Development and Evaluation of a Scored Sodium Questionnaire-Screening Form for Kidney Disease Patients.

OBJECTIVE: To develop and evaluate a screening version of the validated Scored Sodium Questionnaire (SSQ). DESIGN: Development phase-a Scored Sodium Questionnaire-Screening Form (SSQ-SF) and scoring system were developed using data previously collected in 47 chronic kidney disease outpatients participating in the SSQ validation study; evaluation phase-conducted in 49 participants with end-stage kidney disease on hemodialysis and 16 nursing staff. SUBJECTS: A total of 49 outpatients (61% male) aged 63.1 ± 14.8 years attending a hemodialysis kidney clinic at a tertiary referral hospital in Australia. On separate occasions, participants completed the SSQ, the SSQ-SF, and a feasibility questionnaire. Nursing staff from the same clinic completed a feasibility questionnaire. MAIN OUTCOME MEASURES: Time and ease of completion; association and agreement between the SSQ and SSQ-SF scores; assessment of binary classifications for sodium consumption: sensitivity and specificity. RESULTS: Median time to complete the SSQ-SF was 4 minutes versus 10 minutes for the SSQ (P < .01); 93% of participants and nursing staff agreed that the SSQ-SF was easy to complete. There was strong and significant association between total SSQ and SSQ-SF scores (r = 0.777, P ≤ .01), with strong agreement between individual scores and no fixed bias. Compared with the SSQ, the SSQ-SF score cut-point of ≥50 successfully classified 23 of 27 participants as high sodium consumers: sensitivity 85% and specificity 68%. CONCLUSION: The SSQ-SF is quick and feasible to implement in the clinical setting and may be a useful first step for screening the sodium intakes of kidney disease patients for referral into the nutrition care process.

Development and validation of a dietary screening tool for high sodium consumption in Australian renal patients.

OBJECTIVE: The study objective was to develop and evaluate the feasibility and validity of a self-administered Scored Sodium Questionnaire (SSQ) for use in the routine clinical care of Australian chronic kidney disease (CKD) patients. DESIGN AND METHODS: The study took place in community-based outreach clinics using a multidisciplinary model of care. Assessment of sources of dietary sodium intake in the target population used comprehensive diet history interviews (Phase 1) to inform development of a 10-item food frequency questionnaire that was scored and validated using 24-hour urinary sodium and 2 alternative dietary intake methods (Phase 2). Subjects were adults with CKD Stages 3 to 5 (Phase 1 n = 30; Phase 2 n = 47). INTERVENTION: On a single day, participants (n = 47) completed the SSQ, feasibility survey, 24-hour urine collection, and 24-hour food record. A diet history interview was also conducted to confirm sodium intake on the day of data collection reflected habitual intake. MAIN OUTCOME MEASURE: Validity of the SSQ score was confirmed by correlation with 24-hour urine sodium. Validity of a cutpoint on the SSQ score to correctly identify high- versus low-sodium consumers was confirmed by receiver operating characteristic curve analysis: area under the curve, sensitivity, and specificity. RESULTS: Total SSQ score correlated significantly with 24-hour urine sodium (r = 0.371; P = .031). Correlation between 24-hour food record and diet history sodium confirmed consumption on the data collection day reflected habitual intake (r = 0.701; P ≤ .001). A cutpoint of 65 or greater on the SSQ score was confirmed as valid to identify high-sodium consumers: area under the curve 0.713, sensitivity 61%, and specificity 82%. CONCLUSION: The SSQ is feasible and valid to assess habitual sodium intake in the Australian CKD population and to identify high-sodium consumers for referral to individualized counseling on a low-sodium diet.

Re-Thinking Hyperkalaemia Management in Chronic Kidney Disease-Beyond Food Tables and Nutrition Myths: An Evidence-Based Practice Review.

Potassium dysregulation can be life-threatening. Dietary potassium modification is a management strategy for hyperkalaemia. However, a 2017 review for clinical guidelines found no trials evaluating dietary restriction for managing hyperkalaemia in chronic kidney disease (CKD). Evidence regarding dietary hyperkalaemia management was reviewed and practice recommendations disseminated. A literature search using terms for potassium, hyperkalaemia, and CKD was undertaken from 2018 to October 2022. Researchers extracted data, discussed findings, and formulated practice recommendations. A consumer resource, a clinician education webinar, and workplace education sessions were developed. Eighteen studies were included. Observational studies found no association between dietary and serum potassium in CKD populations. In two studies, 40-60 mmol increases in dietary/supplemental potassium increased serum potassium by 0.2-0.4 mmol/L. No studies examined lowering dietary potassium as a therapeutic treatment for hyperkalaemia. Healthy dietary patterns were associated with improved outcomes and may predict lower serum potassium, as dietary co-factors may support potassium shifts intracellularly, and increase excretion through the bowel. The resource recommended limiting potassium additives, large servings of meat and milk, and including high-fibre foods: wholegrains, fruits, and vegetables. In seven months, the resource received > 3300 views and the webinar > 290 views. This review highlights the need for prompt review of consumer resources, hospital diets, and health professionals' knowledge.

Guidelines for review of patients on haemodialysis: Are we meeting patient needs?

AIM: This study aimed to determine satisfaction with dietetic services, identify barriers and enablers to engaging with dietetic services and acceptable methods of delivering nutrition care to patients on haemodialysis. METHODS: A questionnaire was developed based on existing satisfaction surveys and key constructs from the Theoretical Domains Framework to understand patient behaviours around accessing dietetic services. Constructs were grouped according to the COM-B model (Capability, Opportunity and Motivation) of the Behaviour Change Wheel to inform future interventions. Patients at three Brisbane haemodialysis units participated, with questionnaire administered via laptop (by dietetic assistants) or paper-based version (by nurses). RESULTS: Sixty-six patients completed the questionnaire (response rate 40%, 62 ± 14 years, 58% male). Most respondents (n = 63, 95%) reported seeing a dietitian since commencing haemodialysis. A quarter of respondents reported declining or not wanting to see the dietitian. Despite this, questions pertaining to service satisfaction were largely positive. Questions related to enablers and barriers to engaging with the dietitian revealed the domain of motivation as the main barrier with 41% (n = 26) participants not wanting to make dietary changes. The domains of capability and opportunity were not barriers. Patients preferred receiving nutrition information from dietitians, when they had a question or concern, rather than at predefined intervals. Telehealth was not acceptable to the majority of participants. CONCLUSIONS: While patients were satisfied with dietetic care, their preferences for dietetic service delivery were not aligned with current evidence-based guidelines, highlighting need for alternative models of care. Dietetic interventions need to be delivered in a way that addresses motivation.