Educational intervention may help patients with food insecurity, CKD reduce sodium intake
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After attending classes led by a nurse practitioner, patients with chronic kidney disease – 89% of whom were food insecure – showed improved knowledge on disease management, specifically as it relates to sodium intake and hypertension.
“High sodium consumption is strongly associated with high blood pressure, and food insecurity may contribute to the consumption of high sodium food,” Anitha Philip, DNP, RN, FNP-C, nurse practitioner at John H. Stroger Jr. Hospital, Cook County Health, told the audience at the virtual American Nephrology Nurses Association National Symposium.
As per the U.S. Department of Agriculture, Philip defined food insecurity as the “limited or uncertain availability of nutritionally adequate and safe foods” and suggested food insecurity contributes to racial and ethnic disparities in CKD.
Educational intervention
To address some of these disparities, Philip developed an educational intervention (titled “Enhance Access to Food and Educate on Kidney Disease Treatment”), through which she provided twice-monthly classes to individuals recruited from an outpatient renal clinic at a large, urban, public teaching hospital (67% were Black; 39% received Medicare; 33% were uninsured; 28% were taking two antihypertensive medications). She noted 50% were unemployed, with many having lost their jobs due to the COVID-19 pandemic.
Prior to beginning the classes, participants completed a variety of questionnaires that assessed kidney disease knowledge and diet intake; all participants were also screened for food insecurity and, if needed, provided with food vouchers during the study.
“There is a partnership between the hospital and the food depository,” Philip said. “If a patient is positive for food insecurity, they are given food vouchers, which they can take to the food depository and get fresh fruits and vegetables. If they need other resources, like protein, then they are referred to a pantry.”
The curriculum for the classes was developed in collaboration with a dietician; Philip described the in-person classes as interactive.
Blood pressure measurements were taken before the intervention and at 6 to 8 weeks after the intervention.
Philip observed a “huge improvement” in patient knowledge after the intervention, regarding blood pressure targets (56% answered correctly at baseline compared with 83% after the classes) and sodium measures (22% vs. 67%, respectively).
Though there were no significant changes in blood pressure (which Philip attributes to the short duration of the study and the small sample size due to the pandemic) and participants continued to eat the same foods (such as canned foods, deli meats and hamburgers), 54% stated they paid more attention to their daily sodium intake after the intervention, with some also making changes that could lead to a reduction in sodium consumption.
“Food selection did not change much,” Philip said. “However, interestingly, some positive behavioral changes were noted. Patients started to read the nutrition label, which was taught in the class. They started to rinse their vegetables. They started to cook more at home than eating out.” As an example, Philip said one patient switched from eating fast food burgers to cooking burgers at home with limited salt.
Among patients who reported food insecurity, 31% did not redeem their food vouchers, reportedly due to lack of transportation, starting dialysis or the depository running out of food.
Food insecurity
During the course of the study, Philip said she discovered the tool the clinic has to screen patients for food insecurity is frequently not used, despite that more patients in need could be helped if screened.
“There is a policy change that will need to occur, hopefully in the near future, to screen all CKD patients for food insecurity and provide access to healthy foods,” she said. “Future collaboration with the food depository may help address systemic barriers in obtaining food.”
Philip said it remains necessary to test the intervention in larger sample sizes for longer periods of time, as well as to examine how an online class might provide patients with a more convenient and accessible option.
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Philip A, et al. The effect of educational intervention to improve blood pressure control among minority patients with chronic kidney disease. Presented at: American Nephrology Nurses Association National Symposium (virtual meeting); May 2-5, 2021.
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