Sodium Intake and Chronic Kidney Disease

In Chronic Kidney Disease (CKD) patients, elevated blood pressure (BP) is a frequent finding and is traditionally considered a direct consequence of their sodium sensitivity. Indeed, sodium and fluid retention, causing hypervolemia, leads to the development of hypertension in CKD. On the other hand, in non-dialysis CKD patients, salt restriction reduces BP levels and enhances anti-proteinuric effect of renin–angiotensin–aldosterone system inhibitors in non-dialysis CKD patients. However, studies on the long-term effect of low salt diet (LSD) on cardio-renal prognosis showed controversial findings. The negative results might be the consequence of measurement bias (spot urine and/or single measurement), reverse epidemiology, as well as poor adherence to diet. In end-stage kidney disease (ESKD), dialysis remains the only effective means to remove dietary sodium intake. The mismatch between intake and removal of sodium leads to fluid overload, hypertension and left ventricular hypertrophy, therefore worsening the prognosis of ESKD patients. This imposes the implementation of a LSD in these patients, irrespective of the lack of trials proving the efficacy of this measure in these patients. LSD is, therefore, a rational and basic tool to correct fluid overload and hypertension in all CKD stages. The implementation of LSD should be personalized, similarly to diuretic treatment, keeping into account the volume status and true burden of hypertension evaluated by ambulatory BP monitoring.

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Spot urine sodium measurements do not accurately estimate dietary sodium intake in chronic kidney disease

American Journal of Clinical Nutrition ◽

10.3945/ajcn.115.127423 ◽

2016 ◽

Vol 104 (2) ◽

pp. 298-305 ◽

Cited By ~ 18

Author(s):

Carly E Dougher ◽

Dena E Rifkin ◽

Cheryl AM Anderson ◽

Gerard Smits ◽

Martha S Persky ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Sodium Intake ◽

Dietary Sodium ◽

Urine Sodium ◽

Spot Urine

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Achieving Salt Restriction in Chronic Kidney Disease

International Journal of Nephrology ◽

10.1155/2012/720429 ◽

2012 ◽

Vol 2012 ◽

pp. 1-10 ◽

Cited By ~ 34

Author(s):

Emma J. McMahon ◽

Katrina L. Campbell ◽

David W. Mudge ◽

Judith D. Bauer

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Sodium Intake ◽

Epidemiological Studies ◽

Dietary Sodium ◽

Sodium Restriction ◽

Restricted Diet ◽

Salt Restriction ◽

Low Sodium Diet ◽

Low Sodium

There is consistent evidence linking excessive dietary sodium intake to risk factors for cardiovascular disease and chronic kidney disease (CKD) progression in CKD patients; however, additional research is needed. In research trials and clinical practice, implementing and monitoring sodium intake present significant challenges. Epidemiological studies have shown that sodium intake remains high, and intervention studies have reported varied success with participant adherence to a sodium-restricted diet. Examining barriers to sodium restriction, as well as factors that predict adherence to a low sodium diet, can aid researchers and clinicians in implementing a sodium-restricted diet. In this paper, we critically review methods for measuring sodium intake with a specific focus on CKD patients, appraise dietary adherence, and factors that have optimized sodium restriction in key research trials and discuss barriers to sodium restriction and factors that must be considered when recommending a sodium-restricted diet.

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Nocturnal Dipping and Left Ventricular Mass Index in the Chronic Kidney Disease in Children Cohort

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.09810721 ◽

2021 ◽

pp. CJN.09810721

Author(s):

Christine Bakhoum ◽

Ronit Katz ◽

Joshua Samuels ◽

Tala Al-Rousan ◽

Susan Furth ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Chronic Kidney Disease ◽

