A LITERATURE REVIEW: LOW SODIUM RESTRICTION OF PATIENTS WITH HEART FAILURE ON HOSPITAL READMISSION

<p>Sodium restriction effect on hospital readmission in patients with heart failure (HF) has been questioned for decades. Readmission related to low sodium intake recommendations should be changed as well as mortality. A literature review is needed to summarize the effect of low sodium, especially on readmission and mortality. This literature review aimed to summarize the prevalence of hospital readmission and mortality regarding low sodium intake in patients with HF. The searching process involved four databases; MEDLINE, Embase, EBSCO Health, Cochrane was explored for experimental studies of sodium restriction. Of 77 screened citations from 2000 to 2019 invested in patients with HF, four studies were included. Four studies from four databases were included and explained and it was found that hospital readmission was the outcome of implementing sodium restriction in patients with HF. Low sodium restriction (800 mg – 1800 mg/day) results in higher hospital readmission. Moreover, 1800 mg/day of sodium was followed by higher mortality and higher sudden death in patients with HF. Low sodium restriction did not lower hospital readmission as well as mortality of patients with HF. This article provides the reason, effect, and amount of sodium restriction in patients with HF. The recommendation from this literature review is low sodium restriction has no beneficial effect on readmission and mortality in HF conditions.</p>

How Would You Prescribe the Dialysate Sodium Concentration for Your Patients?

Low sodium dialysate was commonly used in the early year of hemodialysis to enhance diffusive sodium removal beyond its convective removal by ultrafiltration. However, disequilibrium syndrome was common, particularly when dialysis sessions were reduced to 4 h. The recent trend of lowering the DNa from the most common level of 140 mEq/L has been associated with intradialytic hypotension and increased risk of hospitalization and mortality. Higher DNa also has disadvantages, such as higher blood pressure and greater interdialytic weight gain, likely due to increased thirst. My assessment of the evidence leads me to choose DNa at the 140 level for most patients and to avoid DNa below 138. Patients with intradialytic symptoms may benefit from DNa 142 mEq/L, if they can avoid excessive fluid weight gains.

The antioxidant activity of seaweed salt from Sargassum polycystum in Sprague-Dawley male White rats

Seaweed has many health benefits and has been the potential raw material for making low sodium and high potassium healthy salt. Sargassum polycystum is widely used as a low-sodium functional salt, which has a strong antioxidant capacity. However, it's in vivo potential is unknown. This research was a purpose to determine the antioxidant activity of SOD and catalase enzymes in seaweed salt through in vivo test in Sprague-Dawley rats. To achieve this, salt was produced from S. polycystum flour and distilled water at a ratio of 1:10 and heated at 40°C for 10 minutes, using a water bath. The mixture was stirred using 500 mesh nylon cloth and filter paper, then dried with an oven at 60°C for 30 hours. In vivo research method was then adopted using 20 male Sprague-Dawley rats, which were divided into 5 treatment groups. The analysis used was the treatment of commercial and seaweed salt, Sargassum polycystum, and plain water (aquades) in the test animals with 4 replications, which include each treatment group consisting of 4 Sprague-Dawley rats. Data were analyzed using Analysis of variance (ANOVA) from Statistical Package for Social Sciences (SPSS) software. S. polycystum salt had a Sodium (Na) and Potassium (K) ratio of 0.38 and NaCl content of 49.05%. The antioxidant activity of SOD and catalase enzymes ranged between 54.09–73.40 U/mL and 0.67 – 0.79 U/mL, respectively. These values indicate that the application of S. polycystum salt is able to balance the antioxidant activity of SOD and catalase. In addition, seaweed salt has the potential to reduce cell damage due to free radicals.

How to Adjust the Sodium Concentration in Dialysate Individually and Practically?

The optimal dialysate sodium concentration for chronic hemodialysis patients remains controversial. Conflicting data from small observational studies and large cohort study data have not convinced nephrologists to choose either a high or low sodium dialysate. Despite a lack of evidence, I would prescribe individualized dialysate sodium concentrations for patients with a risk of hypertension or volume overload, aligning the dialysate sodium concentration with patients’ predialysis serum sodium level. The concentration of dialysate sodium would usually be 0–2 mEq/L below the patient’s serum sodium concentration. I believe that this strategy would help improve hypertension, intradialytic weight gain, cardiac outcomes, and deliver precision medicine.

Perceptions and Feasibility of Actions Related to Sodium Reduction among Restaurant Owners and Cooks in Seongnam, South Korea: Comparison According to Stages of Behavioral Change

With the increase in meals eaten outside the home, sodium reduction in restaurant foods is essential for reducing sodium intake. This study aimed to assess the stages of behavioral change for reducing sodium and the differences in perceptions among restaurant staff by stage. Restaurant owners and cooks (n = 313) in Seongnam, South Korea were surveyed on their stage of behavioral change, practices, and perceptive factors related to sodium reduction in restaurant meals using a questionnaire. The proportion of behavioral change by stage was 20.4% in the maintenance and action (MA) stage, 32.3% in the preparation (P) stage, and 47.3% in the pre-preparation (PP) stage, which included contemplation and pre-contemplation stages. The items that represent differences among the groups were recognition of social environment for sodium reduction, practice of weighing condiments and measuring salinity, and feasibility of actions related to low-sodium cooking. Logistic regression analysis was used to estimate odds ratios for practice and perceptive factors by using stage of behavioral change as the independent variable. Factors associated with being in the MA stage were weighing condiments, measuring salinity, and high feasibility of actions related to low-sodium cooking. Recognition of sodium labeling and anticipation of better taste by reducing sodium increased the odds of being in the P stage rather than the PP stage. These results suggest that customized stepwise education and support are needed for the efficacy of restaurant-based sodium reduction programs.