Protocol for a systematic review assessing the measurement of dietary sodium intake among adults with elevated blood pressure

IntroductionAccurate sodium intake estimates in adults with elevated blood pressure are essential for monitoring salt reduction progress and preventing cardiovascular diseases. However, sodium assessments are challenging in this high-risk population because many commonly used antihypertensive drugs alter urinary sodium excretion. Despite the high cost and substantial participant burden of gold-standard 24-hour urine collection, the relative performance of existing spot-urine based equations and dietary self-report instruments have not been well studied in this population, who will benefit from salt restriction. This systematic review aims to describe the current methods of assessing dietary sodium intake in adults with elevated blood pressure and determine what method can provide a valid and accurate estimate of sodium intake compared with the gold standard 24-hour urine collection.Methods and analysisStudies assessing sodium intake in adults aged 18 years and above with reported elevated blood pressure will be included. Five electronic databases (MEDLINE, Embase, Global Health, WoS and Cochrane CENTRAL) will be systematically searched from inception to March 2021. Also, a manual search of bibliographies and grey literature will be conducted. Two reviewers will screen the records independently for eligibility. One reviewer will extract all data, and two others will review the extracted data for accuracy. The methodological quality of included studies will be evaluated based on three scoring systems: (1) National Heart, Lung and Blood Institute for interventional studies; (2) Biomarker-based Cross-sectional Studies for biomarker-based observational studies and (3) European Micronutrient Recommendation Aligned Network of Excellence for validation studies of dietary self-report instruments.Ethics and disseminationAs the proposed systematic review will collect and analyse secondary data associated with individuals, there will be no ethical approval requirement. Findings will be disseminated in a peer-reviewed journal or presented at a conference.PROSPERO registration numberCRD42020176137.

Short-Term Housing in Metabolic Caging on Measures of Energy and Fluid Balance in Male C57BL/6J Mice (Mus musculus)

Metabolic caging is an important tool for quantitative urine and feces collection in rodents, although significant limitationsand problems accompany its use. Despite strong opinions among investigators regarding the effects of metabolic caging onenergy and fluid homeostasis, careful quantitative analysis of the impact of this caging type—particularly when used for mice—is lacking. The current study assessed the effects of metabolic caging, with or without modifications such as plastic platform inserts, on ingestive behaviors, energy expenditure, accuracy of urine and fecal collection, and ambulatory activities in male C57BL/6J mice. Housing mice in metabolic cages, regardless of platform inclusion, increased energy expenditure without modifying food intake, presumably due to the inability of mice to perform normal thermoregulatory behaviors (burrowing and huddling). Surprisingly, mice in metabolic cages actively avoided platforms, and the inclusion of platforms modified the behavior of the mice and had position-dependent effects that reduced the accuracy of urine collection. Moving mice from cohousing to individual housing in home cages also increased ingestive behaviors and energy expenditure. We conclude that single housing of male C57BL/6J mice increases energy expenditure, that this increase is potentiated in metaboliccaging conditions, and that platforms in metabolic cages alter mouse behavior and urine collection. Additional future workis needed to determine the potential benefits of using higher ambient temperature for studies of mice in metabolic cagingand whether the above effects occur in females and other strains of mice and other rodent species.

Analysis of Etiology and Risk Factors of Catheter-Associated Urinary Tract Infection in Critically Ill Patients and Research on Corresponding Prevention and Nursing Measures

Catheter-associated urinary tract infection (CAUTI) is the most common complication in patients with indwelling catheterization. The incidence of CAUTI in my country is still at a relatively high level compared with foreign countries, especially for the ICU, which has a high usage rate of urinary catheters, to focus on prevention and control. This article focuses on studying the risk factors of CAUTI in critically ill patients and discusses targeted preventive care measures. This article investigates and examines the clinical data of CAUTI in critically ill patients. After statistical analysis, the risk factors that affect CAUTI are summarized, so as to derive the cause of CAUTI in order to strengthen clinical care and to further study the prevention, control, and nursing of CAUTI to provide reference. Clinical data shows that the CAUTI infection rate of patients with catheter indwelling ≥7 days is greater than that of patients with catheter indwelling days less than 7 days. The CAUTI infection rate of the patients who change the urine collection bag every day or ≥7 days is greater than that of the patients who change the urine collection bag within 2 to 4 days.

