Diet therapy along with nutrition education can improve renal function in people with stages 3-4 chronic kidney disease who do not have diabetes: a randomised controlled trial.

Abstract

The current trial investigates the effect of renal diet therapy and nutritional education on the estimated glomerular filtration rate (eGFR), blood pressure (BP) and depression among patients with chronic kidney disease (CKD). A total of 120 CKD patients (stages 3-4) (15<eGFR < 60) were randomised into an intensive nutrition intervention group (individualised renal diet therapy plus nutrition counselling: 0·75 g protein/kg/d and 30-35 kcal/kg/d with Na restriction) and a control group (routine and standard care) for 24 weeks. The primary outcome was the change in the eGFR. Secondary outcomes included changes in anthropometric measures, biochemistry (serum creatinine (Cr), uric acid, albumin, electrolytes, Ca, vitamin D, ferritin, blood urea nitrogen (BUN), and Hb), BP, nutritional status, depression and quality of life. The eGFR increased significantly in the intervention group compared with the control group (P < 0·001). Moreover, serum levels of Cr and the systolic and diastolic BP decreased significantly in the intervention group relative to the control group (P < 0·001, P < 0·001 and P = 0·020, respectively). The nutrition intervention also hindered the increase in the BUN level and the depression score (P = 0·045 and P = 0·028, respectively). Furthermore, the reduction in protein and Na intake was greater in the intervention group (P = 0·003 and P < 0·001, respectively). Nutritional treatment along with supportive education and counselling contributed to improvements in renal function, BP control and adherence to protein intake recommendations. A significant difference in the mean eGFR between the groups was also confirmed at the end of the study using ANCOVA (β = -5·06; 95 % CI (-8·203, -2·999)).