Dietary interventions and strategies to reduce sodium consumption and volume overload in hemodialysis patients

Nearly 80% of patients undergoing maintenance hemodialysis have some degree of volume-dependent hypertension, which contributes to poor quality of life, cardiovascular morbidity, and mortality. Despite routine dialysis and pharmacological treatment, chronic volume overload has remained a challenging problem in hemodialysis. Dietary sodium restriction is a critically important strategy for preventing volume overload, yet has not been the focus of routine clinical counseling or research interventions. This is likely because there are significant barriers to following a low sodium diet, which has contributed to the poor efficacy of dietary counseling to reduce sodium intake in the renal nutrition literature. Home delivery of low-sodium meals is an alternative to low-sodium counseling that bypasses many of the barriers to reducing sodium intake and reducing acute volume overload. This approach has been shown to reduce sodium intake and improve cardiovascular function in individuals with hypertension and heart failure. However, there are no studies to date examining the effects of low-sodium home-delivered meal provision in hemodialysis patients. Recent studies have suggested that dietary sodium may accumulate within tissues and that excess tissue sodium has been associated with markers of cardiovascular risk. No research has investigated the relationship between diet and tissue sodium or whether sodium restriction can reduce excess tissue sodium accumulation. Meal provision represents a feasible method to reducing sodium intake, tissue sodium, and measures of volume-dependent hypertension that could eventually be evaluated for long-term efficacy, cost-effectiveness, and clinical outcomes. The objective of this dissertation is to examine the efficacy of dietary strategies and interventions for reducing dietary sodium intake, with a special emphasis on home-meal delivery as an alternative to dietary counseling for reducing sodium intake