Intensive nutrition conseling by telephone call for improving dietary behavior and inflammatory status in chronic kidney disease

Abstract

Chronic kidney disease (CKD) has still been a worldwide public health problem including Thailand. Inflammation, one of nontraditional risk factors of CKD complications, plays a major role in the pathophysiology of cardiovascular disease. Therefore, the nutrition counseling is required in the CKD patients for dietary control and self-monitoring. This study divided into two parts. The first part was a cross-sectional study and aimed to measure and compare inflammation markers in difference stages of CKD patient. All CKD patients were enrolled from the Endocrine and Metabolic Clinic at Chulalongkorn memorial hospital. Thirty-eight CKD patients and eight healthy participants were recruited and investigated the levels of serum TNF-α and IL6. All participants were asked to perform 7-day food record used for calculating energy and nutrient intake. There was no significant difference of inflammation makers between healthy subjects and CKD patients in various stages. However, this study found a decreasing trend of TNF-alpha and IL-6 in stage 3 and 4 CKD patients and an increasing trend in patients with CKD stage 1&2. There were no significant relationships between eGFR and these inflammation biomarkers of Thai predialysis CKD outpatients. However, there was significance correlation between serum TNF-α levels and muscle mass (r2 = 0.13, p = 0.003) or visceral fat (r2 = 0.22, p = 0.02). The second study aimed to investigate the effect of the intensive nutrition counseling by follow-up telephone call for improving dietary behavior and inflammatory status. Thirty-six patients with CKD stage 1 to 4 were enrolled. The 24-week randomized control trial was applied in this study. The CKD participants in first study were randomized into two groups. The control groups received a routine nutrition counseling and had appointment with a dietitian at the clinic every 12 weeks. Patients in the treatment groups received the follow-up telephone calls every week at first month and twice a month during the rest of the study. Interestingly, this study found significant decrease of serum TNF-α in stage 1&2 CKD patients. Eventhough the intensive nutrition counseling with follow-up telephone calls did not show the effect on inflammation markers of the late stage CKD patients within 6 months. It could maintain self-management on protein intake and the nutrition status of these patients. Therefore, intensive nutrition counseling supplemented with follow-up telephone call may benefit to CKD patients as service in hospitals.