Study ID

Treatment

Control

CKD stage

GFR (mL/min)

Mean age

% men

Mean GFR (mL/min)

Mean BMI (kg/m²)

Detailed inclusion criteria

Counselling

Campbell 2008

Dietary counselling

Written material

4‐5

≤ 30

69.5 (11.7)

70.9 (11.6)

61

23.1 (7.2)

21.6 (6.1)

26.8 (4.7)

27.6 (5.2)

> 18 years; eGFR < 30 mL/min/1.73 m²; CKD not previously seen by a dietitian for stage 4 CKD; absence of communication or intellectual impairment; absence of malnutrition from a cause other than CKD; not expected to require RRT within 6 months

Chanwikrai 2012

Dietary counselling

Standard care

3‐5

‐‐

‐‐

‐‐

‐‐

‐‐

CKD stage 3‐5

Flesher 2011

Dietary counselling + exercise

Standard care

3‐4

20‐60

63.4 (12.1)

63.4 (11.8)

53

37.2 (3.2)

38.4 (3.0)

‐‐

eGFR 20 to 60 mL/min for ≥3 months; presence of urinary protein; adult (≥ 19 years); hypertension or taking at least 1 antihypertensive medication; physician approval to exercise

Leon 2006

Dietary counselling and targeting nutritional barriers

Standard care

5 (HD)

Dialysis

62

60

42

‐‐

29.0

27.9

18 to 85 years; receiving dialysis for at least 9 months; mean serum albumin level for previous 3 months < 3.70 g/dL (bromcresol green method) or < 3.40 g/dL (bromcresol purple method)

Orazio 2011

Dietary counselling

Standard care

Transplant

Transplant

54.9 (9.9)

54.7 (11.8)

61

54 (20)

48 (17)

29 (5)

29 (6)

Kidney transplant > 6 months

Riccio 2014

Dietary counselling

Low protein diet

‐‐

‐‐

‐‐

‐‐

‐‐

‐‐

CKD not requiring dialysis

Sutton 2007

Dietary counselling + physical activity

Standard care

5 (PD)

Dialysis

60.7 (15.5)

58.5 (15.4)

55

‐‐

25.4 (3.8)

25.7 (3.4)

Treatment with CAPD for 3 months or longer; not diabetic

Teng 2013

Dietary counselling + exercise

Standard care

1‐3

‐‐

62.1 (14.0)

65.7 (11.2)

71

53.7 (18.3)

49.5 (13.3)

24.4 (3.9)

25.3 (3.1)

20 years or older; communicate in Mandarin or Taiwanese; aware of CKD diagnosis; GFR range 30 to 106.7 mL/min/1.73 m²

Tzvetanov 2014

Dietary counselling + exercise

Standard care

Transplant

Transplant

46 (6.9)

45 (19)

47

‐‐

‐‐

Kidney transplant; obese

Zhou 2011b

Dietary counselling

Standard care

5 (PD)

Dialysis

57.8 (12.8)

59.9 (13.6)

71

‐‐

23.3 (4.5)

22.8 (6.2)

18 to 70 years; receiving long‐term dialysis > 3 months

Mediterranean diet

DIRECT Study 2013

Mediterranean diet (restricted calorie)

Low‐fat (restricted calorie) diet

Low‐carbohydrate (unrestricted calorie) diet

3

30‐60

52.5 (6.2)

99

52.6 (5.9)

30.9 (3.4)

40 to 65 years with BMI ≥ 27 kg/m²; individuals with type 2 diabetes or coronary heart disease were eligible regardless of age. Post‐hoc analysis among participants with eGFR 30 to 60 mL/min/1.73 m²

Mekki 2010

Mediterranean diet

Standard care

2‐3

60‐89

60 (10)

59 (12)

53

70 (10)

75 (15)

26.9 (3.9)

25.1 (4.2)

eGFR 60 to 89 mL/min/1.73 m²; dyslipidaemia

Stachowska 2005

Modified Mediterranean diet

Low fat diet

Transplant

Transplant

41 (12.5)

46

(9.5)

68

‐‐

25.0 (4.1)

26.2 (4.2)

Stable transplant function

Increased fruit and vegetables

Goraya 2013

Increased fruit and vegetable intake

Oral bicarbonate

4

15‐29

53.9 (6.9)

54.2 (5.3)

