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Published in: BMC Nephrology 1/2022

Open Access 01-12-2022 | Chronic Kidney Disease | Research

Association between urinary sodium excretion and hard outcomes in non-dialysis chronic kidney disease patients

Authors: Cecília Malheiro Cury, Vanessa Burgugi Banin, Pamela Falbo dos Reis, Jacqueline Costa Teixeira Caramori, Pasqual Barretti, Luís Gustavo Modelli de Andrade, Luis Cuadrado Martin

Published in: BMC Nephrology | Issue 1/2022

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Abstract

Background

Restriction of sodium intake is routinely recommended for patients with chronic kidney disease (CKD). Whether or not sodium intake is associated with the progression of CKD and mortality remains uncertain. We evaluated the association between urinary sodium excretion (as a surrogate for sodium intake) with the occurrence of renal failure and mortality in patients with non-dialytic CKD.

Methods

We conducted a retrospective study of patients followed at a CKD clinic care hospital from October 2006 to March 2017. Adult patients with non-dialytic CKD were included. Using a time-to-event analysis, we examined the association of urinary sodium excretion as a categorical variable (categorized as quintiles: 1st quintile: 0.54–2.51 g; 2nd quintile: 2.52–3.11 g, 3rd quintile: 3.12–3.97 g, 4th quintile: 3.98–5.24 g and 5th quintile: 5.26–13.80 g) and the outcomes of interest. The primary outcome was defined as progression to end-stage renal disease requiring any type of renal replacement therapy. The secondary outcome was mortality.

Results

Two hundred five patients were included in the study (mean follow up of 2.6 years) with a mean eGFR of 26 (19–41) ml/min/1.73m2. 37 patients (18%) required renal replacement therapy and 52 (25,3%) died. There was association between urinary sodium excretion and need for renal replacement therapy (adjusted HR 0.245; 95%CI 0.660–0.912). There was no association between urinary sodium excretion and mortality in adjusted models.

