Sevick Mary Ann, Piraino Beth M, St-Jules David E, Hough Linda J, Hanlon Joseph T, Marcum Zachary A, Zickmund Susan L, Snetselaar Linda G, Steenkiste Ann R, Stone Roslyn A
Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, New York.
School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
J Ren Nutr. 2016 May;26(3):149-58. doi: 10.1053/j.jrn.2015.11.006. Epub 2016 Feb 9.
To evaluate the efficacy of behavioral counseling combined with technology-based self-monitoring for sodium restriction in hemodialysis (HD) patients.
Randomized clinical trial.
English literate adults undergoing outpatient, in-center intermittent HD for at least 3 months.
Over a 16-week period, both the intervention and the attention control groups were shown 6 educational modules on the HD diet. The intervention group also received social cognitive theory-based behavioral counseling and monitored their diets daily using handheld computers.
Average daily interdialytic weight gain (IDWGA) was calculated for every week of HD treatment over the observation period by subtracting the post-dialysis weight at the previous treatment time (t-1) from the pre-dialysis weight at the current treatment time (t), dividing by the number of days between treatments. Three 24-hour dietary recalls were obtained at baseline, 8 weeks, and 16 weeks and evaluated using the Nutrient Data System for Research.
A total of 179 participants were randomized, and 160 (89.4%) completed final measurements. IDWGA did not differ significantly by treatment group at any time point considered (P > .79 for each). A significant differential change in dietary sodium intake observed at 8 weeks (-372 mg/day; P = .05) was not sustained at 16 weeks (-191 mg/day; P = .32).
The BalanceWise Study intervention appeared to be feasible and acceptable to HD patients although IDWGA was unchanged and the desired behavioral changes observed at 8 weeks were not sustained. Unmeasured factors may have contributed to the mixed findings, and further research is needed to identify the appropriate patients for such interventions.
评估行为咨询结合基于技术的自我监测对血液透析（HD）患者限钠的疗效。
随机临床试验。
能读写英语、接受门诊中心间歇性血液透析至少3个月的成年人。
在16周的时间里，干预组和注意力控制组均观看了6个关于血液透析饮食的教育模块。干预组还接受了基于社会认知理论的行为咨询，并使用手持电脑每日监测饮食情况。
在观察期内，通过用当前治疗时间（t）的透析前体重减去上一次治疗时间（t-1）的透析后体重，再除以两次治疗之间的天数，计算血液透析治疗每周的平均每日透析间期体重增加量（IDWGA）。在基线、第8周和第16周进行三次24小时饮食回顾，并使用营养数据系统进行研究评估。
共有179名参与者被随机分组，160名（89.4%）完成了最终测量。在任何考虑的时间点，治疗组之间的IDWGA均无显著差异（每次P>.79）。在第8周观察到的饮食钠摄入量的显著差异变化（-372毫克/天；P = 0.05）在第16周未持续（-191毫克/天；P = 0.32）。
尽管IDWGA没有变化，且在第8周观察到的预期行为变化未持续，但BalanceWise研究干预措施对HD患者似乎是可行且可接受的。未测量的因素可能导致了这些混合结果，需要进一步研究以确定适合此类干预措施的患者。
