Geisinger Health System, Kidney Health Research Institute, Danville, PA; Geisinger Health System, Medicine Institute, Danville, PA.
Geisinger Health System, Obesity Institute, Danville, PA.
J Ren Nutr. 2020 Jan;30(1):53-60. doi: 10.1053/j.jrn.2019.03.080. Epub 2019 May 8.
OBJECTIVE(S): Although healthy dietary patterns are associated with decreased mortality in patients with chronic kidney disease (CKD), few patients receive dietitian counseling due to concerns such as dietitian availability, travel distance, and cost. Our objective was to determine the feasibility of dietary smartphone application-supported telecounseling to reduce sodium intake and improve dietary quality in patients with early CKD.
This was a pre-post, mixed methods feasibility study of 16 patients with Stage 1-3a CKD in central/northeast Pennsylvania. Patients recorded and shared dietary data via smartphone applications with registered dietitians, who used motivational interviewing to provide telephone counseling weekly for 8 weeks. Seven patients were assigned to a customized study-specific application and nine patients to a commercially available, free application (MyFitnessPal). Participant satisfaction was assessed via survey, and participants were invited to complete a semistructured interview. Outcomes assessed included sodium intake, Healthy Eating Index 2015 score, weight, and 24-hour blood pressure (BP).
Mean age was 64.7 years, 31% were female, 100% were white, 13% had income <$25,000. Adherence was excellent with 14 (88%) entering dietary data at least 75% of total days. Patients reported high satisfaction with the intervention and dietitian telecounseling. Use of dietary apps was viewed positively for allowing tracking of sodium and energy intake although some participants experienced functionality issues with the customized application that were not generally experienced by those using the commercially available free application. Sodium intake (-604 mg/day, 95% confidence interval [CI]: -1,104 to -104), Healthy Eating Index 2015 score (3.97, 95% CI: 0.03-7.91), weight (-3.4, 95% CI: -6.6 to -0.1), daytime systolic BP (-5.8, 95% CI: -12.1 to 0.6), and daytime diastolic BP (-4.1, 95% CI: -7.9 to -0.2) improved after the intervention.
An application-supported telecounseling program with a registered dietitian appears to be a feasible and well-accepted strategy to improve dietary quality and improve cardiovascular risk factors in patients with early kidney disease.
尽管健康的饮食模式与降低慢性肾脏病（CKD）患者的死亡率有关，但由于营养师的可用性、旅行距离和费用等问题，很少有患者接受营养师咨询。我们的目的是确定基于智能手机应用的远程咨询以减少早期 CKD 患者的钠摄入量和改善饮食质量的可行性。
这是一项在宾夕法尼亚州中心/东北部的 16 名 CKD1-3a 期患者中进行的前后混合方法可行性研究。患者通过智能手机应用记录和共享饮食数据，营养师使用动机性访谈每周进行 8 周的电话咨询。7 名患者被分配到一个特定于研究的定制应用程序，9 名患者使用商业上可用的免费应用程序（MyFitnessPal）。通过调查评估参与者的满意度，并邀请参与者完成半结构化访谈。评估的结果包括钠摄入量、2015 年健康饮食指数得分、体重和 24 小时血压（BP）。
平均年龄为 64.7 岁，31%为女性，100%为白人，13%的收入<25000 美元。患者的饮食数据记录非常好，有 14 名患者（88%）至少在总天数的 75%以上记录饮食数据。患者对干预措施和营养师远程咨询非常满意。尽管一些参与者在使用定制应用程序时遇到了功能问题，但使用饮食应用程序可以很好地跟踪钠和能量摄入，这得到了参与者的积极评价，而这些问题在使用商业上可用的免费应用程序时通常不会出现。干预后，钠摄入量（-604mg/天，95%置信区间[CI]：-1,104 至-104）、2015 年健康饮食指数得分（3.97，95%CI：0.03-7.91）、体重（-3.4，95%CI：-6.6 至-0.1）、日间收缩压（-5.8，95%CI：-12.1 至 0.6）和日间舒张压（-4.1，95%CI：-7.9 至-0.2）均有所改善。
基于应用程序的营养师远程咨询计划似乎是一种可行且被广泛接受的策略，可以改善早期肾病患者的饮食质量和心血管危险因素。