Conclusion

Moderate sodium intake was associated with a lower risk of renal failure.
Literature
1.
go back to reference Snyder JJ, Foley RN, Collins AJ. Prevalence of CKD in the United States: a sensitivity analysis using the National Health and Nutrition Examination Survey (NHANES) 1999–2004. Am J Kidney Dis. 2006;53:218–28.CrossRef Snyder JJ, Foley RN, Collins AJ. Prevalence of CKD in the United States: a sensitivity analysis using the National Health and Nutrition Examination Survey (NHANES) 1999–2004. Am J Kidney Dis. 2006;53:218–28.CrossRef
2.
go back to reference National Kidney Foundation. KDIGO clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney. 2012;39:S1–266. National Kidney Foundation. KDIGO clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney. 2012;39:S1–266.
3.
go back to reference Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes a among a population with chronic kidney disease in a large managed care organization. Arch Int Med. 2004;164:659–63.CrossRef Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes a among a population with chronic kidney disease in a large managed care organization. Arch Int Med. 2004;164:659–63.CrossRef
4.
go back to reference Major RW, Cheng MRI, Grant RA, Shantikumar S, Xu G, Oozeerally I, et al. Cardiovascular disease risk factors in chronic kidney disease: a systematic review and meta-analysis. PLoS One. 2018;13(3):e0192895.CrossRef Major RW, Cheng MRI, Grant RA, Shantikumar S, Xu G, Oozeerally I, et al. Cardiovascular disease risk factors in chronic kidney disease: a systematic review and meta-analysis. PLoS One. 2018;13(3):e0192895.CrossRef
5.
go back to reference Silva PAB, Silva LB, Santos JFG, Soares SM. Brazilian public policy for chronic kidney disease prevention: challenges and perspectives. Rev Saude Publica. 2020;54:86. Silva PAB, Silva LB, Santos JFG, Soares SM. Brazilian public policy for chronic kidney disease prevention: challenges and perspectives. Rev Saude Publica. 2020;54:86.
6.
go back to reference Wang F, He K, Wang J, Zhao MH, Li Y, Zhang L, et al. Prevalence and risk factors for CKD: A comparison between the adult populations in China and the United States. Kidney Int Rep. 2018;3(5):1135–43.CrossRef Wang F, He K, Wang J, Zhao MH, Li Y, Zhang L, et al. Prevalence and risk factors for CKD: A comparison between the adult populations in China and the United States. Kidney Int Rep. 2018;3(5):1135–43.CrossRef
7.
go back to reference Pandy V, Rao A, Chaudhary K. Lipid abnormalities in kidney disease and management strategies. World J Nephrol. 2015;4(1):83–91.CrossRef Pandy V, Rao A, Chaudhary K. Lipid abnormalities in kidney disease and management strategies. World J Nephrol. 2015;4(1):83–91.CrossRef
8.
go back to reference Garland JS. Elevated body mass index as a risk factor for chronic kidney disease: current perspectives. Diabetes Metab Syndr Obes. 2014;29(7):347–55.CrossRef Garland JS. Elevated body mass index as a risk factor for chronic kidney disease: current perspectives. Diabetes Metab Syndr Obes. 2014;29(7):347–55.CrossRef
9.
go back to reference Júnior UFE, Elihimas HCS, Lemos VM, Leão MA, Sá MPBO, França EET, et al. Smoking as risk factor for chronic kidney disease: systematic review. J Bras Nefrol. 2014;36(4):519–28. Júnior UFE, Elihimas HCS, Lemos VM, Leão MA, Sá MPBO, França EET, et al. Smoking as risk factor for chronic kidney disease: systematic review. J Bras Nefrol. 2014;36(4):519–28.
10.
go back to reference Palmer SC, Maggo JK, Campbell KL, Craig JC, Johnson DW, Sutanto B, et al. Dietary interventions for adults with chronic kidney disease. Cochrane Database Syst Rev. 2017;23(4):CD011998. Palmer SC, Maggo JK, Campbell KL, Craig JC, Johnson DW, Sutanto B, et al. Dietary interventions for adults with chronic kidney disease. Cochrane Database Syst Rev. 2017;23(4):CD011998.
11.
go back to reference Ko GY, Obi Y, Amanda R, TortoricciKamyarKalantar-Zadeh. Dietary protein intake and chronic kidney disease. Curr Opin Clin Nutr Metab Care. 2017;20(1):77–85.CrossRef Ko GY, Obi Y, Amanda R, TortoricciKamyarKalantar-Zadeh. Dietary protein intake and chronic kidney disease. Curr Opin Clin Nutr Metab Care. 2017;20(1):77–85.CrossRef
12.
