Dietary salt reduction in rural patients with albuminurea using family and community support: the Mima study

All consecutive outpatients with an ACR >= 30 mg/gCr were recruited from the Koyadaira Clinic. Patients self-selected their participation in the intervention group (IG) or the control group (CG) because the rural population expressed concern about not being treated at the same time. In the IG, patients and their families were educated in SR for 30 minutes in their home by experienced dieticians. In addition, patients, families and neighborhood residents were also educated in SR for 2 hours at a public town meeting hall, with educational content encouraging reduction in salt intake through interactive activity. The CG received conventional treatment, and ACR and blood pressure (BP) were measured after 3 months.Of the 37 subjects recruited (20 male, 16 female, mean age; 72.8 ± 9.2 years), 36 completed the 3-month follow up and were analyzed. In the IG, ACR decreased significantly from baseline (706 ± 1,081 to 440 ± 656; t = 2.28, p = 0.04) and was reduced compared to the CG (213 ± 323 to 164 ± 162; F = 3.50, p = 0.07), a treatment effect approaching significance. Systolic BP in the IG (145 ± 14 to 131 ± 13 mmHg; t = 3.83, p = 0.002) also decreased significantly compared to the CG (135 ± 13 to 131 ± 14; F = 4.40, p = 0.04).Simultaneous education of patients, their families and neighborhood residents may be important in rural areas for treatments and interventions requiring health behavior change.UMIN000001972Albuminuria is a risk marker of renal failure (RF) and its reduction suggests a slowing of RF [1]. Salt reduction (SR) improves the urine albumin-to-creatinin ratio (ACR) directly and/or via a reduction of blood pressure (BP) [2].The Koyadaira area is an isolated rural community of approximately 1,000 residents in the Mima City, and has the highest mortality associated with RF in Japan [3]. The local government has provided the population with regular community health promotion classes, some of which target SR, but with little success at improving RF outcomes. In c