Well-Balanced Lunch Reduces Risk of Lifestyle-Related Diseases in Middle-Aged Japanese Working Men

Based on the results of a previous WHO-CARDIAC study, this study was designed to test the effect of the daily consumption of a diet rich in potassium with optimal salt content, rich in fish meat and soy isoflavones, corresponding to the ingredients of a traditional Japanese diet. The test meals were a Balanced Lunch (BL) with chicken as the main dish and a Fortified Lunch (FL) with fish and soy as the main dish, which appeared the same. A double-blind, randomized controlled trial was conducted in 64 relatively obese men (47.2 ± 5.5 years old) who consumed the lunch at their work site for 4 weeks. All participants underwent fasting blood sampling, 24-h urine collection, as well as measurements of height, weight, and blood pressure before and after the intervention. Body mass index, blood pressure, and HbA1c were significantly improved and a 3-g reduction of salt intake was proven by 24-h urine collection in both groups. Moreover, HDL cholesterol and the Atherogenic Index (AI) were significantly improved in the FL group. In conclusion, the risks of lifestyle-related diseases in working men were reduced by one meal per day intervention of optimally-salted traditional Japanese diets containing soy and fish nutrients with high vegetable ingredients.

Quick-Wee method Versus Standard method for urine collection in infants 1-12 month old

BACKGROUND: Urinary Tract infections [UTI] often presents with fever and nonspecific findings in infants less than one year. So urine sample collection is mandatory for diagnosis or exclusion. Collecting Urine sample is very challenging in infants and choosing the method of collection must balance the reliability, speed and contamination. Clinical guidelines have different recommendations so there is a need for reliable collection method. Therefore this study was conducted to determine if a simple stimulation method (Quick–wee Method) increases the rate of clean catch voiding of urine within five minutes. METHODS: A prospective age and sex matched case control study in 1-12 months children conducted from June 2017 – June 2018 in Pediatric ward of Manipal college of medical sciences, Pokhara, after Ethical clearance from Institutional review Board [IRB]. The study population was randomized to either clean catch midstream urine with stimulation [Quick–Wee method] or without stimulation [Standard method]. The primary outcome was voiding of urine within 5 minute. Secondary outcome were waiting time for voiding, successful collection, parental satisfaction, and contamination. The analysis was done using SPSS version 20 and a ‘p’value <0.05 was considered statistically significant. RESULTS: Waiting time for voiding in Quick wee group was less and statistically significant compared to standard group. There was 10% increment in voiding within 5 minutes in Quick wee group . It had higher successful urine collection rate (91.4%), slightly higher contamination rate (14.28%) but better parental satisfaction. CONCLUSIONS: Quick wee method is easy, reliable, successful method of urine collection in infants with better parental satisfaction and slightly higher contamination rate.

Estimation of sodium consumption by novel formulas derived from random spot and 12-hour urine collection

The gold standard for estimating sodium intake is 24h urine sodium excretion. Several equations have been used to estimate 24h urine sodium excretion, however, a validated formula for calculating 24h urine sodium excretion from 12h urine collection has not yet been established. This study aims to develop novel equations for estimating 24h urine sodium excretion from 12h and random spot urine collection and also to validate existing spot urine equations in the Thai population. A cross-sectional survey was carried out among 209 adult hospital personnel. Participants were asked to perform a 12h daytime, 12h nighttime, and a random spot urine collection over a period of 24 hours. The mean 24h urine sodium excretion was 4,055±1,712 mg/day. Estimated urine sodium excretion from 3 different equations using random spot urine collection showed moderate correlation and agreement with actual 24h urine sodium excretion (r = 0.54, P<0.001, ICC = 0.53 for Kawasaki; r = 0.57, P<0.001, ICC = 0.44 for Tanaka; r = 0.60, P<0.001, ICC = 0.45 for INTERSALT). Novel equations for predicting 24h urine sodium excretion were then developed using variables derived from 12h daytime urine collection, 12h nighttime urine collection, random spot urine collection, 12h daytime with random spot urine collection, and 12h nighttime with random spot urine collection which showed strong correlation and agreement with actual measured values (r = 0.88, P<0.001, ICC = 0.87; r = 0.83, P<0.001, ICC = 0.81; r = 0.67, P<0.001, ICC = 0.62; r = 0.90, P<0.001, ICC = 0.90; and r = 0.83, p<0.001, ICC = 0.82 respectively). Bland-Altman plots indicated good agreement between predicted values and actual 24h urine sodium excretion using the new equations. Newly derived equations from 12h daytime and 12h nighttime urine collection with or without casual spot urine collection were able to accurately predict 24h urine sodium excretion.