54

22.8 (4.9)

23.0 (3.5)

‐‐

Non‐malignant hypertension; eGFR 15 to 29 mL/min/1.73 m²; plasma TCO₂< 22 mM; no diabetes or cardiovascular disease; two or more primary care physician visits in previous year; age ≥ 18 years

Goraya 2014

Increased fruit and vegetable intake

Oral bicarbonate

Standard care

3

30‐59

53.5 (5.2)

53.9 (4.8)

44

42.3 (7.1)

42.6 (7.6)

‐‐

Non‐malignant hypertension, eGFR 30 to 59 mL/min/1.73 m²; plasma TCO₂< 25 mM; macroalbuminuria; able to tolerate angiotensin‐converting inhibition; non‐smoking for ≥ 1 year; no diabetes or cardiovascular disease; 2 or more primary care physician visits in previous year; ≥ 18 years

Carbohydrate‐restricted, low‐iron, polyphenol enriched (CR‐LIPE) diet

Facchini 2003

CR‐LIPE diet

Protein restriction

2‐5

15‐75

59 (10)

60 (12)

51

64 (28)

62 (32)

28 (5)

28 (5)

Type 2 diabetes; referred to nephrology clinic for kidney failure (15 ± 75 mL/min); otherwise unexplained proteinuria (350 ± 12,000 mg/d); kidney disease attributed to diabetes

High‐nitrogen, low‐carbohydrate diet

Whittier 1985

High‐nitrogen, low carbohydrate diet

Standard care

Transplant

Transplant

33

32

75

‐‐

‐‐

Kidney transplant; no diabetes

Study ID

Materials

Dietary intervention

Adherence

Why

What

Who

How

Where

When and how much

Tailoring

Modification

Planned

Actual

Counselling

Campbell 2008

To determine whether individual nutrition counselling improves body composition, energy intake, and nutritional status

Individualised dietary prescription (including energy (125 to 146 kJ/kg/d) and protein (0.75 to 1.0 g/kg/d)) incorporating KDOQI recommendations to provide intensive nutritional counselling with regular monitoring

Dietitian

Face‐to‐face, telephone, individualised

‐‐

Baseline for 60 min; then biweekly for 1st month (15 to 30 min); then weekly till end of study period

Depending on dietary requirements, diet was tailored following clinical data and initial interview. Delivery was guided by the medical nutrition therapy framework from the American Dietetic Association

Self‐management principles: goal‐setting, menu planning, label reading, and identification of foods containing protein, sodium, and so on, depending on requirements

Dietary intake assessed using 3‐day food record, verified by the dietitian. Strategies to improve adherence or fidelity not reported

No patient voluntarily withdrew from the study

Chanwikrai 2012

Changes of diet and lifestyle can slow progression of CKD

Dietary modification with or without exercise by an empowerment approach (including low protein 0.6 to 0.8 g/kg/d) and low salt (5 g/d).

‐‐

‐‐

‐‐

‐‐

‐‐

‐‐

‐

81 (96%) completed the study program

Flesher 2011

To determine whether additional of cooking and exercise classes would slow progression of CKD

Individual nutrition counselling on moderate protein and low sodium, with individualised modification of potassium and/or phosphate plus a group nutrition class, cooking classes with a dietitian and cook education, CKD cookbook, shopping tour, and 12‐week exercise program led by a Certified Exercise Physiologist and nurse. Exercise program started after 6 months

Cooking class ‐ dietitian and cook educator; Exercise ‐ exercise physiologist and nurse

Face‐to‐face; individual and group sessions

Exercise class took place in well‐equipped gym at Garatt Wellness Centre: details regarding cooking class not provided

Cooking classes over 4 weeks for 2 hour session, shopping tour; Exercise class at Garratt Wellness centre, 3 x 1 hour session/week with strength training, flexibility components, resistance training

Skills for tailoring and modifying diet and lifestyle were provided. Diet history was discussed in detail at the individual appointments

Self‐management focus in using goal‐setting and building confidence in the management of disease

Adherence to exercise was assessed by physical activity readiness questionnaire and 6 minute submaximal walk test; biochemical and clinical parameters related to cardiovascular health; monitored at baseline, 6 months and 12 months

Overall, the experimental group showed ‘improvement’’
in their exercise frequency, concern over health condition, and frequency of visits to health providers or hospitalisation; also 20 versus 83 improved endpoints in control group

