Abstract
Background: Despite the importance of healthy diet for cardiovascular (CVD) health, the vast majority of patients with chronic kidney disease (CKD) do not receive dietitian counseling or make dietary modifications. Evidence for using dietary apps and tele-counseling to improve CVD risk factors is limited. Methods: We examined the effects of dietary app-supported tele-counseling on sodium intake and diet quality in 44 patients with type 2 diabetes and stage 1-3a CKD. Patients recorded and shared dietary data via MyFitnessPal with registered dietitians, who used motivational interviewing to provide telephone counseling weekly for 8 weeks. Outcomes included 24-hour urine sodium (2 collections per timepoint), Healthy Eating Index (HEI) 2015 score (multiple 24-hour dietary recalls per timepoint), 24-hour systolic blood pressure (SBP), and 24-hour urine albumin excretion. We report interim results for patients who completed 8-week and 6-month data collection; final outcome data at 12 months will be completed in November 2018. Results: Out of 44 consented patients (mean age 60.3 ± 11.9 y, 43% female, 93% white, 20% <$25,000 annual income, 84% hypertension), 32 (73%) completed 8-week follow-up and 29 (66%) completed 6-month follow-up. While 78% owned a smartphone, 52% entered dietary data using a computer. Among patients who completed 6-month follow-up, sodium excretion did not significantly decrease from baseline to 8 weeks (-345 mg/d, 95% CI: -865, 175) or 6 months: (-182 mg/d, CI: -460, 97) (Table) . However, HEI-2015 score improved by 3.19 (CI: 0.51-5.87) at 8 weeks and 7.21 (CI: 3.07, 11.3) at 6 months; 24-hour SBP improved by -3.7 (CI: -7.4, 0.1) at 8 weeks and by -4.9 (CI: -8.8, -0.9) at 6 months. Conclusions: An app-supported tele-counseling program with a registered dietitian appears to be a feasible strategy to improve dietary quality and blood pressure, even in patients with diabetes and early CKD. Sodium is ubiquitous in the food supply and hard to change at the individual level. Studies to demonstrate efficacy are needed.
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