Web-based coaching may help patients with CKD restrict dietary sodium intake
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A web-based coaching intervention administered at Dutch nephrology outpatient clinics helped patients with chronic kidney disease reduce their sodium intake during a 3-month period, according to study results.
Arguing that “current approaches to reduce sodium intake are largely unsuccessful,” Jelmer K. Humalda, MD, PhD, of the University of Groningen in the Netherlands, and colleagues used recommendations from previous studies which have demonstrated “self-regulation theory-based interventions are associated with good outcomes.” Despite the good outcomes associated with behavioral approaches, the researchers noted one-to-one counseling is costly. Therefore, they used e-health to design the Sodium burden lowered by lifestyle intervention: Self-management and e-health technology intervention.
Patients were randomized to routine care (control) or routine care plus a web-based self-management intervention, which included individual e-coaching and group meetings. Coaching focused on self-monitoring, skills to “decline salty snacks” and education on processed foods. The intervention lasted 3 months and was followed by a 6-month “maintenance phase,” wherein participants were provided with additional self-management modules and one to four individual e-coaching sessions.
Researchers found that, during the intervention period, sodium excretion decreased in the intervention group from 188 mmol/d to 148 mmol/day. No significant changes were observed in the control group. In addition, mean sodium excretion was 24.8 mmol/d lower in the intervention group at 3 months.
Further findings indicated differences between groups regarding blood pressure, with systolic blood pressure decreasing from 140 mm/Hg to 132 mm/hG for those receiving the intervention, while remaining unchanged for the control group.
Differences between groups were no longer observed in the maintenance phase, with sodium excretion increasing in the intervention group (though, the researchers noted, still remaining lower than at baseline).
The researchers gleaned some “important lessons” from the study for future interventions, including the positive reaction by participants to feedback from objective data (such as 24-hour urine sodium excretion) and the preference of face-to-face contact with a personal coach prior to e-sessions. Furthermore, participants viewed social support from their partner and family as “essential.”
“The web-based self-management program should be user friendly,” the researchers concluded. “Future studies should elucidate whether effectively accounting for these factors can further enhance the efficacy of sodium management in patients with CKD on a long-term basis and whether these principles can also be applied for the management of other dietary factors.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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