Beyond traditional approaches: Innovative salt reduction education for optimising fluid management in end-stage renal disease

Background: Excessive interdialytic weight gain (IDWG) is a significant concern for haemodialysis patients, associated with increased cardiovascular risk and mortality. Dietary sodium intake plays a crucial role in determining IDWG, making salt reduction a key component of patient management. However, adherence to salt restriction remains challenging due to various factors, including dietary habits, cultural influences and lack of knowledge. Objectives: This review aims to evaluate the effectiveness of salt reduction education strategies in haemodialysis patients and their impact on IDWG, exploring both traditional and innovative approaches. Methods: Salt intake assessment methods, including dietary recalls and validated questionnaires, are discussed, along with their correlation to actual intake. The review examines various educational interventions, from conventional group sessions to personalised approaches based on questionnaire results. The integration of technology, such as mobile applications and virtual counselling, shows promise in enhancing engagement and self-monitoring. Short-term effects of education on IDWG are generally positive, but long-term sustainability remains a challenge. Physiological mechanisms underlying the relationship between salt intake and fluid balance are explored, including hormonal responses and cardiovascular implications. Psychological aspects, such as patient motivation and quality of life, are considered in the context of dietary restrictions. Conclusion: While salt reduction education strategies have evolved to include personalised and technology-driven approaches, challenges persist in achieving long-term adherence. Future directions include the development of novel interventions, integration of artificial intelligence for personalised strategies and comprehensive care models that address the multifaceted nature of dietary management in haemodialysis patients.