Leon 2006

Whether targeting specific nutritional barriers will improve albumin levels

Study coordinators abstracted medical records and interviewed participants to determine the presence of 10 specific nutritional barriers (nutritional knowledge, appetite, help needed with cooking and shopping, low fluid intake, dialysis dose, depression, difficulty chewing, difficulty swallowing, gastrointestinal symptoms, acidosis). Study coordinators educated all intervention patients about
the meaning and importance of good nutritional status. They then provided feedback and recommendations to intervention patients. The information was provided during a dialysis treatment and tailored to the specific barriers present. Study coordinators also communicated information about barriers to facility dietitians and modified recommendations based on feedback from these dietitians. Facility dietitians were asked to reinforce study coordinator recommendations when they met with their study patients

Study coordinators; dietitians

Face‐to‐face; individualised

During dialysis sessions

During the next 12 months, study coordinators met monthly with patients to reinforce recommendations,
monitor progress, and answer questions. Study coordinators
also updated patients’ dietitians monthly

Tailored to specific nutritional barriers identified during interviews

Specific to nutritional barriers

‐‐

‐‐

Orazio 2011

To investigate the effect of dietitian involvement in a multidisciplinary lifestyle intervention comparing risk factor modification for cardiovascular disease with standard post‐transplant care in kidney transplant recipients with abnormal glucose tolerance

Individualised dietary advice was provided to participants for the duration of the study. Achievement and/or maintenance of a healthy weight (BMI), 20 to 25 kg/m²) was the primary goal of nutrition therapy using a Mediterranean‐style (< 30% total energy from
fat), low GI diet. A moderate energy deficit of 500 kcal/d (2,000 kJ/d) to promote 0.5 kg of weight loss/week was used. Study materials used to teach participants included a study manual with dietary and lifestyle information, food models, and pictures.

The long‐term goal of physical activity advice was to achieve 150 min of accumulated physical activity/week, in accordance with current National Physical Activity Recommendations. To help achieve this, goals
were individualised for each patient according to
mobility, fitness, personal preference, and self‐efficacy
for activities. Moderate physical activity, such as walking,
was encouraged, both as structured activity
and activity of daily living.

The Transtheoretical Model of Health Behavior Change or Stage of Change Model underpinned the lifestyle intervention to provide a framework for goal‐setting throughout the study

Multidisciplinary team (nephrologist, dietitian, nurse, endocrinologist)

Individualised advice from nephrologist, dietitian, nurse and endocrinologist (individual or group)

Multiple locations and settings including during routine transplant care, outpatient dietetic and nursing care, and routine diabetes management

Bimonthly reviews for 2 years by nephrologist; 4‐week initial program from dietitian with bimonthly reviews for 2 years and 6 monthly group meetings; bimonthly reviews by nurse and endocrinologist

Dietitian delivery of individual diet initially and then individualist dietetic reviews including weight, waist circumference and hip circumference measurements

Specific to patient and anthropomorphic measurements during follow‐up

‐‐

8/96 participants chose to withdraw

Riccio 2014

To determine if a simplified dietary approach self‐managed by patients had beneficial impact on nutritional and metabolic control of CKD, to be acceptable and safe

List of recommendations to modify dietary habits (do not add salt at table or for cooking; foods to avoid; replacing noodles or bread; meat, fish and egg intake; 4‐5 servings of fruit or vegetables; replacement of noodles with legumes

Nephrologist

Face‐to‐face; individualised

‐‐

‐‐

The goal of the study was to tailor and modify diet for participants in intervention group (not otherwise specified)

‐‐

Adherence to diet was assessed at regular intervals (1, 3 and 6th), method for assessing adherence was not reported

19/27 in intervention group were adherent with protein prescription whereas 12/27 in control group were adherent with protein prescription

Sutton 2007

To determine whether offering dietary advice was effective in supporting patients in adjusting energy intake

The intervention group was offered follow‐up dietary advice that would encourage them to match energy intake with their estimated energy expenditure allowing for dialysate calories and with a protein intake of not < 0.8 to 1.0 g/kg IBW

Dietitian

Face‐to‐face

‐‐

Face‐to‐face contact at baseline and 4 months. Suggested snack ideas, alterations in food preparation, or modification of portion sizes

