Can renal nutrition education improve adherence to a low-protein diet in patients with stages 3 to 5 chronic kidney disease?

Objective: Low adherence is frequently observed in patients with chronic kidney disease (CKD) who are following a low-protein diet. We have evaluated whether a specific nutrition education program motivates patients with CKD who do not yet receive dialysis to reduce their protein intake and whether such a program improves adherence to a low-protein diet over and above standard dietary counseling.

Design and methods: This was a randomized controlled clinical trial conducted at the CKD outpatient clinic at Pedro Ernesto University Hospital, Rio de Janeiro, Brazil.

Subjects: This study included adult patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) who were receiving conservative treatment. Participants had received their first referrals to a renal dietitian.

Intervention: Patients were randomized to a normal counseling group (individualized dietary program: 0.6 to 0.75 g protein/kg/day or 0.6 to 0.8 g/kg/day for patients with diabetes and 25 to 35 kcal/kg/day with sodium restriction) or an intense counseling group (same dietary program plus nutrition education materials). The nutrition education material included 4 different actions to improve patient knowledge and understanding of the low-protein and low-sodium diet. Both groups were followed by means of individual monthly visits to the outpatient clinic for 4 months.

Main outcome measure: We looked for a change in protein intake from baseline values as well as the adherence rate, assessed as a 20% decrease of the initial protein intake (by 24-hour food recall).

Results: Eighty-nine patients completed the study (normal counseling n = 46; intense counseling n = 43). The number of patients who adhered to a low-protein diet was high but did not differ between groups (in the last visit 69% vs. 48%; P = .48; intense vs. normal counseling, respectively). The reduction in protein intake from baseline values was greater for the intense counseling group compared with the normal counseling group (at the last visit, -20.7 g/day [-30.9%] vs. -10.5 g/day [-15.1%], intense vs. normal counseling, respectively; P = .04).

Conclusion: An intense nutrition education program contributed to reducing protein intake in patients with stage 3 to 5 CKD over and above our standard dietary counseling. Nutritional education programs are effective in increasing patient adherence to protein intake recommendations.