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‘NO, I DON’T EAT ANY SALT!’ AN AUDIT TO DETERMINE SALT INTAKE AND
COMMON SOURCES OF SALT IN HAEMODIALYSIS PATIENTS
Jan Flint, Claire Donnelly
Renal Dietetics, Therapy Services, Royal Free London NHS Foundation Trust
Introduction:
The World Health Organisation has set a target to achieve a reduction of salt intake of 30% by
2025. The average daily intake of salt in the UK is around 9-12g with the physiological
requirement being 1g. The Kidney Disease Improving Global Outcomes guideline on
management of blood pressure recommends a sodium intake of <2g per day. Lack of adherence
to a no added salt diet in haemodialysis (HD), increases thirst and results in large inter dialytic
weight gains. This has been associated with poor long term clinical outcomes. A recent study
from Australia developed a validated a self-assessment questionnaire to assess salt intake. They
categorised foods and developed a scoring system based on salt content of those foods and
frequency of consumption. The higher the score, the higher the salt content of the food .This
questionnaire was trialed with a sample of patients with Chronic Kidney Disease. The tool was
found to be a useful way of identifying high salt consumers and being able to target intervention.
Aim:
To modify the questionnaire for a UK population and trial with dialysis patients to see if this
could be used routinely to aid with assessment of salt intake
Methods:
The questionnaire was adapted to ensure that names of foods e.g. cereals and biscuits were UK
specific. A volunteer Dietitian visited 3 haemodialysis units and conducted the questionnaire
with a sample of patients whilst they were on HD in order to assess intake of high salt foods.
Information was also collected on patients’ reported daily fluid intake. Patients were verbally
consented by the dietitian to participate in the audit and the results were anonymised.
Results:
69 patients were interviewed and completed the questionnaire. The mean score from the
questionnaire was 61.07 (0-110), with the highest score that could be achieved being 215. In the
10 patients with the highest score for salt intake, average daily fluid intake was reported as
1120mls (1000-1500). The top contributors of salt in the diet of the sample participants were:
bread, savoury biscuits, cheese and sweet biscuits. 33% of patients interviewed reported adding
salt during cooking and 31% reported eating crisps on a regular basis.
Conclusion:
The questionnaire was easy to complete and would be useful in clinical practice to help identify
patients who may benefit from further dietary intervention and support in reducing salt intake.
Although in this audit patients were interviewed it is intended for self completion. Of particular
interest was the number of patients continuing to add salt to meals. Almost All patients on HD
are encouraged to avoid the addition of salt and salt substitutes (with very few exceptions).
Relevance:
We aim to undertake further work using the questionnaire and include other markers such as
brain natriuretic peptide, beta 2 microglobulin, Inter dialytic weight gain and blood pressure as
it is recognised that salt intake may have an impact on these clinical indicators. Consideration
also needs to be given to novel patient education methods for reducing salt and fluid intake in
order to improve patient outcomes.