‐‐

‐‐

‐

49/59 participants completed the study

Teng 2013

To examine effects of a targeted Lifestyle Modification Program on lifestyle behaviours, knowledge, and physical indicators of CKD

The Trans Theoretical model using the stage‐of‐change construct was used to assess the patient's readiness stage to promote behaviour change. Targeted interventions were given according to the stage of change about diet and exercise. Patients were encouraged to find individual methods of overcoming barriers to regular exercise. Written materials were provided to encourage adherence to a CKD diet. An information booklet on protecting kidney function was provided and reviewed with patient. Discussion provided information about kidney function and disease, and dietary and lifestyle management

Registered nurse research assistants

Face‐to‐face; individualised

Clinic

Counselling provided with each clinic visit

The goal of the study to tailor and modify diet for participants in intervention group

‐‐

To ensure the fidelity of the Lifestyle Modification Program, all provided counselling and information were recorded, and the interventions were reviewed by the investigators at random

There was a 64.4% retention rate at 12 months

Tzvetanov 2014

Examine the effectiveness of a physical exercise program including behaviour modification interventions and nutritional training for obese recipients of a kidney transplant

Individual physical training (one‐to‐one sessions with a coach) using low‐impact, low‐repetition, resistance‐based weight training with 2 x 1‐hour sessions each week in
a private environment. The objective of the exercise protocol was to maximize adherence, improve medical health, reduce pain, improve energy, and enhance emotional wellness and quality of life. Each session had a clearly defined protocol incorporating physical, educational, and psychological aspects

Coach

Individual training

Private environment

2 x 1‐hour sessions each week for 12 months

Standardised process
and curriculum customised to each individual patients’ energy level, medical wellness, physical status/limitations, and emotional life

Response to participants muscle strength, empowerment, and identifying most impactful behaviour/lifestyle changes for each patient

‐

Only 4/8 people allocated to the control returned to the 6 month follow up appointment and 2 for the 12 month appointment. Adherence with the supervised rehabilitation program and follow up was 100% in people allocated to the intervention

Zhou 2011b

To investigate the effects of nutrition intervention and individualised nursing care on nutritional status and quality of life in people with ESKD receiving peritoneal dialysis

An individualised nutrition intervention developed by dietitian with regard to the patient's nutritional status, clinical condition, and characteristics. The study group received the following intervention: energy 125 kJ/kg/d, protein 1.2 to 1.3 g/kg/d, and 70% to 75% proportion of protein as of high biological value. Oral enteral nutrition supplements were used for patients who did not receive enough nutrients from food. The volume of water intake was equivalent to the urine volume plus 500 mL/d and sodium was 3 g/d. In addition, nurse practitioners provided psychological care, an individualised exercise program, and blood pressure treatment

Dietitian and nurses

Individual face‐to‐face

‐‐

Psychological support was given for 30 min once‐monthly over 6 months

Individualised according to nutritional and clinical status

‐‐

‐‐

Not reported

Mediterranean diet

DIRECT Study 2013

To investigate the long‐term effect of Mediterranean diet on kidney function

Mediterranean diet: moderate‐fat, restricted calorie, rich in vegetables and low in red meat, with poultry and fish replacing beef and lamb. Energy intake was restricted to 1500 kcal/d for women and 1800 kcal/d for men, with a goal of no more than 35% of calories from fat; the main sources of added fat were 30 to 45 g of olive oil and a handful of nuts (5 to 7 nuts, < 20 g)/d.

Low carbohydrate diet: low‐carbohydrate, non‐restricted‐calorie diet aimed to provide 20 g of carbohydrates/d for the 2‐month induction phase and immediately after religious holidays, with a gradual increase to a maximum of 120 g/d to maintain weight loss.

Low fat diet: Low‐fat calorie restricted diet based on American Heart Association guidelines, with an energy intake of 1500 kcal/d for women and 1800 kcal/d for men with 30% of calories from fat, 10% of calories from saturated fat, and an intake of 300 mg of cholesterol/d. Patients were counselled to consume low‐fat grains, vegetables, fruits, and legumes and to limit consumption of additional fats, sweets, and high‐fat snacks.