African American ◽

Kidney Disease ◽

Left Ventricular Mass Index ◽

Sodium Intake ◽

Left Ventricular ◽

Spline Regression ◽

African American Race

Background and objectives: The physiological nocturnal blood pressure decline is often blunted in patients with chronic kidney disease (CKD); however, the consequences of blood pressure non-dipping in children are largely unknown. Our objective was to determine risk factors for non-dipping and to investigate if non-dipping is associated with higher left ventricular mass index (LVMI) in children with CKD. Design, setting, participants, and measurements: We conducted a cross-sectional analysis of ambulatory blood pressure monitoring and echocardiographic data in participants of the Chronic Kidney Disease in Children study. Multivariable linear and spline regression analyses were used to evaluate the relationship of risk factors with dipping, and of dipping with LVMI. Results: Within 552 participants, mean age was 11 (± 4) years, mean eGFR was 53 (± 20) ml/min/1.73m2, and 41% were classified as non-dippers. In subjects with non-glomerular CKD, female sex and higher sodium intake were significantly associated with less systolic and diastolic dipping (p≤ 0.05). In those with glomerular CKD, African American race and greater proteinuria were significantly associated with less systolic and diastolic dipping (p≤ 0.05). Systolic and diastolic dipping were not significantly associated with LVMI; however, in spline regression plots, diastolic dipping appeared to have a non-linear relationship with LVMI. As compared to diastolic dipping of 20-25%, dipping of < 20% was associated with 1.41 g/m2.7 higher LVMI (95% CI -0.47, 3.29), and dipping of > 25% was associated with 1.98 g/m2.7 higher LVMI (95% CI -0.77, 4.73), though these relationships did not achieve statistical significance. Conclusion: African American race, female sex, and greater proteinuria and sodium intake were significantly associated with blunted dipping in children with CKD. We did not find a statistically significant association between dipping and LVMI.

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Development of a Formula for Estimation of Sodium Intake from Spot Urine in People with Chronic Kidney Disease

Nephron Clinical Practice ◽

10.1159/000363297 ◽

2014 ◽

Vol 128 (1-2) ◽

pp. 61-66 ◽

Cited By ~ 8

Author(s):

Fabiana B. Nerbass ◽

Roberto Pecoits-Filho ◽

Natasha J. McIntyre ◽

Christopher W. McIntyre ◽

Maarten W. Taal

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Sodium Intake ◽

Spot Urine

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Use of mean spot urine sodium concentrations to estimate daily sodium intake in patients with chronic kidney disease

Nutrition ◽

10.1016/j.nut.2011.06.006 ◽

2012 ◽

Vol 28 (3) ◽

pp. 256-261 ◽

Cited By ~ 11

Author(s):

Shin Sook Kang ◽

Eun Hee Kang ◽

Seon Ok Kim ◽

Moo Song Lee ◽

Changgi D. Hong ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Sodium Intake ◽

Urine Sodium ◽

Spot Urine ◽

Daily Sodium Intake

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Dietary Sodium Restriction in the Management of Chronic Kidney Disease: A Systematic Review and Meta-Analysis of RCTs

10.21203/rs.3.rs-806377/v1 ◽

2021 ◽

Author(s):

Sai Sidharth Manikandan ◽

Murali Dhar

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Salt Intake ◽

Sodium Intake ◽

Meta Analysis ◽

Cost Effective ◽

Mean Difference ◽

Dietary Sodium ◽

High Sodium

Abstract Background: Non-pharmacological strategies such as lowering sodium intake aim to protect renal function and delay the initiation of renal replacement therapy. It might also be a cost-effective method to improve chronic kidney disease (CKD) prognosis. We decided to perform a meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of low versus high sodium intake in adults with CKD. Results:Our search strategy yielded seven studies from six countries with 465 participants. The overall effect on restricted sodium intake favored reduction in systolic blood pressure with an overall mean difference of -6.14(95% CI: -9.52, -2.76) and reduction in diastolic blood pressure with a mean difference of -3.08 (95% CI: -4.62, -1.55). There was lowering of estimated glomerular filtration rate (eGFR), however the same was not statistically significant.Conclusion:The study found that restricted salt intake could significantly reduce systolic and diastolic BP. Further, multi-center RCTs for longer durations across different stages of CKD could effectively assess the effects of restricted sodium intake on vital parameters. Such study designs could also help clinicians identify the optimal intake of dietary sodium to achieve better renal and cardio vascular outcomes.

