Effects of a 6‐Month Lifestyle Intervention on Dietary Intake and Blood Pressure in Hemodialysis Patients

Abstract

Previous studies have demonstrated a positive correlation between dietary sodium intake and blood pressure (BP) in hemodialysis (HD) patients. High BP is linked to increased cardiovascular (CV) mortality, and CV disease contributes to 41% of deaths among HD patients. To reduce these risks, HD patients are often counseled to restrict their dietary sodium intake, but few studies have examined the efficacy of this strategy.In this study, we aimed to assess the impacts of individualized low sodium dietary counseling in conjunction with a liberalized diet approach on sodium intake and BP. Liberalized dietary guidelines include more whole food consumption, decreasing foods eaten outside the home, and increased food label reading.32 patients (age = 53.8 ± 13.5y, 44% female) enrolled in the study and underwent baseline testing, including three 24‐hour recalls, and standardized BP measurement. Dietary recalls were analyzed using the Nutrition Data System for Research. During the 6‐month intervention, participants received weekly one‐on‐one dietary counseling to reduce sodium intake, address a liberalized diet, and set individual goals. Study coordinators performed counseling, supervised by both research and clinical dietitians. Baseline testing measures were repeated at the end of the 6‐month intervention period.Comparing baseline (BL) measurements to those post‐intervention (6m), average kilocalorie (kcal) intake was not significantly different (BL 1489 ± 968 vs. 6m 1445 ± 484 kcal, p= 0.876). Daily protein intake did not change over 6 months (BL 55.16 ± 21.62 vs. 6m 59.63 ± 21.15 grams, p=0.605). Total sodium intake numerically decreased (BL 2780.4 ± 1112.6 vs 6m 2482.5 ± 1147.6 mg, p=0.297), as did milligrams of sodium normalized per kcal (BL 2.07 ± 0.87 vs 1.68 ± 0.54 mg/kcal, p=0.08). Systolic BP (BL 154.71 ± 26.89 vs. 6m 157.57 ± 25.07 mmHg, p=0.674) and diastolic BP (BL 77.78 ± 20.54 vs 6m 77.85 ± 16.17 mmHg, p= 0.991) showed no significant changes, but total number of BP medications prescribed to patients (BL 2.93 ± 1.26 vs 6m 1.5 ± 1.09 medications) were significantly reduced (p=0.004).Maintenance of energy and protein intake is important for HD patients to preserve their lean mass and serum protein values, a potential challenge during sodium restrictions. Notably, this six‐month dietary intervention was not associated with decreases in kcal and protein intake, although patients remain below recommendations. Though not statistically significant, the modestly reduced sodium intake that was found may suggest developing changes in consumption due to our intervention. Minimal changes in sodium intake had no significant effects on systolic and diastolic BP values, but may have played a role in the significant decrease in number of BP medications. This indicates that a six‐month dietary intervention may be meaningful for both systolic and diastolic BP maintenance with decreased BP medication usage.