Introduction: There is a clear relationship between sodium intake and blood pressure in patients on chronic hemodialysis (HEMO). To date, there are few studies that assess sodium knowledge, beliefs, and behaviors in patients on chronic HEMO. The purpose of this research study was to determine sodium knowledge, beliefs and behaviors in patients on chronic HEMO. Methods: A descriptive correlational study was conducted using an investigator developed online sodium knowledge, beliefs, and behaviors survey. Participants were recruited via nephrology social media websites. Findings: One hundred and fourteen participants completed the survey, the majority of participants (n = 39, 34.2%) were between the ages of 36 and 50 years, 55.3% (n = 63) were female, and 70% (n = 80) were white. Fifty-four participants (47%) could not identify their recommended salt intake limit. Participants answered an average of 4 out of 7 questions pertaining to sodium knowledge correctly (SD 1.5). Increased age was associated with total sodium knowledge (r = 0.33, p= 0.01) and length of time on HEMO was related to total sodium knowledge (r = –0.20, p = 0.04). In terms of beliefs, 38% (n = 44) were unsure or did not believe that salt intake was related to blood pressure and 30% (n = 33) did not feel it was related to fluid gains. Forty-two participants (37%) responded that they were not informed by a health care provider to cut down their salt intake. Discussion: Knowledge about sodium levels is lacking in patients on chronic HEMO. Patients may be more likely to decrease their sodium intake if they know their recommended sodium levels. Health care providers are not doing enough to educate patients on the need to decrease sodium intake and reinforce the relationship between sodium intake, fluid gains, and blood pressure. Findings from this study are useful to help develop educational programs to target these knowledge needs.

Keywords:
Blood pressure, Fluid overload, Sodium, Hemodialysis, Hypertension
1.
Agarwal R. Epidemiology of interdialytic ambulatory hypertension and the role of volume excess.
Am J Nephrol
. 2011;34(4):381–90.
2.
Sarafidis PA, Persu A, Agarwal R, Burnier M, de Leeuw P, Ferro CJ, et al. Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the -European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH).
Nephrol Dial Transplant
. 2017 Apr;32(4):620–40.
3.
Mc Causland FR, Waikar SS, Brunelli SM. Increased dietary sodium is independently associated with greater mortality among prevalent hemodialysis patients.
Kidney Int
. 2012 Jul;82(2):204–11.
4.
Kayikcioglu M, Tumuklu M, Ozkahya M, Ozdogan O, Asci G, Duman S, et al. The benefit of salt restriction in the treatment of end-stage renal disease by haemodialysis.
Nephrol Dial Transplant
. 2009 Mar;24(3):956–62.
5.
Kooman JP, van der Sande F, Leunissen K, Locatelli F. Sodium balance in hemodialysis therapy.
Semin Dial
. 2003 Sep-Oct;16(5):351–5.
6.
Lindley EJ. Reducing sodium intake in hemodialysis patients.
Semin Dial
. 2009 May-Jun;22(3):260–3.
7.
Maduell F, Navarro V. Dietary salt intake and blood pressure control in haemodialysis patients.
Nephrol Dial Transplant
. 2000 Dec;15(12):2063.
8.
Sinha AD, Agarwal R. Can chronic volume overload be recognized and prevented in hemodialysis patients? The pitfalls of the clinical examination in assessing volume status.
Semin Dial
. 2009 Sep-Oct;22(5):480–2.
9.
Weir MR, Dworkin LD. Antihypertensive drugs, dietary salt, and renal protection: how low should you go and with which therapy?
Am J Kidney Dis
. 1998 Jul;32(1):1–22.
10.
Levey AS, Lau J, Uhlig K, Chew P, Kausz A, Kupelnick B, et al.; Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease.
Am J Kidney Dis
. 2004 May;43(5 Suppl 1):S1–290.
11.
Agarwal R, Flynn J, Pogue V, Rahman M, Reisin E, Weir MR. Assessment and management of hypertension in patients on dialysis.
J Am Soc Nephrol
. 2014 Aug;25(8):1630–46.
12.
Daugirdas JT, Depner TA, Inrig J, Mehrotra R, Rocco MV, Suri RS, et al. K/DOQI clinical practice guideline 2015 update. Control of Volume and Blood Pressure.