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Evaluation of Salt Intake, Urinary Sodium Excretion and Their Relationship to Overhydration in Chronic Kidney Disease Patients

Blood Purification ◽

10.1159/000430902 ◽

2015 ◽

Vol 40 (1) ◽

pp. 59-65 ◽

Cited By ~ 5

Author(s):

Andrea E.C. Hallvass ◽

Lígia Maria Claro ◽

Simone Gonçalves ◽

Márcia Olandoski ◽

Fabiana Baggio Nerbass ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Sodium Excretion ◽

Salt Intake ◽

Fluid Overload ◽

Sodium Intake ◽

Urinary Sodium Excretion ◽

Urinary Sodium ◽

Hydration Status ◽

Body Composition Monitor

The purpose of this study was to estimate sodium intake in a group of patients with chronic kidney disease (CKD) and to correlate the results with the urinary excretion values of sodium and signs of fluid overload. We included patients with CKD in different stages. Urinary sodium was measured in 24 h urine samples. Body composition monitor (BCM) was used to estimate the hydration status. Sixty patients (38 ± 15 ml/min of GFR) presented 4.14 ± 1.71 g/24 h of urinary sodium excretion. Overhydration was detected in 50% of the patients by the BCM. There was a positive correlation between the measured sodium excretion values and BCM, ICW, ECW and TBW. In conclusion, markers of overhydration evaluated by BCM were positively correlated with urinary sodium excretion.

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Urine chloride self-measurement to monitor sodium chloride intake in patients with chronic kidney disease

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2018-1227 ◽

2019 ◽

Vol 57 (8) ◽

pp. 1162-1168 ◽

Cited By ~ 3

Author(s):

Vincenzo Panuccio ◽

Patrizia Pizzini ◽

Giovanna Parlongo ◽

Graziella Caridi ◽

Rocco Tripepi ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Sodium Intake ◽

Urinary Sodium ◽

Dietary Sodium ◽

Hypertension Control ◽

Roc Curve Analysis ◽

Self Monitoring ◽

Predictive Values ◽

Sodium Chloride Intake

Abstract Background Excessive sodium intake is a risk factor for hypertension, cardiovascular disease and the risk for kidney failure in chronic kidney disease (CKD) patients. Methods We tested the diagnostic performance and the feasibility of an inexpensive method based on urine chloride strips for self-monitoring sodium intake in a series of 72 CKD patients. Results Twenty-four hour urinary chloride as measured by the reactive strips and 24 h urinary sodium were interrelated (r=0.59, p<0.001). Forty-nine out of 72 patients (78%) had a 24 h urinary sodium >100 mmol/24 h, i.e. the upper limit recommended by current CKD guidelines. The strip method had 75.5% sensitivity and 82.6% specificity to correctly classify patients with urine sodium >100 mmol/24 h. The positive and the negative predictive values were 90.2% and 61.3%, respectively. The overall accuracy (ROC curve analysis) of urine chloride self-measurement for the >100 mmol/24 h sodium threshold was 87% (95% CI: 77%–97%). The large majority of patients (97%) perceived the test as useful to help compliance with the prescribed dietary sodium and considered the test as simple and of immediate application (58%) or feasible but requiring attention (39%). Conclusions A simple and inexpensive test for urine chloride measurement has a fairly good performance for the diagnosis of excessive sodium intake. The test is feasible and it is perceived by CKD patients as helpful for enhancing compliance to the dietary sodium recommendations. The usefulness of this test for improving hypertension control in CKD patients will be tested in a clinical trial (Clinicaltrials.gov RF-2010-2314890).

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