Purpose: The purpose of this presentation is to explore the effect of dietary sodium restriction on patient quality of life and hemodialysis related symptom profiles. Dietary sodium intake independently increases the risk of mortality in end stage renal disease (ESRD)
1,2. It plays a significant role in hypertension, hypervolemia, and left ventricular hypertrophy (LVH), and blunts the effectiveness of hypertensive agents
3. In addition, the hypervolemia associated with excessive dietary sodium intake results in the need for more intense fluid removal during hemodialysis (ultrafiltration), resulting in symptoms such as pain, cramps, hypotension, nausea, and vomiting during hemodialysis (HD) treatment sessions
4,5. Although sodium restriction is a universal recommendation for ESRD management, the National Kidney Foundation (NKF) recommendation of 2400 mg per day is consensus-based per the Dietary Approaches to Stop Hypertension (DASH) studies, not an evidence-based recommendation from data derived from a hemodialysis population. In addition, The Dietary Guidelines for Americans 2010 and American Heart Association (AHA), recommend further restriction of dietary sodium intake to 1500 mg per day for persons with hypertension and/or kidney disease, middle-aged and older adults, and African Americans, though there is also little empiric evidence to support this recommendation in the general population and none in the hemodialysis population
6. Therefore, it remains to be demonstrated that a diet with such sodium restrictions is attainable, sustainable, safe or beneficial.
Methods: We conducted a double-blinded randomized controlled trial of 42 ESRD patients undergoing hemodialysis therapy. Patients were randomized into one of three dietary sodium intake groups. Primary outcomes were quality of life and symptom scores as operationalized by the Kidney Quality of Life and Palliative Outcome Scale-Renal Assessments.
Results: There was no statistically significant difference in symptom scores, though participants reported clinical improvement in symptoms.
Conclusion: The findings from this study provides the first data from a randomized controlled trial on the effectiveness of reduced dietary sodium intake in hemodialysis patients to inform evidenced based practice, patient education, and nursing care quality.