Am J Kidney Dis
. 2015;66(5):884–930.
13.
Ersan S, Liv F, Tanrisev M, Colak H, Yilmaz B, Alp A. Hemodialysis patients’ knowledge and awareness about dietary sodium: there is still need for awareness raising interventions.
Acta Med Mediter
. 2017 Jan;33(2):217–22.
14.
Mc Causland FR, Waikar SS, Brunelli SM. The relevance of dietary sodium in hemodialysis.
Nephrol Dial Transplant
. 2013 Apr;28(4):797–802.
15.
World Health Organization. Strategies to monitor and evaluate population sodium consumption and sources of sodium in the diet: report of a joint technical meeting convened by WHO and the Government of Canada. 2011.
16.
Sarmugam R, Worsley A. Current levels of salt knowledge: a review of the literature.
Nutrients
. 2014 Dec;6(12):5534–59.
17.
Wright Nunes JA, Anderson CA, Greene JH, Ikizler TA, Cavanaugh KL. Results of a novel screening tool measuring dietary sodium knowledge in patients with chronic kidney disease.
BMC Nephrol
. 2015 Mar;16(1):42.
18.
Tomson CR. Advising dialysis patients to restrict fluid intake without restricting sodium intake is not based on evidence and is a waste of time.
Nephrol Dial Transplant
. 2001 Aug;16(8):1538–42.
19.
Lindley EJ. Reducing sodium intake in hemodialysis patients.
Semin Dial
. 2009 May-Jun;22(3):260–3.
20.
Cobb LK, Appel LJ, Anderson CA. Strategies to reduce dietary sodium intake.
Curr Treat Options Cardiovasc Med
. 2012 Aug;14(4):425–34.
21.
Glyde M, Keane D, Dye L, Sutherland E. Patients’ perceptions of their experience, control and knowledge of fluid management when receiving haemodialysis.
J Ren Care
. 2019 Jun;45(2):83–92.
22.
Krespi R, Bone M, Ahmad R, Worthington B, Salmon P. Haemodialysis patients’ beliefs about renal failure and its treatment.
Patient Educ Couns
. 2004 May;53(2):189–96.
23.
Saran R, Robinson B, Abbott KC, Agodoa LY, Albertus P, Ayanian J, et al. US renal data system 2016 annual data report: epidemiology of kidney disease in the United States.
Am J Kidney Dis
. 2017 Mar;69(3 Suppl 1):A7–8.
24.
Hecking M, Karaboyas A, Saran R, Sen A, Hörl WH, Pisoni RL, et al. Predialysis Serum Sodium Level, Dialysate Sodium, and Mortality in Maintenance Hemodialysis Patients: The Dialysis Outcomes and Practice Patterns Study (DOPPS).
Am J Kidney Dis
. 2012 Feb;59(2):238–48.
25.
How to Use and Understand Nutrition Fact Labels. U.S. Foods and Drug Administration, 2004. Available from: https://www.fda.gov/food/nutrition-education-resources-materials/how-understand-and-use-nutrition-facts-label.
26.
The Healthy Six. American Heart Association. The American Heart Association, 2018. Available from: https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/salty-six-infographic.
27.
Gutman T, Tong A, Howell M, Dansie K, Hawley CM, Craig JC, et al.; Better Evidence and Translation in Chronic Kidney Disease (BEAT-CKD) Workshop Investigators. Principles and strategies for involving patients in research in chronic kidney disease: report from national workshops.
Nephrol Dial Transplant
. 2019 May;gfz076.
28.
Lindberg M, Wikström B, Lindberg P. A behavioural nursing intervention for reduced fluid overload in haemodialysis patients. Initial results of acceptability, feasibility and efficacy.
J Nurs Healthc Chronic Illn
. 2011 Jun;3(2):87–98.
29.
Sevick MA, Stone RA, Novak M, Piraino B, Snetselaar L, Marsh RM, et al. A PDA-based dietary self-monitoring intervention to reduce sodium intake in an in-center hemodialysis patient.
Patient Prefer Adherence
. 2008 Feb;2:177–84.
© 2019 S. Karger AG, Basel
2019
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.