go back to reference He J, Mills KT, Appel LJ, Yang W, Chen J, Lee BT, et al. Urinary sodium and potassium excretion and CKD progression. J Am Soc Nephrol. 2016;27:1202–12.CrossRef He J, Mills KT, Appel LJ, Yang W, Chen J, Lee BT, et al. Urinary sodium and potassium excretion and CKD progression. J Am Soc Nephrol. 2016;27:1202–12.CrossRef
13.
go back to reference Chang AR, Anderson C. Dietary phosphorus intake and the kidney. Annu Rev Nutr. 2017;21(37):321–46.CrossRef Chang AR, Anderson C. Dietary phosphorus intake and the kidney. Annu Rev Nutr. 2017;21(37):321–46.CrossRef
14.
go back to reference Wright JA, Cavanaugh KL. Dietary sodium in chronic kidney disease: a comprehensive approach. Semin Dial. 2010;23(4):415–21.CrossRef Wright JA, Cavanaugh KL. Dietary sodium in chronic kidney disease: a comprehensive approach. Semin Dial. 2010;23(4):415–21.CrossRef
15.
go back to reference Mente a, O'Donnel M, Yusulf S. Sodium Intake and Health: What Should We Recommend Based on the Current Evidence? Nutrients. 2021;13(9):3232. Mente a, O'Donnel M, Yusulf S. Sodium Intake and Health: What Should We Recommend Based on the Current Evidence? Nutrients. 2021;13(9):3232.
16.
go back to reference Brown IJ, Tzoulalu I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. Int J Epidemiol. 2009;38(3):791–813.CrossRef Brown IJ, Tzoulalu I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. Int J Epidemiol. 2009;38(3):791–813.CrossRef
17.
go back to reference He FJ, MacGregor GA. How far should salt intake be reduced? Hypertension. 2003;42(6):1093–9.CrossRef He FJ, MacGregor GA. How far should salt intake be reduced? Hypertension. 2003;42(6):1093–9.CrossRef
18.
go back to reference He FJ, Li J, MacGregor GA. Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev. 2004;3:4937. He FJ, Li J, MacGregor GA. Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev. 2004;3:4937.
19.
go back to reference Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Scidlcrová J, Richart T, et al. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium exrcretion. JAMA. 2011;305:1777–85.CrossRef Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Scidlcrová J, Richart T, et al. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium exrcretion. JAMA. 2011;305:1777–85.CrossRef
20.
go back to reference Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ. 2013;34:f1326.CrossRef Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ. 2013;34:f1326.CrossRef
21.
go back to reference Mente A, O’donnel MJ, Rangarajan S, Mcqueen MJ, Poirier P, Wielgosz A, et al. Association of urinary sodium and potassium excretion whit blood pressure. N Engl J Med. 2014;371(7):601–11.CrossRef Mente A, O’donnel MJ, Rangarajan S, Mcqueen MJ, Poirier P, Wielgosz A, et al. Association of urinary sodium and potassium excretion whit blood pressure. N Engl J Med. 2014;371(7):601–11.CrossRef
22.
go back to reference He FJ, Tan M, Ma Y, Macgregor GA. Salt reduction to prevent hypertension and cardiovascular disease: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(6):632–47.CrossRef He FJ, Tan M, Ma Y, Macgregor GA. Salt reduction to prevent hypertension and cardiovascular disease: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(6):632–47.CrossRef
23.
go back to reference Vegter S, Perna A, Postma MJ, Navis G, Remuzzi G, Ruggenenti P. Sodium intake, ACE inhibition, and progression to ESRD. J Am Soc Nephrol. 2012;23:165–73.CrossRef Vegter S, Perna A, Postma MJ, Navis G, Remuzzi G, Ruggenenti P. Sodium intake, ACE inhibition, and progression to ESRD. J Am Soc Nephrol. 2012;23:165–73.CrossRef
24.
go back to reference Slagman MCJ, Waanders F, Hemmelder MH, Woittiezinternis AJ, Janssen WMT, Heerspink HJL, et al. Moderate dietary sodium restriction added to angiotensin converting enzyme inhibition compared with dual blockade in lowering proteinuria and blood pressure: randomized controlled trial. BMJ. 2011;26(343):d4366.CrossRef Slagman MCJ, Waanders F, Hemmelder MH, Woittiezinternis AJ, Janssen WMT, Heerspink HJL, et al. Moderate dietary sodium restriction added to angiotensin converting enzyme inhibition compared with dual blockade in lowering proteinuria and blood pressure: randomized controlled trial. BMJ. 2011;26(343):d4366.CrossRef