This study was included as a post‐hoc analysis of the main study including people with CKD (eGFR < 60 mL/min/1.73 m²)

Dietitian

Members of each treatment group were assigned to subgroups of between 17 and 19 participants, with 6 groups for each dietary treatment group. Each group was assigned to a registered dietitian who led all 6 subgroups of that dietary group. Self‐service cafeterias in workplaces worked closely with dietitians to adjust specific food items to specific diet groups. Each food item was provided with a label showing the number of calories and the number of grams of carbohydrates, fat and saturated fat

‐‐

Dietitians met with groups in weeks 1, 3, 5, and 7, and thereafter at 6‐week intervals, for a total of 18 sessions of 90 min each. The Israeli version of the diabetes prevention program was adapted including additional themes for each dietary change. In addition, a group of spouses received education.

6 times during the 2‐year intervention, another dietitian conducted 10 to 15 min motivational telephone calls with patients who were having difficulty adhering to the diet.

‐‐

Adherence with the diets was evaluated by a validated food‐frequency questionnaire that included 127 food items and three portion‐size pictures for 17 items. A subgroup of participants completed two repeated 24‐hour dietary recalls to verify absolute intake. We used a validated questionnaire to assess physical activity. At baseline, and at 6, 12, and 24 months of follow‐up, the questionnaires were self‐administered electronically through the workplace intranet. The 15% of patients who request aid in completing the questionnaires were assisted by the study nurse

Adherence with study intervention was 95.4% at first year and 84.6% at second year

Mekki 2010

To evaluate effect of nutritional advice on dyslipidaemia and biomarkers

Nutritional advice based on the National Kidney Foundation—Kidney Disease Outcomes Quality Initiative guideline (energy intake 0.12 MJ/kg BW/d, protein 0.75 g/kg BW/d, lipid intake 35%, and carbohydrates 55% of total energy intake). Dietary recommendations were modified and adapted to a Mediterranean diet with increased intake of mono‐unsaturated fatty acids (MUFA), poly‐unsaturated fatty acids (PUFA), and fibres. Patients were asked to consume olive oil and nuts for seasonings, whole grains (50 g bread at each meal, 250 g cereal or starch once a day), fruits (once a day), vegetables (200 g twice a day) and fish (twice a week). A list of foods rich in salt, potassium and phosphorus was provided. In addition, patients received advice about cooking methods best suited to adherence

‐‐

Face‐to‐face

Nephrology ward

‐‐

‐‐

‐‐

Recall and record every 4 days, patients interviewed by trained interviewers using adapted and structures questionnaire regarding 24 hour dietary intake. Serving sizes were estimated by the use of the food portion model handbook. Dimensions of dishes, utensils and
foods were measured, and the portion sizes were estimated accurately. The consumed foods were converted into various
nutrients using the software GENI

By 90 days, the qualitative distribution of nutrients had a tendency to be closer to the recommended diet

Stachowska 2005

To verify the effect of the Mediterranean diet on risk factors of atherosclerosis in people with a kidney transplant

This diet featured carbohydrates with a low GI (poor in glucose, simple carbohydrates, and amylose, rich in cellulose). Approved diet constituents included cereals, pulse, whole‐rye bread, vegetables (cooked or fresh), oat flakes (cooked), and noodles prepared al dente. Amylose‐rich foods, sweets, and sweet drinks were prohibited. Breakfast was the main meal, providing 39% 2% of daily calorie intake, whereas supper provided the least (16% 3%). In the study group, daily energy intake was attributed as follows: 47% carbohydrates, 38% fatty acids (including 10% saturated, 22% monounsaturated, and 6% polyunsaturated species), and 15% protein. Cholesterol and fibre supply was 165 ± 17 mg/d and 47 ± 9 g/d, respectively. The significant content of fibre in the diet was attributed to the use of fresh, unprocessed food, elimination of semi processed products, and daily intake of pulse/cereal (e.g. buckwheat, barley)/vegetables/whole‐meal rye bread. The dominating fatty acid was oleic acid from olive oil and erucic acid‐poor rapeseed oil. Patients consumed 30 mL cold‐pressed
olive oil/d (fresh salads) and prepared their cooked meals exclusively with rapeseed oil. All other oils were totally eliminated from the diet. Patients consumed approximately 30 g daily of products rich in alpha‐tocopherol and alpha‐linolenic acid C 18:3 n‐3 (grains, flaxseed, nuts). The patients were advised to consume fresh vegetables with every meal. The daily animal protein consumption was 25 to 50 g for men and 23 to 46 g for women, representing one third of the total protein. No additional vitamin supplementation was offered

