Objective: Investigate the impacts of individual liberalized renal diet counseling in conjunction with a volume reduction hemodialysis (HD) protocol.

Design & Methods: Twenty-three maintenance HD patients (age = 55.7 +/- 13.3y, 47.8% female), consented and completed this pilot intervention. Across the six-month intervention, participants received thrice weekly dietary counseling about a liberalized renal diet. Liberalized renal dietary guidelines promoted a low sodium diet with greater unprocessed food consumption, decreasing foods eaten outside the home, and increased food label reading. Participant HD sessions were conducted per a volume reduction protocol, gradually decreasing patient post-dialysis weight by removing an additional 200-300 mL/session. Preliminary outcome measures included dietary intake and knowledge, blood pressure (BP), anti-hypertensive medication use, and volume overload (VO).

Results: From baseline (BL) to six months (6m), total sodium intake numerically decreased (BL 2886 +/- 1570.6 vs 6m 2315 +/- 1095 mg, p=0.13), systolic BP (BL 160 +/- 25 vs. 6m 156 +/- 23 mmHg, p=0.56) and diastolic BP (BL 81 +/- 20 vs 6m 79 +/- 15 mmHg, p= 0.73) showed no significant changes, but total number of anti-hypertensive medications prescribed to patients (BL 3 +/- 1 vs 6m 2 +/- 1 medications) were significantly reduced (p=0.003). Additionally, significant improvements were noted in VO (BL 3.6L +/- 3.9L vs 6m 2.5L +/- 3.5L, p=0.01).

Conclusion: Liberalized renal diet education had little effect on sodium intake, likely contributing only minimally to BP control. Volume reduction protocol with gradual reduction of post dialysis weight resulted in significantly decreased VO, and maintenance of BP with coinciding decreases in anti-hypertensive medication usage. Our findings document intervention opportunities to improve BP and decrease medication usage for HD patients.