Four to seven random casual urine specimens are sufficient to estimate 24-h urinary sodium/potassium ratio in individuals with high blood pressure

Objective: High dietary sodium (Na) and low dietary potassium (K) intakes are associated with adverse blood pressure levels and excess risks of cardiovascular diseases. The Sodium/potassium (Na/K) ratio is a composite index of Na and K. Recently, we found Na/K ratio of casual urine is useful for estimating 24-h urinary Na/K ratio in healthy Japanese participants. However, this finding has not been validated in different ethnic groups. Our aim was to assess the utility across and within populations of casual (spot) urine specimens to estimate 24-h urinary Na/K ratio using data from the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT). Methods: The INTERSALT study collected standardized data on casual urinary Na and K concentrations, and also on timed 24-h urinary Na and K excretion for 10,079 men and women ages 20-59 years from 52 population samples in 32 countries. Pearson correlation coefficients and agreement quality analysis (by the Bland-Altman method) were computed for Na/K ratio of casual urine against 24-h urinary Na/K ratio. Results: Overall mean value of Na/K ratio in 24-h urine collections was 3.24. 24-h urinary Na/K ratio and Na/K ratio of casual urine across the 52 population samples were highly correlated: r=0.96 (overall), r=0.96 (men), r=0.95 (women), r=0.94 (ages 20-29), r=0.94 (ages 30-39), r=0.95 (ages 40-49) and r=0.95 (ages 50-59). 24-hour urinary Na/K ratio and Na/K of casual urine across the 10,079 individuals had moderately strong correlations: r=0.69 (overall), r=0.70 (men), r=0.68 (women), r=0.58 (white), r=0.47 (black), r=0.81 (Amerindian), r=0.70 (Asian Indian), r=0.64 (east-Asian), r=0.70 (other ethnicities), r=0.58 (with anti-hypertensive medication use) and r=0.72 (without anti-hypertensive medication use). The bias estimate with the Bland-Altman method, defined as the difference between Na/K of 24-h urine collection and casual urine, was approximately 0.4 across both populations and individuals, independent of age, gender and anti-hypertensive medication use across the 52 population samples. Bias estimates across population samples were 0.39 (overall), 0.42 (men), 0.36 (women), 0.32 (ages 20-29), 0.41 (ages 30-39), 0.37 (ages 40-49) and 0.46 (ages 50-59). Bias estimates for the 10,079 individuals were 0.40 (overall), 0.42 (men), 0.37 (women), 0.33 (white), 0.69 (black), 0.04 (Amerindian), 0.22 (Asian Indian), 0.65 (east-Asian), 0.31 (other ethnicities), 0.45 (with anti-hypertensive medication use) and 0.38 (without anti-hypertensive medication use). Conclusions: These findings indicate that casual urine Na/K ratio is a useful, low-burden, low-cost method alternative to 24-h urine collection for estimation of urinary Na/K ratio across populations of various ethnicities. It is also applicable to individual urinary Na/K ratio.

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SODIUM, POTASSIUM, AND HIGH BLOOD PRESSURE

ACSMʼs Health & Fitness Journal ◽

10.1249/01.fit.0000414751.69007.b5 ◽

2012 ◽

Vol 16 (3) ◽

pp. 13-21 ◽

Cited By ~ 1

Author(s):

Thomas P. Martin ◽

Anastasia N. Fischer

Keyword(s):

Blood Pressure ◽

High Blood Pressure ◽

Sodium Potassium

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Abstract P398: Uric Acid And Prehypertension: Salt Intake in Addition to Insulin Resistance are not Mediators.

Circulation ◽

10.1161/circ.129.suppl_1.p398 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Paulo A Lotufo ◽

Itamar S Santos ◽

Isabela M Bensenor

Keyword(s):

