The Short-Term Impact of Dietary Counseling on Sodium Intake and Blood Pressure in Renal Allograft Recipients

Abstract

Background:

Sodium retention causes posttransplant hypertension, and sodium restriction is recommended in kidney allograft recipients. However, there have been few studies on the impact of dietary counseling on sodium intake and blood pressure (BP) in this population.

Objective:

To determine the effect of dietary counseling on sodium intake and consequent BP control in kidney allograft recipients.

Design, Setting, and Participants:

A prospective single-arm study to determine the effect of dietary counseling on sodium intake. Enrolled were renal allograft recipients with sodium intake >100 mEq/d, BP >130/80, antihypertensive use, or body mass index >25 kg/m². Of 53 renal transplant recipients who met the criteria, 48 participated in the present study. Sodium intake was estimated based on 24-hour urinary sodium excretion before and after 3 sessions of dietary counseling by a board-certified dietitian.

Results:

Sodium intake was significantly decreased after dietary counseling (158.7 vs 129.6 mEq/d; P = .005). Systolic BP was significantly decreased from 124 mm Hg (interquartile range: 122-134) before counseling to 121 mm Hg (interquartile range: 117-128) after counseling (P < .001). The number of patients with systolic BP >130 mm Hg was decreased by 30% (n = 19-13; P = .07). Among 34 patients on antihypertensive medications, 8 (23.5%) ceased or reduced their drugs due to improvement in BP, whereas 2 increased or changed the drugs due to poor control of BP.

Conclusion:

Dietary counseling showed a short-term efficacy of reducing sodium intake and clinically relevant BP improvement in renal allograft recipients.

Keywords

kidney transplantation salt intake posttransplant hypertension dietitian counseling

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References

Kasiske

Anjum

Shah

. Hypertension after kidney transplantation. Am J Kidney Dis. 2004;43(6):1071–1081.

Opelz

Dohler

; Collaborative Transplant Study. Improved long-term outcomes after renal transplantation associated with blood pressure control. Am J Transplant. 2005;5(11):2725–2731.

Paoletti

Gherzi

Amidone

Massarino

Cannella

. Association of arterial hypertension with renal target organ damage in kidney transplant recipients: the predictive role of ambulatory blood pressure monitoring. Transplantation. 2009;87(12):1864–1869.

Carpenter

Weir

Adey

House

Bostom

Kusek

. Inadequacy of cardiovascular risk factor management in chronic kidney transplantation—evidence from the FAVORIT study. Clin Transplant. 2012;26(4):E438–E446.

Lakkis

Weir

. Treatment-resistant hypertension in the transplant recipient. Semin Nephrol. 2014;34(5):560–570.

Thomas

Taber

Srinivas

. Hypertension after kidney transplantation: a pathophysiologic approach. Curr Hypertens Rep. 2013;15(5):458–469.

Weir

Burgess

Cooper

. Assessment and management of hypertension in transplant patients. J Am Soc Nephrol. 2015;26(6):1248–1260.

Mangray

Vella

. Hypertension after kidney transplant. Am J Kidney Dis. 2011;57(2):331–341.

Opelz

Wujciak

Ritz

. Association of chronic kidney graft failure with recipient blood pressure. Collaborative Transplant Study. Kidney Int. 1998;53(1):217–222.

10.

Gray

Kasiske

. Patient and renal allograft survival in the late posttransplant period. Semin Nephrol. 1992;12(4):343–352.

11.

Olyaei

deMattos

Bennett

. A practical guide to the management of hypertension in renal transplant recipients. Drugs. 1999;58(6):1011–1027.

12.

Stoumpos

Jardine

Mark

. Cardiovascular morbidity and mortality after kidney transplantation. Transpl Int. 2015;28(1):10–21.

13.

Ojo

. Cardiovascular complications after renal transplantation and their prevention. Transplantation. 2006;82(5):603–611.

14.

Fellstrom

Jardine

Soveri

. Renal dysfunction as a risk factor for mortality and cardiovascular disease in renal transplantation: experience from the Assessment of Lescol in Renal Transplantation trial. Transplantation. 2005;79(9):1160–1163.

