Cross-sectional relations of urinary sodium excretion to cardiac structure and hypertrophyThe Framingham Heart Study

ABSTRACT Background The gold standard to assess salt intake is 24-h urine collections. Use of a urine spot sample can be a simpler alternative, especially when the goal is to assess sodium intake at the population level. Several equations to estimate 24-h urinary sodium excretion from urine spot samples have been tested in adults, but not in children. Objective The objective of this study was to assess the ability of several equations and urine spot samples to estimate 24-h urinary sodium excretion in children. Methods A cross-sectional study of children between 6 and 16 y of age was conducted. Each child collected one 24-h urine sample and 3 timed urine spot samples, i.e., evening (last void before going to bed), overnight (first void in the morning), and morning (second void in the morning). Eight equations (i.e., Kawasaki, Tanaka, Remer, Mage, Brown with and without potassium, Toft, and Meng) were used to estimate 24-h urinary sodium excretion. The estimates from the different spot samples and equations were compared with the measured excretion through the use of several statistics. Results Among the 101 children recruited, 86 had a complete 24-h urine collection and were included in the analysis (mean age: 10.5 y). The mean measured 24-h urinary sodium excretion was 2.5 g (range: 0.8–6.4 g). The different spot samples and equations provided highly heterogeneous estimates of the 24-h urinary sodium excretion. The overnight spot samples with the Tanaka and Brown equations provided the most accurate estimates (mean bias: −0.20 to −0.12 g; correlation: 0.48–0.53; precision: 69.7–76.5%; sensitivity: 76.9–81.6%; specificity: 66.7%; and misclassification: 23.0–27.7%). The other equations, irrespective of the timing of the spot, provided less accurate estimates. Conclusions Urine spot samples, with selected equations, might provide accurate estimates of the 24-h sodium excretion in children at a population level. At an individual level, they could be used to identify children with high sodium excretion. This study was registered at clinicaltrials.gov as NCT02900261.

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Impaired Daytime Urinary Sodium Excretion Impacts Nighttime Blood Pressure and Nocturnal Dipping at Older Ages in the General Population

Nutrients ◽

10.3390/nu12072013 ◽

2020 ◽

Vol 12 (7) ◽

pp. 2013

Author(s):

Rosaria Del Giorno ◽

Chiara Troiani ◽

Sofia Gabutti ◽

Kevyn Stefanelli ◽

Sandro Puggelli ◽

...

Keyword(s):

Blood Pressure ◽

Sodium Excretion ◽

Urinary Sodium Excretion ◽

Urinary Sodium ◽

P Value ◽

Excretion Ratio ◽

Cross Sectional ◽

Nocturnal Dipping ◽

Nighttime Blood Pressure ◽

The Impact

The circadian rhythm of urinary sodium excretion is related to the diurnal blood pressure regulation (BP) and the nocturnal dipping pattern. The renal sodium excretion expressed as daytime/nighttime ratio impacts BP, but a limited number of studies have investigated this topic to date. In this cross-sectional study, we aimed to investigate the impact of different daily patterns of sodium excretion (comparing low with high ratios) on BP and nocturnal dipping and to explore the relationship with age. Twenty-four-hour ambulatory BP monitoring and daytime and nighttime urinary sodium collections were used to assess 1062 subjects in Switzerland. Analyses were performed according to the day/night urinary sodium excretion ratio quartiles (Q1–Q4) and by age group (≤50 and ≥50 years). Subjects in Q1 can be considered low excretors of sodium during the daytime since the rate of sodium excretion during the daytime was 40% lower than that of subjects in Q4. Quartiles of the day/night urinary sodium excretion ratio showed that subjects in Q1 were 7 years older and had respectively 6 and 5 mmHg higher nighttime systolic and diastolic BP and a higher nocturnal dipping compared with subjects in Q4 (p-value ≤0.001). Associations found were significant only for subjects older than 50 years (all p < 0.05). The present results suggest that a decreased capacity to excrete sodium during daytime is more prevalent as age increases and that it impacts nighttime blood pressure and nocturnal dipping in older subjects.

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Daytime cold exposure and salt intake based on nocturnal urinary sodium excretion: A cross-sectional analysis of the HEIJO-KYO study

Physiology & Behavior ◽

10.1016/j.physbeh.2015.10.015 ◽

2015 ◽

Vol 152 ◽

pp. 300-306 ◽

Cited By ~ 3

Author(s):

Keigo Saeki ◽

Kenji Obayashi ◽

Nobuhiro Tone ◽

Norio Kurumatani

Keyword(s):

Cold Exposure ◽

Sodium Excretion ◽

Salt Intake ◽

Urinary Sodium Excretion ◽

Urinary Sodium ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Sectional Analysis

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Associations between the Intake of Miso Soup and Japanese Pickles and the Estimated 24-hour Urinary Sodium Excretion: A Population-based Cross-sectional Study

Internal Medicine ◽

10.2169/internalmedicine.54.4336 ◽

2015 ◽

Vol 54 (8) ◽

pp. 903-910 ◽

Cited By ~ 13

Author(s):

Minako Wakasugi ◽

Junichiro James Kazama ◽

Ichiei Narita

Keyword(s):

Sodium Excretion ◽

Urinary Sodium Excretion ◽

Population Based ◽

Cross Sectional Study ◽

Urinary Sodium ◽

Sectional Study ◽

Cross Sectional

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Association of urinary sodium excretion with blood pressure and risk factors associated with hypertension among Cameroonian pygmies and bantus: a cross-sectional study

