#2002 Impact of personalized nutrition care in patients with advanced chronic kidney disease: ERCANUT RCT
Authors: Padial Marina , Rebollo Ana , Jiménez Tamara , Lindholm Bengt , Avesani Carla Maria , Olveira Gabriel 
Published: May 2024

Abstract

Background and Aims
A careful dietary plan is part of an integral treatment of patients with chronic kidney disease (CKD) stages 3 to 5 not on dialysis. It aims to slow disease progression, mitigate metabolic derangements and maintain adequate nutritional status. However, the dietary plan can overwhelm patients, affect their social life and increase anxiety and depression. Therefore, effective nutritional strategies are needed to improve the quality of the diet while also maintaining the quality of life (QoL). We analyzed the impact of personalized nutrition care (PNC) with a nutritional educational program on QoL, nutritional status, and anxiety and depression in patients with advanced CKD.

Method
ERCANUT is a 3-months RCT comprising 76 adult patients with GFR &lt;30 ml/min/1.73 m2 who were randomized to study group (n = 38), which received PNC combined with a nutritional education program, or to the control group (n = 38) that received general dietary recommendations. Both groups received dietary counseling from the same dietitian to follow a healthy and protein-controlled diet (0.65-0.8 g/kg/day) based on Mediterranean pattern. The nutritional educational program in the study group consisted in three one-hour sessions, using nutritional coaching. Patients and relatives received information about healthy diet and lifestyle. They were encouraged to increase their physical activity. In addition, during the follow-up period (3 months), they had the support of health care professionals by phone calls and text messages. Baseline and 3-month data were collected: QoL (KDQOLTM-36), nutritional status (anthropometry and bioelectrical impedance) and grade of anxiety and depression (HADS). Dietary adherence was assessed using the short version of the Mediterranean diet adherence questionnaire.
All patients were counselled by a dietitian to follow a diet containing whole grain foods, vegetables and fruits, nuts and extra virgin olive oil as the main dietary fat. Plant protein (legumes) was preferred over animal protein, especially processed meat and red meat. Patients were advised to reduce the intake of ultra-processed foods (UPFs). Only in case of the study group, they received a personalized diet according to their food preferences, energy and nutrients requirements and physical activity level. They were also supported by a cookbook created especially for the study.

Results
After three months, 67 patients (mean age 66.1 ± 14.9 years; 68% men; mean GFR 22.2 ± 3.1 mL/min/1.73 m2) finalized the study (control group n = 34, study group n = 33). No significant differences were observed between groups regarding age, sex, body mass index (BMI), serum albumin and Charlson index at baseline.
QoL improved in 4 out of 5 domains in the study group (as can be seen in Table 1 as an increase in score), while in the control group there is a worsening in effects of disease and disease burden (score reduction at 3 months). In addition, anxiety and depression scores declined in the study group but not in the control group. In both groups, the adherence to the Mediterranean diet increased and BMI and markers of body fat decreased. Lean mass and phase angle decreased only in the control group.

Conclusion
This RCT shows that having the support of a dietitian improved dietary quality and markers of body fat, and the use of PNC with nutritional educational program improved aspects of QoL, reduced anxiety and depression, and maintained lean mass and phase angle. Therefore, the support from a dietitian and use of PNC in clinical practice seems to be effective in improving QoL, anxiety and depression.