Benefits of and Barriers to Dietary Sodium Adherence

Welch, Janet L.; Bennett, Susan J.; Delp, Roberta L.; Agarwal, Rajiv

doi:10.1177/0193945905282323

Cited by 39 publications

(61 citation statements)

References 49 publications

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“…17,18 Poor adherence to sodium restriction is a common problem in clinical trials and in clinical practice. 19,20 In the observational CRISP study, dietary sodium intake was found to be a relatively fixed trait. 8 During HALT PKD, instructions on a sodium restricted diet at entry into the study and during the biannual study visits resulted in a modest reduction in UNaE averaging 11.6 mEq in Study A and 25.7 mEq in Study B.…”

Section: Discussionmentioning

confidence: 99%

Dietary salt restriction is beneficial to the management of autosomal dominant polycystic kidney disease

Torres

Abebe

Schrier

et al. 2017

Kidney International

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The CRISP study of polycystic kidney disease (PKD) found that urinary sodium excretion associated with the rate of total kidney volume increase. Whether sodium restriction slows the progression of Autosomal Dominant PKD (ADPKD) is not known. To evaluate this we conducted a post-hoc analysis of the HALT-PKD clinical trials of renin-angiotensin blockade in patients with ADPKD. Linear mixed models examined whether dietary sodium affected rates of total kidney volume or change in estimated glomerular filtration rate (eGFR) in patients with an eGFR over 60 ml/min/1.73 m2 (Study A) or the risk for a composite endpoint of 50% reduction in eGFR, end-stage renal disease or death or the rate of eGFR decline in patients with an eGFR 25-60 ml/min/1.73 m2 (Study B) all in patients initiated on an under100 mEq sodium diet. During the trial urinary sodium excretion significantly declined by an average of 0.25 and 0.41 mEq/24 hour per month in studies A and B, respectively. In Study A, averaged and time varying urinary sodium excretions were significantly associated with kidney growth (0.43%/year and 0.09%/year, respectively, for each 18 mEq urinary sodium excretion). Averaged urinary sodium excretion was not significantly associated with faster eGFR decline (−0.07 ml/min/1.73m2/year for each 18 mEq urinary sodium excretion). In Study B, the averaged but not time-varying urinary sodium excretion significantly associated with increased risk for the composite endpoint (hazard ratio 1.08 for each 18 mEq urinary sodium excretion) and a significantly faster eGFR decline (−0.09 ml/min/1.73m2/year for each mEq 18 mEq urinary sodium excretion). Thus, sodium restriction is beneficial in the management of ADPKD.

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Section: Discussionmentioning

confidence: 99%

Dietary salt restriction is beneficial to the management of autosomal dominant polycystic kidney disease

Torres

Abebe

Schrier

et al. 2017

Kidney International

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“…22 In addition to this study, lack of taste has been reported as key barriers to sodium-restricted diet in many other studies. 9,23 Since lack of taste, has been the most consistently identified barrier to adherence to a low salt diet, future strategies to increase compliance should aim to improve food taste without adding salt, such as adopting sodium-replacement/partial replacement salts. Sodium replacements salts have the same taste as standard table salt but use potassium instead of sodium as their key ingredient.…”

