Mindful practice shows no impact on fluid management but may improve dietary adherence
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For patients on hemodialysis, a mindfulness-based intervention aimed at helping patients adhere to fluid restrictions did not lead to improvements in interdialytic weight gain or quality of life.
However, based on previous work, Gayle M. Timmerman, PhD, RN, CNS, FNAP, FAAN, of the University of Texas at Austin School of Nursing, suggested mindfulness might be beneficial in helping patients adhere to dietary recommendations.
Timmerman told Healio Nephrology that the study on mindful practices for fluid management, which was presented at the National Kidney Foundation Spring Clinical Meetings, was an “offshoot” of a previous study regarding mindful eating interventions to better manage dietary intake for patients with early stage chronic kidney disease. This intervention, she said, brought about both weight loss and improved quality of life.
“With the CKD intervention, mindful eating – being in the moment and being fully aware of the sight, smell, texture and taste of food – is designed to improve joy of eating (CKD diets are often viewed as bland and restrictive), allowing individuals to enjoy small amounts of restricted food,” she said. “I thought that converting the mindful eating exercises to mindful drinking and adding mindful eating of foods that help control thirst might help those with fluid restrictions to be more satisfied with less fluid.”
For this study, Timmerman and colleagues randomized 33 participants to either intervention or control. The intervention, which was delivered during dialysis sessions once a week for 4 weeks, consisted of a guided mindful meditation designed to encourage participants to focus on the sensory experience of small amounts of fluids (two to three sips). Timmerman said that a different beverage was introduced each week (water, juice, a hot beverage and lemon water), with participants asked to reflect on the experience. In addition to mindful drinking, a mindful eating meditation was provided; for this, participants would take two to three bites of foods used to control thirst (such as frozen grapes, frozen blueberries, popsicles and hard candy) and again reflect on the experience. They were also asked to practice mindful eating and drinking at home (at least once daily) and to document their progress.
Timmerman said the participants seemed to enjoy the intervention overall, though the practice of mindful eating might have been more effective; she noted that participants told her, for instance, they had never tried a frozen grape and that this helped them.
However, at the end of the study period, researchers observed no significant differences between intervention and control for average interdialytic weight gain per week or total kidney disease QOL score.
“It could be that mindful drinking did not work as well because it is hard to drink slowly,” she said.
Further, Timmerman suggested the intervention might have had a stronger impact if the study had evaluated immediate level of thirst, instead of interdialytic weight gain as a marker of adhering to fluid restrictions.
“Many of the participants were already drinking during dialysis and not thirsty, so the immediate impact on thirst may have been obscured,” she said. “If they did not see the benefit during the meditation, it may have influenced their practice and expectations at home.”
These results, coupled with her previous work, led Timmerman to conclude: “I think as far as the mindfulness, it may be better to utilize mindful eating for dietary adherence.”
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Timmerman GM, et al. Abstract #349. Presented at: National Kidney Foundation Spring Clinical Meetings (virtual meeting); April 6-10, 2021.
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