Insulin Resistance ◽

Blood Pressure ◽

Body Mass Index ◽

Uric Acid ◽

Blood Glucose ◽

Serum Uric Acid ◽

Body Mass ◽

High Blood Pressure ◽

Urinary Sodium ◽

Full Model

Introduction: The association "uric acid and high blood pressure" is still matter of debate. Therefore, to distinguish serum uric acid as an independent factor for high blood pressure can start new trials to prevent hypertension. A paleoantropological rationale for this association was a knockout of uricase occurred during the Miocene among hominids that induced high levels of uric acid. As consequence, during food shortage times, high uric acid had an evolutionary benefit increasing salt-sensitivity for keep blood pressure and rising insulin resistance that maintaining high blood glucose levels provided fuel for the brain. Nowadays, the average levels of uric acid are substantially higher compared to chimpanzees, a uricase-deficient primate, and among remote populations as the yanomamo. Hypothesis: we assessed the hypothesis that the link between uric acid and blood pressure in individuals without hypertension is independent of sex, age, race, salt and alcohol intakes, glucose homeostasis, body-mass index and renal function. Methods: from the 15105 participants of the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil) aged 35-74 years, we selected 7954 individuals (median age = 48 years-old; women =58.1; White = 56.6%) without hypertension, diabetes, previous cardiovascular diseases. The presence or not of prehypertension (7th JNC criteria) was the dependent variable and quartiles (Q) of serum uric acid, the independent variable. We applied an unconditional logistic regression adjusted for age and sex. After this, according to our hypothesis, we added the following variables: (1) 24-hour urinary sodium; (2) log Homeostasis Model Assessment (fasting blood glucose (mg/dL) х fasting insulin (mg/dL)/450), and (3) a full model, adding race, body-mass index, alcohol intake, and glomerular filtration rate by CKD-epi). Results: the uric acid quartiles ranges (md/dL) were Q1 ≤ 4.1; Q2:4.2-5.0; Q3:5.1-6.0; Q4: ≥ 6.1 and the number of participants were Q1= 1909; Q2=2029; Q3=2000; Q4= 2016. Considering Q1 as reference, the age-sex adjusted odds ratios (95% Confidence Interval) through the quartiles were: Q2= 1.22 (1.05-1.41); Q3= 1.40 (1.20-1.63); Q4= 2.03 (1.71-2.39) [P for trend <0.001]. Adding 24 hour urinary sodium, the ORs (95% CI) were: Q2= 1.19 (1.01-1.40); Q3= 1.37 (1.16-1.62); and 1.94 (1.61-2.33) [P for trend <0.001]. Adding HOMA-IR, the ORs (95% CI) were: Q2= 1.14 (0.97-1.34); Q3= 1.25(1.05-1.48); and Q4=1.62(1.34-1.96) [P for trend <0.001]. Finally, for the full model the ORs were Q2= 1.04 (0.88-1.23); Q3= 1.05 (0.88-1.26) and Q4= 1.32(1.08-1.62) [P for trend <0. 01]. Conclusion: Uric acid levels were correlated to prehypertension among a middle-aged urban population. It occurred independently of other variables classically associated to high blood pressure or the origin of higher uric acid in hominids.

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Association patterns of urinary sodium, potassium, and their ratio with blood pressure across various levels of salt-diet regions in China

Scientific Reports ◽

10.1038/s41598-018-25097-1 ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 5

Author(s):

Lu Yin ◽

Guijuan Deng ◽

Andrew Mente ◽

Yi Sun ◽

Xiaoyun Liu ◽

...

Keyword(s):

Blood Pressure ◽

Urinary Sodium ◽

Association Patterns ◽

Sodium Potassium ◽

Salt Diet

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Relationship of urinary sodium/potassium excretion and calcium intake to blood pressure and prevalence of hypertension among older Chinese vegetarians

European Journal of Clinical Nutrition ◽

10.1038/sj.ejcn.1601553 ◽

2003 ◽

Vol 57 (2) ◽

pp. 299-304 ◽

Cited By ~ 25

Author(s):

T C Y Kwok ◽

T Y K Chan ◽

J Woo

Keyword(s):

Blood Pressure ◽

Calcium Intake ◽

Urinary Sodium ◽

Potassium Excretion ◽

Sodium Potassium ◽

Older Chinese ◽

Relationship Of

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Urinary sodium potassium ratio is associated with clinical success after adrenalectomy in patients with unilateral primary aldosteronism

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622321990274 ◽

2021 ◽

Vol 12 ◽

pp. 204062232199027

Author(s):

Ming-Jse Lee ◽

Chiao-Yin Sun ◽

Ching-Chu Lu ◽

Yuan-Shian Chang ◽

Heng-Chih Pan ◽

...

Keyword(s):

Blood Pressure ◽

Serum Potassium ◽

Primary Aldosteronism ◽

Clinical Success ◽

Plasma Aldosterone ◽

Urinary Sodium ◽

Dietary Sodium ◽

Sodium Potassium ◽

Inflammatory Status ◽

Lower Urinary

Background: The urinary sodium potassium (NaK) ratio is associated with dietary sodium and potassium intake and blood pressure, and it also reflects the activity of aldosterone. Herein we evaluated the value of the urinary NaK ratio in predicting the surgical outcomes of patients with unilateral primary aldosteronism (uPA). Methods: This non-concurrent prospective cohort study was conducted from 2011 to 2017 and included 241 uPA patients who had undergone adrenalectomy. Predictors of successful clinical outcomes were analyzed using logistic regression. Results: Among the 241 uPA patients, 197 (81.7%) achieved clinical complete or partial success. A urinary sodium potassium ratio <3 (odds ratio (OR): 2.5; 95% confidence interval (CI): 1.2–5.4; p = 0.015), body mass index <25 kg/m2 (OR: 2.82; 95% CI: 1.31–6.06; p = 0.008), renin <1 ng/mL/h (OR: 2.51; 95% CI: 1.01–6.21; p = 0.047) and mean preoperative blood pressure >115 mmHg (OR: 5.02; 95% CI: 2.10–11.97; p < 0.001) could predict clinical success after adrenalectomy. Furthermore, higher pre-treatment plasma aldosterone (OR: 1.014; 95% CI 1.005–1.024; p = 0.002) or lower serum potassium (OR: 0.523; 95% CI: 0.328–0.836; p = 0.007) were correlated with lower urinary NaK ratio (<3), and log urinary NaK ratio was positively correlated with serum C-reactive protein ( β value 2.326; 95% CI 0.029–4.623; p = 0.047). Conclusions: uPA patients with a lower urinary NaK ratio, due to high plasma aldosterone and low serum potassium concentrations, were more likely to have clinical success after adrenalectomy. uPA patients with a higher urinary NaK ratio were associated with more severe inflammatory status, and possibly more resistant hypertension post-operatively.

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