vegetables, fish, omega-3 fatty acids, legumes, whole grain cereals, and nuts and lower in sodium, red meat, saturated fats, and common phosphate additives.14-18 However, to date, there has been a distinct lack of clinical trials to confirm these observational data and guide clinical practice in CKD. This is an area of great need for focused effort and investigation in nephrology. Meuleman and colleagues are to be commended for their patient-centered theory-based approach to dietary sodium management, which produced modest and short-term benefits on risk factors for kidney disease progression, and through setting a methodological example for hypothesis testing of nutritional strategies overdue for evaluation in nephrology. Nutritional interventions have the potential to unlock Editorial Am J Kidney Dis. 2017;69(5):558-560 559 health benefits in CKD beyond that achieved by pharmacologic treatments. Our challenge for the future is to collaborate with patients to develop integrated holistic nutritional approaches that meet patient and system needs, consider overall dietary patterns, are cost-effective. These need to be tested to sustainably improve patient-level outcomes in large, high-quality, randomized controlled trials. Katrina L. Campbell, PhD1,2 Suetonia C. Palmer, MBChB, PhD3 David W. Johnson, MBBS, DMed (Res), PhD1,4,5 1 Princess Alexandra Hospital, Brisbane, Australia 2 Bond University, Robina, Australia 3 University of Otago Christchurch, Christchurch, New Zealand 4 University of Queensland, Brisbane, Australia 5 Translational Research Institute, Brisbane, Australia ACKNOWLEDGEMENTS Support: None. Financial Disclosure: The authors declare that they have no relevant conflicts of interest. Peer Review: Evaluated by a Co-Editor and Editor-in-Chief Levey. REFERENCES 1. Palmer SC, Hanson CS, Craig JC, et al. Dietary and fluid restrictions in CKD: a thematic synthesis of patient views from qualitative studies. Am J Kidney Dis. 2014;65(4):559-573. 2. Tong A, Crowe S, Chando S, et al. Research priorities in CKD: report of a National Workshop Conducted in Australia. Am J Kidney Dis. 2015;66(2):212-222. 3. Meuleman Y, Hoekstra T, Dekker FW, et al. Sodium restriction in patients with CKD: a randomized controlled trial of self-management support. Am J Kidney Dis. 2017;69(5):576-586. 4. He J, Mills KT, Appel LJ, et al. Urinary sodium and potassium excretion and CKD progression. J Am Soc Nephrol. 2016;27(4):1202-1212. 5. Lambers Heerspink HJ, Navis G, Ritz E. Salt intake in kidney disease—a missed therapeutic opportunity? Nephrol Dial Transplant. 2012;27(9):3435-3442. 6. McMahon EJ, Campbell KL, Bauer JD, et al. Altered dietary salt intake for people with chronic kidney disease. Cochrane Database Syst Rev. 2015;2:CD010070. 7. Craig P, Dieppe P, Macintyre S, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655. 8. Domecq JP, Prutsky G, Elraiyah T, et al. Patient engagement in research: a systematic review. BMC Health Serv Res. 2014;14: 89. 9. Kwasnicka D, Dombrowski SU, White M, et al. Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories. Health Psychol Rev. 2016;10(3): 277-296. 10. Merrill RM, Aldana SG, Greenlaw RL, et al. Can newly acquired healthy behaviors persist? An analysis of health behavior decay. Prev Chronic Dis. 2008;5(1):1-13. 11. Fjeldsoe B, Neuhaus M, Winkler E, et al. Systematic review of maintenance of behavior change following physical activity and dietary interventions. Health Psychol. 2011;30(1): 99-109. 12. Kelly JT, Reidlinger DP, Hoffmann TC, et al. Telehealth methods to deliver dietary interventions in adults with chronic disease: a systematic review and meta-analysis. Am J Clin Nutr. 2016;104(6):1693-1702. 13. Smyth A, Griffin M, Yusuf S, et al. Diet and major renal outcomes: a prospective cohort study. The NIH-AARP Diet and Health Study. J Ren Nutr. 2016;26(5):288-298. 14. Gutierrez OM, Muntner P, Rizk DV, et al. Dietary patterns and risk of death and progression to ESRD in individuals with CKD: a cohort study. Am J Kidney Dis. 2014;64(2): 204-213. 15. Lew Q-LJ, Jafar TH, Koh HWL, et al. Red meat intake and risk of ESRD. J Am Soc Nephrol. 2017;28(1):304-312. 16. Sullivan C, Sayre SS, Leon JB, et al. Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial. JAMA. 2009;301(6): 629-635. 17. Kelly JT, Palmer SC, Wai SN, et al. Healthy dietary patterns and risk of mortality and ESRD in CKD: a metaanalysis of cohort studies. Clin J Am Soc Nephrol. 2017;12(2): 272-279. 18. Huang X, Jimenez-Moleon JJ, Lindholm B, et al. Mediterranean diet, kidneyEating well when you have kidney disease is very important to help you stay as healthy and strong as possible. Including the right kinds and amounts of foods each day recommended for healthy eating can help your kidneys to work more easily and keep you well for longer. Sometimes having kidney disease can make you feel unwell. Your appetite may not be so good and food may taste different. This is because waste products produced from the foods you eat build up in the blood instead of being removed by the kidneys. The need to make changes to your diet depends on how well your