Inferior vena cava thrombosis as a possible cause of nephrotic-range proteinuria: two case reports

Background Nephrotic-range proteinuria is a common reason for nephrological consultation in clinical practice. The differential diagnosis is wide, and generally focuses on different forms of glomerulonephritis, but other causes should not be overlooked, as illustrated in this article. Case presentations We report two female patients with nephrotic-range proteinuria. In the first case, a 46 year old Caucasian patient who suffered from extreme obesity (Body mass index (BMI) 77 kg/m2), acute kidney injury and nephrotic-range proteinuria were discovered during an emergency consultation for acute abdominal pain. The second patient (aged 52, also Caucasian) developed stage 4 chronic kidney disease and nephrotic proteinuria (protein/creatinine ratio 1821 g/mol) after accidental rupture of the inferior vena cava during a gastric bypass operation. On split-urine collection, both had a much higher degree of proteinuria during the day than during the night, compatible with orthostatic proteinuria. At further work-up, inferior vena cava thrombosis was diagnosed in both patients, whereas renal veins were patent. Discussion After simple anticoagulation in the first case, and anticoagulation plus endovascular recanalization in the second, there was almost complete resolution of the orthostatic proteinuria and a strong improvement of the estimated glomerular filtration rate in both patients. These cases highlight that nephrotic-range proteinuria can be linked to inferior vena cava thrombosis, and that a split-urine collection may also be very useful in the diagnostic work-up of proteinuria in adults.

SPOT Protein/Creatinine Ratio As an Alternative for 24-Hour Urine Collection for Proteinuria in Patients with Multiple Myeloma

Background: Proteinuria is observed in &gt;80% of patients with multiple myeloma (MM) and most often consists of free light chains (FLC) and albumin. The standard method of following patients with light-chain MM includes a 24-hour urine collection to determine the degree of monoclonal proteinuria as response criteria are in part based on this parameter. This is often cumbersome, especially in the elderly population and frequently raises concerns for accuracy. An untimed urine collection to provide a spot protein-to-creatinine (SPOT) ratio has been proposed as a reliable and quicker alternative, but its correlation with 24-hour urine protein collection in MM patients is not well established. Our group previously demonstrated a good correlation between the two methods in a small study of 15 patients. We now present the updated results with urine samples from 40 patients to evaluate the correlation between SPOT ratio and 24-hour collection in patients with MM. Methods: With the approval of the Institutional Review Boards, patients with MM were enrolled in the study after obtaining informed consent. The patients were provided with detailed instructions and supplies to collect a 24-hour urine collection and up to three additional urine samples at different time points during the day. For all the samples submitted, urine protein was measured by benzethonium chloride turbidimetry and creatinine by an IDMS-standardized enzymatic method on a Siemens ADVIA 1800 or the pyrocatechol violet method on the Ortho Vitros 5.1. A linear regression method using R version 3.2.2 was used to correlate values obtained by the two methods. A Bland-Altman plot was used to analyze the limits of agreement between the two methods of measuring proteinuria. Results: Sixty-four urine samples were obtained for SPOT ratio analysis from 40 patients between 2015-2020. Only complete 24-hour urine samples containing ≥ 0.7 g creatinine were included. The median age of participants was 68.5 [interquartile range (IQR) 59-73] years. Twenty-three (57.5%) of the patients were female. Thirteen patients had only light chain disease, while the remaining 27 patients had either IgG/IgA paired ƙ/ƛ myeloma. Thirty (75%) patients were on therapy at the time of sample collection. A linear regression model of the 24-hour urine protein versus the SPOT ratio was performed. The average 24-hour protein was 457.2 +/- 805.9 mg. The average SPOT ratio was 327.5 +/- 724.0 mg prot/gram Cr. The linear regression line was y = -7.1 + 0.7x where y is the 24-hour urine protein & x is the spot ratio value. The coefficient of the linear regression model was significant (p&lt;0.001). The adjusted R2 value was 0.63 for the model. Conclusion: In patients with MM, there is a strong correlation between 24-hour urine protein & SPOT ratio, particularly for proteinuria under 1,000 mg. Given its accuracy and lack of inconvenience for the patients, SPOT ratio may be a suitable alternative to 24-hour urine protein collection. In patients with a high SPOT ratio, a 24-hour urine testing should be performed to confirm the results. Before 24-hour urine collection in myeloma can be completely abandoned, studies in larger patient cohorts are needed to differentiate between the monoclonal protein component and other proteins in urine. Figure 1 Figure 1. Disclosures Jamshed: Takeda: Honoraria. Hillengass: GlaxoSmithKline: Membership on an entity's Board of Directors or advisory committees; Beijing Medical Award Foundation: Speakers Bureau; Sanofi: Membership on an entity's Board of Directors or advisory committees; Axxess Network: Membership on an entity's Board of Directors or advisory committees; Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees; Beijing Life Oasis Public Service Center: Speakers Bureau; Curio Science: Speakers Bureau; Adaptive: Membership on an entity's Board of Directors or advisory committees; Skyline: Membership on an entity's Board of Directors or advisory committees; Oncotracker: Membership on an entity's Board of Directors or advisory committees; Oncopeptides: Membership on an entity's Board of Directors or advisory committees.