15.

Ponticelli

Cucchiari

Graziani

. Hypertension in kidney transplant recipients. Transpl Int. 2011;24(6):523–533.

16.

van den Berg

Geleijnse

Brink

. Sodium intake and blood pressure in renal transplant recipients. Nephrol Dial Transplant. 2012;27(8):3352–3359.

17.

Moeller

Buhl

Schorr

Distler

Sharma

. Salt intake and hypertension in renal transplant patients. Clin Nephrol. 2000;53(3):159–163.

18.

Abbud-Filho

Adams

Alberu

. A report of the Lisbon Conference on the care of the kidney transplant recipient. Transplantation. 2007;83(8 suppl):S1–S22.

19.

Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004;43(5 suppl 1):S1–S290.

20.

Keven

Yalcin

Canbakan

. The impact of daily sodium intake on posttransplant hypertension in kidney allograft recipients. Transplant Proc. 2006;38(5):1323–1326.

21.

Soypacaci

Sengul

Yildiz

. Effect of daily sodium intake on post-transplant hypertension in kidney allograft recipients. Transplant Proc. 2013;45(3):940–943.

22.

Guida

Trio

Laccetti

. Role of dietary intervention on metabolic abnormalities and nutritional status after renal transplantation. Nephrol Dial Transplant. 2007;22(11):3304–3310.

23.

Rees

Dyakova

Ward

Thorogood

Brunner

. Dietary advice for reducing cardiovascular risk. Cochrane Database Syst Rev. 2013;3:CD002128. doi:10.1002/14651858.CD002128.pub4.

24.

Kasiske

Zeier

Chapman

. KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney Int. 2010;77(4):299–311.

25.

James

Oparil

Carter

. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–520.

26.

Jih

Mukherjea

Vittinghoff

. Using appropriate body mass index cut points for overweight and obesity among Asian Americans. Prev Med. 2014;65:1–6.

27.

Zeng

Dong

. Optimal cut-off values of BMI, waist circumference and waist:height ratio for defining obesity in Chinese adults. Br J Nutr. 2014;112(10):1735–1744. doi:10.1017/S0007114514002657.

28.

Pan

Flegal

Chang

Yeh

Lee

. Body mass index and obesity-related metabolic disorders in Taiwanese and US whites and blacks: implications for definitions of overweight and obesity for Asians. Am J Clin Nutr. 2004;79(1):31–39.

29.

Frost

Law

Wald

. By how much does dietary salt reduction lower blood pressure? II—analysis of observational data within populations. BMJ. 1991;302(6780):815–818.

30.

Tanaka

Okamura

Miura

. A simple method to estimate populational 24-h urinary sodium and potassium excretion using a casual urine specimen. J Hum Hypertens. 2002;16(2):97–103.

31.

Dobrowolski

Bemelman

van Donselaar-van der Pant

Hoitsma

ten Berge

Krediet

. Treatment efficacy of hypertension in kidney transplant recipients in the Netherlands. Neth J Med. 2014;72(5):258–263.

32.

Vogt

Waanders

Boomsma

de Zeeuw

Navis

. Effects of dietary sodium and hydrochlorothiazide on the antiproteinuric efficacy of losartan. J Am Soc Nephrol. 2008;19(5):999–1007.

33.

Rossi

Vella

. Hypertension, living kidney donors, and transplantation: where are we today? Adv Chronic Kidney Dis. 2015;22(2):154–164.

34.

Ramesh Prasad

Huang

Nash

Zaltzman

. The role of dietary cations in the blood pressure of renal transplant recipients. Clin Transplant. 2006;20(1):37–42.

35.

Stenehjem

Gudmundsdottir

. Office blood pressure measurements overestimate blood pressure control in renal transplant patients. Blood Press Monit. 2006;11(3):125–133.

36.

Haydar

Covic

Jayawardene

. Insights from ambulatory blood pressure monitoring: diagnosis of hypertension and diurnal blood pressure in renal transplant recipients. Transplantation. 2004;77(6):849–853.