Introduction:
Reducing mean population sodium intake by ~1200 mg is projected to reduce thousands of deaths from heart disease and stroke and save billions of health care dollars annually. Twenty-four hour urine collection is recommended for assessing changes in mean population sodium intake, but can be difficult to implement. Predicting 24-hour urine sodium excretion using spot urines is not recommended due to diurnal variations in excretion. Further, sodium excretion patterns differ between black and white persons. We assessed the validity of previously published prediction equations for 24-hour sodium excretion in black and other young adults by timing of spot urine collection.
Design:
Of 481 adult volunteers aged 18-39 years (50% Blacks) asked to participate in a 2011 study in the Metropolitan DC area, 407 collected each urine void in a separate container for 24 hours. Four timed voids from the 24-h urine collection were selected (morning, afternoon, evening, and overnight) to use with previously published predictive equations. Predictive equations were based on one of two approaches; 1) an indirect approach using spot urine sodium-to-creatinine concentrations and predicted 24-hour creatinine excretion (
Tanaka, Kawasaki, Mage
), and 2) a direct approach using spot urine sodium, potassium, and creatinine concentrations, and age, and body mass index with separate equations by sex (
Brown
). We assessed mean differences between predicted and measured 24-hour sodium excretion (bias) and individual differences across levels of sodium excretion using Bland-Altman plots.
Results:
Among participants, mean measured 24-hour sodium excretion was ~3300 mg (SD ~1400 mg). Of the equations evaluated, mean bias in predicted 24-hour sodium excretion was least from
Brown
equations when using morning (-165 mg, 95% confidence interval [CI], -295, -36 mg), afternoon (-90 mg, 95% CI, -208, 28 mg) or evening ( -120 mg, 95% CI -230, -11 mg) spot urines. When using overnight spot urines, mean bias from
Brown
equations was greatest and statistically significant (-247 mg, 95% CI, -348, -151 mg). When using overnight spot urines, mean bias from
Tanaka
(-23 mg) or
Mage
(-145 mg) equations was not significant, however, when stratified by sex, mean biases were significant and in opposite directions. Among Blacks, mean biases from
Brown
were not significant (-167 to 122 mg) except using overnight specimens among Black females (-267 mg, 95% CI, -525, -47 mg). Across equations and time periods, Bland-Altman plots indicated significant bias at the individual level.
Conclusions:
Of the evaluated equations, predicted 24-hour urine sodium excretion using the
Brown
equations with morning, afternoon, or evening specimens may provide the least biased estimates of group mean sodium intake among young US adults. None of the equations adequately predicted individual 24-hour sodium excretion measured on the same day.
Differential Impact of Ultrafiltration and Diuretics on Urine Sodium Excretion in Acute Heart Failure: Insights from CARRESS-HF
