wang Y.
        • Shi H.
        • Wang M.
        • Lu P.
        Systematic review and meta-analyses: dietary behavior interventions in non-dialysis chronic kidney disease.
        West J Nurs Res. 2020; 42: 937-947
        • Santos S.F.
        • Peixoto A.J.
        Revisiting the dialysate sodium prescription as a tool for better blood pressure and interdialytic weight gain management in hemodialysis patients.
        Clin J Am Soc Nephrol. 2008; 3: 522-530
        • Cole N.I.
        • Swift P.A.
        • He F.J.
        • MacGregor G.A.
        • Suckling R.J.
        The effect of dietary salt on blood pressure in individuals receiving chronic dialysis: a systematic review and meta-analysis of randomised controlled trials.
        J Human Hypertens. 2019; 33: 319-326
        • He J.
        • Mills K.T.
        • Appel L.J.
        • et al.
        Urinary sodium and potassium excretion and CKD progression.
        J Am Soc Nephrol. 2016; 27: 1202-1212

      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.