Original InvestigationPathogenesis and Treatment of Kidney DiseaseRandomized Controlled Trial of Nutritional Counseling on Body Composition and Dietary Intake in Severe CKD
Section snippets
Methods
Potential participants were approached upon consecutive entry into a predialysis outpatient clinic at the Royal Brisbane and Women's Hospital. Eligible participants met the following criteria: adult (>18 years), eGFR less than 30 mL/min/1.73 m2 (<0.50 mL/s/1.73 m2), CKD, not previously seen by a dietitian for stage 4 CKD, absence of communication or intellectual impairment inhibiting their ability to undertake the intervention, absence of malnutrition from a cause other than CKD, and not
Results
Sixty-six consecutive subjects were considered eligible upon entry into the predialysis clinic during the recruitment period from September 2004 to September 2005. Informed consent was provided by 62 participants (62 of 66 study participants; 94% consent rate); after this, 6 were excluded before the baseline assessment (see CONSORT flowchart, Fig 2). Therefore, 56 patients (men, 62%; mean age, 70.7 ± 14.0 [SD] years) received either intervention (n = 29) or control (written material only, n =
Discussion
There is little literature to inform nutrition practice in patients with CKD before dialysis therapy. The outcome of this study supports the use of individualized self-management nutrition interventions with regular monitoring, as previously shown to achieve compliance in predialysis patients with CKD in the MDRD Study.17, 18, 19 However, in this study, the benefits of this intervention appeared to be restricted to women, with no difference in change after intervention in the men in this sample.
Acknowledgements
We thank Dr Helen Healy, Director of Renal Medicine, and Julie Hulcombe, Director of Allied Health, at Royal Brisbane and Women's Hospital for their in-kind support and contribution to the study; and Justin Scott, Queensland Institute of Medical Research, for statistical support.
Support: This study was funded in part by a Royal Brisbane and Women's Hospital Foundation Seeding grant, Queensland University of Technology Postgraduate Research Award (PhD scholarship), and an Institute of Health and
References (55)
- et al.
Hand-grip muscle strength, lean body mass, and plasma proteins as markers of nutritional status in patients with chronic renal failure close to start of dialysis therapy
Am J Kidney Dis
(2000) - et al.
Prediction of early death in end-stage renal disease patients starting dialysis
Am J Kidney Dis
(1997) - et al.
A meta-analysis of the effects of dietary protein restriction on the rate of decline in renal function
Am J Kidney Dis
(1998) - et al.
Factors associated with adherence to the dietary protein intervention in the Modification of Diet in Renal Disease Study
J Am Diet Assoc
(1995) - et al.
Whole-body skeletal muscle mass: Development and validation of total-body potassium prediction models
Am J Clin Nutr
(2003) - et al.
A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation
J Chronic Dis
(1987) - et al.
Outcome of protein-energy malnutrition in elderly medical patients
Am J Med
(1995) - et al.
Elderly women accommodate to a low-protein diet with losses of body cell mass, muscle function, and immune response
Am J Clin Nutr
(1995) - et al.
Prevalence and prognostic significance of malnutrition in chronic renal insufficiency
J Ren Nutr
(2001) - et al.
Can malnutrition in predialysis patients be prevented by dietetic intervention?
J Ren Nutr
(2001)
Dietary protein and energy requirements in ESRD patients
Am J Kidney Dis
Severe dietary protein restriction in overt diabetic nephropathy: Benefits or risks?
J Ren Nutr
Can a nutrition intervention improve albumin levels among hemodialysis patients?A pilot study
J Ren Nutr
Improving albumin levels among hemodialysis patients: A community-based randomized controlled trial
Am J Kidney Dis
Sex differences in the associations of HIV disease characteristics and body composition in antiretroviral-naive persons
Am J Clin Nutr
Relative influences of sex, race, environment, and HIV infection on body composition in adults
Am J Clin Nutr
Gender differences in adherence to the sodium-restricted diet in patients with heart failure
J Card Fail
Health locus of control, gender differences and adjustment to persistent pain
Pain
A comparative analysis of nutritional parameters as predictors of outcome in male and female ESRD patients
Nephrol Dial Transplant
Renal Physicians Association clinical practice guideline: Appropriate patient preparation for renal replacement therapy: Guideline number 3
J Am Soc Nephrol
Evidence based practice guidelines for nutritional management of chronic kidney disease
Nutr Diet
Adequacy of dialysis and nutrition in continuous peritoneal dialysis: Association with clinical outcomesCanada-USA (CANUSA) Peritoneal Dialysis Study Group
J Am Soc Nephrol
Spontaneous dietary protein intake during progression of chronic renal failure
J Am Soc Nephrol
K/DOQI Clinical Practice Guideline for Nutrition in Chronic Renal Failure
Am J Kidney Dis
Low protein diets for chronic kidney disease in non diabetic adults
Cochrane Database Syst Rev
Low protein diets for chronic renal failure in non diabetic adults
Cochrane Database Syst Rev
The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases: A meta-analysis
Ann Intern Med
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2020, American Journal of Kidney DiseasesCitation Excerpt :Three RCTs, including 2 study populations, reported on the effect of MNT on SGA scores. Campbell et al demonstrated that malnourished patients with stage 4 CKD had SGA scores that significantly improved in the intervention group compared with the control group, for whom malnutrition by SGA score increased.129 The intervention consisted of nutritional counseling from an RDN for 12 weeks, with an emphasis on self-management techniques, face-to-face consultation at baseline, and telephone consultation every 2 weeks for the first month and then monthly for the next 2 months.
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2018, Journal of Renal NutritionCitation Excerpt :The prevalence of PEW among AKI studies18,19(n = 189 patients) was higher but again with broad variability between studies (60% and 82%). Five studies included nondialysis-dependent CKD patients with stages 3-59,20-23 (n = 1776 patients). Four of those studies20-23 used SGA and reported PEW prevalence that ranged from 11% to 18%.
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2018, MaturitasCitation Excerpt :The odds of being malnourished at follow-up were also not significant between groups (OR: 0.27 [95%CI: 0.01–5.24] P = .39; n = 2 studies; n = 70 participants; I2 = 62%). The two studies which measured energy and protein intake reported significant improvements compared with control [29,38]. Pooled data showing a trend in improved energy intake at follow-up did not reach significance (SMD: 0.85 [95%CI: −0.11–1.81] P = .08; n = 2 studies; n = 200 participants; I287%; GRADE level: very low) [29,38].
Trial registration: www.anzctr.org.au; study number: ACTRN012606000493549.
Originally published online as doi:10.1053/j.ajkd.2007.12.015 on February 29, 2008.