‐‐

‐‐

‐‐

‐‐

‐‐

‐‐

Dietary adherence was ascertained every 4 weeks using questionnaires (24‐h food diaries) and monitoring oleic acid content in plasma triglycerides

The content of oleic acid in triglycerides
continued to increase in the study group and remained unchanged in controls (Table 2)

Increased fruit and vegetables

Goraya 2013

To evaluate increased intake of base‐producing fruits and vegetables on kidney function and metabolic acidosis

Patients received fruits and vegetables free of charge, distributed from the food bank in amounts to reduce potential renal acid load by half. Prescriptions emphasised base‐producing fruits and vegetables such as apples, apricots, oranges, peaches, pears, raisins, strawberries, carrots, cauliflower, eggplant, lettuce, potatoes, spinach, tomatoes, and zucchini

Dietitian prescribed

Individuals were not given specific dietary instructions and they integrated the prescribed fruits and vegetables into their diets as they wished. To better assure that each patient ate all the prescribed fruits and vegetables, the prescribed amount was given for each household person

‐‐

‐‐

‐‐

‐‐

Formal assessment methods was not employed; however to ensure participants consumed required amount of fruit and vegetables, fruit and vegetables were distributed for whole family/household

‐‐

Goraya 2014

To evaluate increased intake of base‐producing fruits and vegetables on kidney function and metabolic acidosis

Patients received fruits and vegetables free of charge, distributed from the food bank in amounts to reduce potential renal acid load by half. Prescriptions emphasised base‐producing fruits and vegetables such as apples, apricots, oranges, peaches, pears, raisins, strawberries, carrots, cauliflower, eggplant, lettuce, potatoes, spinach, tomatoes, and zucchini

Dietitian prescribed

Individuals were not given specific dietary instructions and they integrated the prescribed fruits and vegetables into their diets as they wished. To better assure that each patient ate all the prescribed fruits and vegetables, the prescribed amount was given for each household person

‐‐

‐‐

‐‐

‐‐

Formal assessment methods was not employed; however to ensure participants consumed required amount of fruit and vegetables, fruit and vegetables were distributed for whole family/household

‐‐

Carbohydrate‐restricted, low‐iron, polyphenol enriched (CR‐LIPE) diet

Facchini 2003

To evaluate whether dietary modification had effect on progression of CKD

CR‐LIPE diet; 50% reduction in carbohydrate intake; substitution of iron‐enriched meats (beef and pork) with iron‐poor white meats (poultry and fish) and with protein‐enriched food items known to inhibit iron absorption (dairy; eggs; soy); elimination of all beverages other than tea, water and red wine; exclusive use of polyphenol‐enriched extra‐virgin olive oil

‐‐

‐‐

‐‐

‐‐

‐‐

‐‐

Serum ferritin level; to assess adherence with low iron diet

Serum ferritin level decreased in group on CR‐LIPE diet

High‐nitrogen, low carbohydrate diet

Whittier 1985

Whether a high‐nitrogen, low carbohydrate diet could result in a positive nitrogen balance and fewer cushingoid side effects in the immediate post‐transplant period

On the morning of the 4th postoperative day, the patients were randomly assigned to receive either the control or the experimental diet. A general daily diet order was prescribed for all patients; it consisted of 800 mL fluid restriction plus an amount equal to the urine volume/d, 2 g sodium, 80 mEq potassium, 800 to 1200 mg of calcium, and 30 calories/kg. Total calories and content of the diet, in identical proportions, were adjusted up or down per kilogram to the nearest 10 kg for patients who weighed more or less than 70 kg since the ideal body weight of these patients varied from 50 to 90 kg prior to transplantation

Dietitian

Diets were prepared in batches in the metabolic kitchen by a research dietician. One meal from each batch was slurried and analysed for nitrogen and electrolyte
content. The remainder of the diet trays from the batch were frozen and microwaved prior to serving to the patient. Uneaten food from each tray was weighed and subtracted from the daily total intake

Inpatient General Clinical Research Centre for 4‐week duration of study.

