Determinants and the Role of Self-Efficacy in a Sodium-Reduction Trial in Hemodialysis Patients

Abstract

Objective: To assess the impact of baseline dietary self-efficacy on the effect of a dietary intervention to reduce sodium intake in hemodialysis (HD) patients, and identify determinants of low dietary self-efficacy.Design: Post-hoc analysis of the BalanceWise study, a randomized controlled trial that aimed to reduce dietary sodium intake in HD patients Setting: 17 dialysis centers in Pennsylvania Subjects: 151 HD patients Main Outcome Measures: Dietary self-efficacy and reported dietary sodium density Analysis: ANOVA with post-hoc group-wise comparison was used to examine the effect of baseline dietary self-efficacy on changes in reported sodium density in the intervention and control groups at 8-and 16-weeks. Chi square or independent t-tests or Wilcoxon rank sum tests were used to identify determinants of low dietary self-efficacy. Results:The interaction between dietary self-efficacy and impact of the intervention on changes in reported dietary sodium density approached significance at 8-and 16-weeks (p-int = 0.051 and

Pilot study to reduce interdialytic weight gain by provision of low‐sodium, home‐delivered meals in hemodialysis patients

“…43 Furthermore, there are numerous barriers to low-sodium dietary adherence in the United States that have previously been reported. [14][15][16][17] The home-delivered meal approach used in the current study may be a more efficacious approach for reducing sodium intake, especially in patients with higher IDWG's, because it bypasses many of the barriers upon following a low-sodium diet or other renal diet restrictions. However, cost considerations should be taken into account for provision of these meals ($6.99 per renal meal; $587 per patient in this study).…”

“…13 These findings may be attributed to a high-sodium food environment and a variety of barriers to dietary and behavioral changes. [14][15][16][17] A multitude of other HD dietary restrictions (e.g., phosphorus and potassium) further complicates dietary adherence. 18,19 Recent studies have shown that sodium can be stored in soft tissues, such as skin and muscle, and that elevated tissue sodium is associated with hypertension and left ventricular hypertrophy.…”

“…Unfortunately, most HD patients still consume excessive dietary sodium and nutritional education, and counseling to reduce sodium intake is largely ineffective 13 . These findings may be attributed to a high‐sodium food environment and a variety of barriers to dietary and behavioral changes 14–17 . A multitude of other HD dietary restrictions (e.g., phosphorus and potassium) further complicates dietary adherence 18,19 …”

The relationship of volume overload and its control to hypertension in hemodialysis patients

“…69 However, in a post hoc analysis of this trial, investigators found that self-efficacy (defined as one's confidence in performing a behavior) was an important determinant of the success of interventions at reducing dietary sodium. 70 Therefore, sodium and fluid restriction interventions that focus on self-efficacy and empowerment may have meaningful impact on outcomes among individuals receiving HD.…”

Why the Nutritional Management of Acute Versus Chronic Kidney Disease Should Differ

“…17 However, an important challenge is to maintain a high protein intake while avoiding concomitant high-salt consumption. In this issue of the Journal of Renal Nutrition, Hu et al 18 assessed the impact of baseline dietary self-efficacy on the effect of a dietary intervention to reduce sodium intake in patients receiving maintenance hemodialysis and found that younger age and perceived income inadequacy were among the determining factors for a low self-efficacy in these patients. These findings 18 may suggest that those with low selfefficacy may benefit the most from interventions that are based on social cognitive therapy to reduce dietary sodium, and hence, more attention should be paid to underlying behavioral constructs such as self-efficacy.…”