BMC Cardiovascular Disorders ◽

10.1186/s12872-018-0787-3 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 8

Author(s):

Daniel Lemogoum ◽

William Ngatchou ◽

Claude Bika Lele ◽

Cecile Okalla ◽

Marc Leeman ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Sodium Excretion ◽

Urinary Sodium Excretion ◽

Cross Sectional Study ◽

Urinary Sodium ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated

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SUN-P181: Urinary Sodium Excretion Among Ecuadorian Adult Population: A Cross-Sectional Study

Clinical Nutrition ◽

10.1016/s0261-5614(17)30447-8 ◽

2017 ◽

Vol 36 ◽

pp. S120-S121

Author(s):

I. Sisa ◽

M.E. Herrera-Fontana ◽

M.M. Bovera ◽

M. Palomeque ◽

E. Teran

Keyword(s):

Sodium Excretion ◽

Adult Population ◽

Urinary Sodium Excretion ◽

Cross Sectional Study ◽

Urinary Sodium ◽

Sectional Study ◽

Cross Sectional

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Association of Urinary Sodium Excretion and Left Ventricular Hypertrophy in People With Type 2 Diabetes Mellitus: A Cross-Sectional Study

Frontiers in Endocrinology ◽

10.3389/fendo.2021.728493 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jianfang Liu ◽

Xiaoyu Yang ◽

Peizhen Zhang ◽

Dan Guo ◽

Bingyan Xu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Sodium Excretion ◽

Ventricular Hypertrophy ◽

Sodium Intake ◽

Urinary Sodium Excretion ◽

Left Ventricular ◽

Urinary Sodium ◽

Cross Sectional

BackgroundIt has been well documented that left ventricular hypertrophy (LVH) is highly associated with the incidence of cardiovascular disease (CVD). Evidence indicated that high sodium intake was closely related with LVH in general population. However, information is not available regarding the association between urinary sodium excretion and LVH in patients with type 2 diabetes mellitus (T2DM). This study aimed to explore the association between urinary sodium excretion and LVH in patients with T2DM.MethodsThis cross-sectional analysis included baseline data from 1,556 individuals with T2DM enrolled in the NanFang Prospective Diabetes Study (NFPDS). Urinary sodium excretion levels were measured from 24-hour urine samples of inpatients and morning fasting urine samples of outpatients. Left ventricular dimensions were assessed by echocardiography. The associations between urinary sodium excretion and the risks of cardiovascular events, LVH and left ventricular mass index (LVMI) were examined using linear regression analysis, logistic regression and restricted cubic splines (RCS).ResultsUrinary sodium excretion levels were positively associated with cardiometabolic risk factors, including systolic blood pressure, body mass index, waist circumference and LVMI (All P<0.001). Odds ratios of the highest quartile of urinary sodium excretion compared with the lowest quartile were 1.80 (95% CI, 1.28-2.54; P=0.001) for LVH and 1.77 (95% CI, 1.06-2.94; P=0.028) for CVD, after adjusted for demographics, lifestyle risk factors and cardiovascular risk factors. Multivariable-adjusted RCS analysis of the association between urinary sodium excretion and LVMI showed a significant association (P=0.001) and lacked evidence of a nonlinear association (P=0.406).ConclusionThis study indicated that high urinary sodium excretion was independently associated with increased risk of LVH and CVD in patients with T2DM, suggesting that control of sodium intake may be valuable for the prevention of diabetic cardiovascular complications.

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Association of Urinary Sodium Excretion and Diabetic Kidney Disease in Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Study

Frontiers in Endocrinology ◽

10.3389/fendo.2021.772073 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yan Huang ◽

Wenhui Liu ◽

Jianfang Liu ◽

Dan Guo ◽

Peizhen Zhang ◽

...

Keyword(s):

Regression Analysis ◽

Kidney Disease ◽

Sodium Excretion ◽

Diabetic Kidney Disease ◽

Urinary Sodium Excretion ◽

Cross Sectional Study ◽

Urinary Sodium ◽

Sectional Study ◽

Cross Sectional

BackgroundDiabetic kidney disease (DKD) is the leading cause of end-stage kidney disease worldwide. Epidemiological evidence of the association between urinary sodium excretion and the presence of DKD in patients with type 2 diabetes mellitus (T2DM) has not yet been well established.MethodsWe performed a cross-sectional study of 1545 patients with T2DM over aged 20 years old from January 2018 to December 2020. Urinary sodium excretion was measured by 24-hour urine samples in inpatients and morning fasting urine samples in outpatients. The associations between urinary sodium excretion and the risks of DKD were examined using stepwise regression analysis, logistic regression analysis and multivariable-adjusted restricted cubic splines (RCS).ResultsRegression analysis showed that urinary sodium was independently associated with urinary albumin to creatinine ratio (UACR) level (P = 0.006) and the risks of DKD (P = 0.042). In multivariable-adjusted RCS analysis, urinary sodium excretion was significantly associated with UACR in all patients (P = 0.008), and exhibited a J-shaped relationship. Logistic regression analysis showed that increased urinary sodium excretion was significantly associated with increased risks of DKD [OR (95% CI); 1.56 (1.07-2.27); P = 0.020]. However, the relationships between urinary sodium excretion and the risks of DKD and albuminuria showed no significance, after further adjustment for HOMA-IR and ba-PWV (brachial-ankle pulse wave velocity) (Both P > 0.05).ConclusionsHigher urinary sodium excretion level was associated with increased risks of DKD among patients with T2DM, dependent of vascular sclerosis and insulin resistance.

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