Continuous assessment

The composition of the diet was determined according
to inclusion into either the treatment or control group

‐‐

Uneaten food from each tray was weighed and subtracted from the daily
total intake. The patients were encouraged to report any non‐tray items (e.g. candy, fruit, snacks) to the dietician so that the totals could reflect actual intake

Both groups ingested a similar amount of total calories, and when factored by weight, intakes per kg of body weight were very close to the objective of 28 to 30
calories/kg of body weight. As prescribed, the control group's intake of carbohydrate was significantly greater and the protein intake was significantly less than that of the experimental diet group. In the control group there was little variation in protein or caloric intake from patient to patient with the exception of patient 9, whereas in the experimental group, the protein intake varied from 1.4 g/kg/d up to the goal of 3.0 g/kg/d

Study ID

Tool

Description

Dietary counselling

Campbell 2008

Kidney Disease Quality of Life Short Form Version 1.3 (combining the SF‐36 with a kidney‐disease specific module)

"There was a clear trend for a mean increase in ratings from the intervention group with a clinically significant mean improvement in 13 of the 18 sub‐scales from baseline to week 12, indicated by an effect size of 0.2 or greater...". There was a statistically significant difference in mean change for scores of symptoms of kidney disease (7.1 (0.1‐14.1) P = 0.047); cognitive functioning (14.6 (5.4‐23.7) P = 0.003); and vitality (12.0 (4.6‐19.5) P = 0.002) in favour of the intervention."

Chanwikrai 2012

‐‐

Not reported

Flesher 2011

Self‐Management Questionnaire

"Overall, the experimental group showed 'improvement' in exercise frequency, concern over health condition, and frequency of visits to health providers or hospitalisation. Overall the control group answers indicated an improvement in their communication with health providers in asking question and discussing personal issues."

Leon 2006

Kidney Disease Quality of Life questionnaire (combining the SF‐36 with a kidney‐disease specific module)

"There were no differences between intervention and control patients in quality‐of‐life subscales, including general health, physical functioning, emotional well‐being, social function, pain, and dialysis‐related symptoms."

Orazio 2011

‐‐

Not reported

Riccio 2014

‐‐

Not reported

Sutton 2007

‐‐

Not reported

Teng 2013

52‐item HPLP‐IIC questionnaire

Intervention had a significant effect on health responsibility and physical activity, but not stress management, interpersonal relations, spiritual growth or nutrition

Tzvetanov 2014

SF‐36

"The mean SF‐36 score at 6 months was significantly higher in the intervention group compared with the control group (583±13 vs 436±22, P = 0.008), reflecting an improved perception of health status. ... The intervention group had improvements compared with the control group in the domains of vitality and general health."

Zhou 2011b

Kidney Disease Quality of Life Short Form Version 1.3 (combining the SF‐36 with a kidney‐disease specific module)

"Prior to intervention, the differences in KDTA and SF‐36 scores were not statistically significant in both groups (P >0.05 for all). After intervention, both KDTA and SF‐36 scores were improved in the study group, but decreased in the control group. The difference in KDTA (P = 0.001) and SF‐36 scores (P = 0.001) before and after intervention were statistically significant in both groups (Table 2)."

Mediterranean diet

DIRECT Study 2013

‐‐

Not reported

Mekki 2010

‐‐

Not reported

Stachowska 2005

‐‐

Not reported

Increased fruit and vegetables

Goraya 2013

‐‐

Not reported

Goraya 2014

‐‐

Not reported

Carbohydrate‐restricted, low‐iron‐available, polyphenol‐enriched diet

Facchini 2003

‐‐

Not reported

High‐protein, low carbohydrate diet

Whittier 1985

‐‐

Not reported

Study

Adverse events reported in study

Campbell 2008a

Mortality; need for dialysis

Chanwikrai 2012

Not reported

DIRECT Study 2013

Not reported

Facchini 2003

Not reported

Flesher 2011

Not reported

Goraya 2013

No participants meeting eGFR and plasma potassium criteria developed plasma potassium concentration >5.0 mEq/L

Goraya 2014

Not reported

Leon 2006

Not reported

Mekki 2010

Not reported

Orazio 2011

Not reported

Riccio 2014

Not reported

Stachowska 2005

Not reported

Sutton 2007

Mortality; transfer from PD to HD

Teng 2013

Not reported

Tzvetanov 2014

Not reported

Whittier 1985

Dialysis due to elevated blood urea and potassium concentrations

Zhou 2011b

Not reported