Section: Discussionmentioning

confidence: 99%

Barriers to Dietary Salt Reduction among Hypertensive Patients

Ghimire¹,

Shrestha

Callahan

2018

J Nepal Health Res Council

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Background: Despite knowing the ill consequences of high salt intake, many hypertensive patients in Nepal continue to consume high levels of salt in their diet. Hence, this study aims to reveal the barriers to dietary salt reduction among hypertensive patients in Nepal.Methods: A barrier analysis was conducted in the outpatient department of Sahid Gangalal National Heart Center, Nepal among 180 hypertensive patients under physician advice to reduce salt in their diet. A logistic regression modeling was used to calculate odds ratios (ORs) for the barriers.Results: Low self-efficacy (OR=0.04; 95%CI: 0.01-0.24) was a significant barrier to dietary salt reduction among study participants, as well as lack of taste (23.3% Compliant vs. 53.3% Non-Compliant) and lack of family support (5.6% compliant vs. 27.8% noncompliant). Difficulty in remembering to eat low salt (OR=3.89; 95%CI: 1.28-11.87) was a barrier for males. There were differences seen by gender in barriers: among female participants, low perceived social acceptability (OR=0.05; 95%CI: 0.01-0.32), and living in a joint rather than nuclear family (OR=0.21; 95%CI: 0.06-0.77) were significant barriers to dietary salt reduction. Presence of a son (7.8% Compliant vs.30.0% NonCompliant) and/or husband (1.1% Compliant vs. 11.1% Non-Compliant) had an influence on females’ decisions to reduce salt.Conclusions: Perceived self-efficacy, reminder to action, social acceptability, and family structure were barriers to dietary salt reduction among hypertensive patients in Nepal. Presence of a son and/or husband had an influence on females’ decisions to reduce salt. Addressing the modifiable barriers identified in this study is important for successful salt reduction initiatives in Nepal. The inclusion of a son and/or husband in nutritional counseling may be beneficial to achieve salt reduction in this population.

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“…Self-efficacy will be measured using the health-related general self-efficacy scale [57] and health-related locus of control using the Multidimensional Health Locus of Control [58]. Beliefs about dietary compliance scale (BDCS) [59] and attitudes to dietary recommendations scale (ADRS) (modified from [60]) will be assessed. Results from the locus of control and self-efficacy scales will be used to identify predictors of dietary adherence.…”

Section: Methodsmentioning

confidence: 99%

The effect of lowering salt intake on ambulatory blood pressure to reduce cardiovascular risk in chronic kidney disease (LowSALT CKD study): protocol of a randomized trial

et al. 2012

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BackgroundDespite evidence implicating dietary sodium in the pathogenesis of cardiovascular disease (CVD) in chronic kidney disease (CKD), quality intervention trials in CKD patients are lacking. This study aims to investigate the effect of reducing sodium intake on blood pressure, risk factors for progression of CKD and other cardiovascular risk factors in CKD.Methods/designThe LowSALT CKD study is a six week randomized-crossover trial assessing the effect of a moderate (180 mmol/day) compared with a low (60 mmol/day) sodium intake on cardiovascular risk factors and risk factors for kidney function decline in mild-moderate CKD (stage III-IV). The primary outcome of interest is 24-hour ambulatory blood pressure, with secondary outcomes including arterial stiffness (pulse wave velocity), proteinuria and fluid status. The randomized crossover trial (Phase 1) is supported by an ancillary trial (Phase 2) of longitudinal-observational design to assess the longer term effectiveness of sodium restriction. Phase 2 will continue measurement of outcomes as per Phase 1, with the addition of patient-centered outcomes, such as dietary adherence to sodium restriction (degree of adherence and barriers/enablers), quality of life and taste assessment.DiscussionThe LowSALT CKD study is an investigator-initiated study specifically designed to assess the proof-of-concept and efficacy of sodium restriction in patients with established CKD. Phase 2 will assess the longer term effectiveness of sodium restriction in the same participants, enhancing the translation of Phase 1 results into practice. This trial will provide much-needed insight into sodium restriction as a treatment option to reduce risk of CVD and CKD progression in CKD patients.Trial registrationUniversal Trial Number: U1111-1125-2149. Australian New Zealand Clinical Trials Registry Number: ACTRN12611001097932

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Benefits of and Barriers to Dietary Sodium Adherence

Cited by 39 publications

References 49 publications

Dietary salt restriction is beneficial to the management of autosomal dominant polycystic kidney disease

Dietary salt restriction is beneficial to the management of autosomal dominant polycystic kidney disease

Barriers to Dietary Salt Reduction among Hypertensive Patients

The effect of lowering salt intake on ambulatory blood pressure to reduce cardiovascular risk in chronic kidney disease (LowSALT CKD study): protocol of a randomized trial

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