SP626A SYSTEMATIC REVIEW OF NON-PHARMACOLOGICAL INTERVENTIONS TO PROMOTE ADHERENCE TO DIETARY SALT AND FLUID INTAKE RESTRICTIONS IN END-STAGE KIDNEY DISEASE
Bibliographic record
Abstract
INTRODUCTION AND AIMS: Dietary restriction of salt and fluid intake is an important strategy to prevent volume overload, a common complication in end-stage kidney disease. The aim of this study was to evaluate the effects of non-pharmacologic interventions to improve adherence to dietary salt and fluid restriction in patients with stage 5 CKD, including pre-dialysis patients and those on chronic hemodialysis (HD) or peritoneal dialysis (PD). METHODS: A systematic review and meta-analysis of randomised controlled trials (RCTs) and quasi-RCTs in adults with stage 5 CKD was conducted. Electronic databases (MEDLINE, Embase, Cochrane) were searched without language restriction in December 2014 . Study selection was done by two independent authors. Mean differences (MD) were pooled using random effects meta-analysis. Primary outcomes were mortality, cardiovascular events, and quality of life. Secondary outcomes included interdialytic weight gain (IDWG), and blood pressure (BP). Risk of bias was assessed using the Cochrane Risk of Bias Tool. The GRADE approach was applied to assess certainty of evidence for each outcome. RESULTS: Seventeen studies assessing educational, behavioural, cognitive, or organizational interventions were included, with 15 studies in HD (N=1305 participants) and 2 studies in PD (N=135 participants). There were no studies in pre-dialysis patients, and no studies assessed mortality or cardiovascular events. Among studies reporting Short-Form 36 quality of life scores, there was overall improvement in physical role scores (MD, +12.42, 95% CI +5.29, +19.55) in educational and cognitive intervention groups compared with routine care, with no significant changes in other subscales. Among studies in HD patients, pooled results did not show a significant effect on IDWG (MD -0.11 kg, 95% CI -0.29, +0.07) and this was consistent across all interventions (low risk of bias; moderate certainty). Among HD studies reporting pre-HD BP, the pooled effect size showed a statistically significant reduction in systolic BP (MD -7.72 mmHg, 95% CI -12.88, -2.57) and diastolic BP (MD -4.12 mm Hg, 95% CI -7.91, -0.32), with greater effect in behavioural interventions than organizational interventions. There was insufficient evidence to make conclusions about the effect of interventions on fluid adherence, body weight, or BP in PD studies. CONCLUSIONS: There was moderate certainty evidence demonstrating minimal effect of interventions to promote adherence to salt/fluid restrictions on IDWG in chronic HD patients. Educational and cognitive interventions may improve quality of life in the domain of role limitations due to physical health problems, but the certainty of the evidence is low as studies had high risk of bias due to lack of blinding. Behavioural and organizational interventions may improve BP control in HD patients. Studies assessing mortality, cardiovascular events, and nutritional status were lacking. More RCTs of interventions in PD and non-dialysis stage 5 CKD populations are needed.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".