25.
go back to reference Mirkovic K, Frenay AS, Van Den Born J, Van Goor H, Navis G, De Borst MH, et al. Sodium restriction potentiates the renoprotective effects of combined vitamin D receptor activation and angiotensin-converting enzyme inhibition in established proteinuric nephropathy. Nephrol Dial Transplant. 2017;32(8):1293–301.CrossRef Mirkovic K, Frenay AS, Van Den Born J, Van Goor H, Navis G, De Borst MH, et al. Sodium restriction potentiates the renoprotective effects of combined vitamin D receptor activation and angiotensin-converting enzyme inhibition in established proteinuric nephropathy. Nephrol Dial Transplant. 2017;32(8):1293–301.CrossRef
26.
go back to reference Mills KT, Chen J, Yang W, Appel LJ, Kusek JW, et al. Sodium excretion and the risk of cardiovascular disease in patients with chronic kidney disease. JAMA. 2016;315(20):2200–10.CrossRef Mills KT, Chen J, Yang W, Appel LJ, Kusek JW, et al. Sodium excretion and the risk of cardiovascular disease in patients with chronic kidney disease. JAMA. 2016;315(20):2200–10.CrossRef
27.
go back to reference EkincI EI, Clarke S, Thomas MC, Moran JL, Cheong K, Maclassac RJ, et al. Dietary salt intake and mortality in patients with type 2 diabetes. Diabetes Care. 2011;34(3):703–9.CrossRef EkincI EI, Clarke S, Thomas MC, Moran JL, Cheong K, Maclassac RJ, et al. Dietary salt intake and mortality in patients with type 2 diabetes. Diabetes Care. 2011;34(3):703–9.CrossRef
28.
go back to reference O’Donnell MJ, Yusuf S, Mente A, Gao P, Mann JF, Teo K, et al. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA. 2011;306(20):2229–38.CrossRef O’Donnell MJ, Yusuf S, Mente A, Gao P, Mann JF, Teo K, et al. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA. 2011;306(20):2229–38.CrossRef
29.
go back to reference American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl1):S13–28.PubMed American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl1):S13–28.PubMed
30.
go back to reference Masi S, Uliana M, Virdin A. Angiotensin II and vascular damage in hypertension: role of oxidative stress and sympathetic activation. Vascul Pharmacol. 2019;115:13–7.CrossRef Masi S, Uliana M, Virdin A. Angiotensin II and vascular damage in hypertension: role of oxidative stress and sympathetic activation. Vascul Pharmacol. 2019;115:13–7.CrossRef
31.
go back to reference Ivanovski O, Szumilak D, Nguyen-Khoa T, Dechaux M, Massy ZA, et al. Dietary salt restriction accelerates atherosclerosis in apolipoprotein E-deficient mice. Atherosclerosis. 2005;180(2):271–6.CrossRef Ivanovski O, Szumilak D, Nguyen-Khoa T, Dechaux M, Massy ZA, et al. Dietary salt restriction accelerates atherosclerosis in apolipoprotein E-deficient mice. Atherosclerosis. 2005;180(2):271–6.CrossRef
32.
go back to reference Shankar A, Klein R, Klein BE. The association among smoking, heavy drinking, and chronic kidney disease. Am J Epidemiol. 2006;164(3):263–71.CrossRef Shankar A, Klein R, Klein BE. The association among smoking, heavy drinking, and chronic kidney disease. Am J Epidemiol. 2006;164(3):263–71.CrossRef
33.
go back to reference Jones-Burton C, Seliger SL, Scherer RW, Mishra SI, Vessal G, Brown J, et al. Cigarette smoking and incident chronic kidney disease: a systematic review. Am J Nephrol. 2007;27(4):342–51.CrossRef Jones-Burton C, Seliger SL, Scherer RW, Mishra SI, Vessal G, Brown J, et al. Cigarette smoking and incident chronic kidney disease: a systematic review. Am J Nephrol. 2007;27(4):342–51.CrossRef
34.
go back to reference Rezonzew G, Chumley P, Feng W, Hua P, Siegal GP, Jaimes EA. Nicotine exposure and the progression of chronic kidney disease: role of the α7-nicotinic acetylcholine receptor. Am J Physiol Renal Physiol. 2012;303(2):F304–12.CrossRef Rezonzew G, Chumley P, Feng W, Hua P, Siegal GP, Jaimes EA. Nicotine exposure and the progression of chronic kidney disease: role of the α7-nicotinic acetylcholine receptor. Am J Physiol Renal Physiol. 2012;303(2):F304–12.CrossRef
35.
go back to reference Markowitz GS, Lin J, Valeri AM, Avila C, Nasr SH, D’agati VD. Idiopathic nodular glomerulosclerosis is a distinct clinicopathologic entity linked to hypertension and smoking. Hum Pathol. 2002;33(8):826–35.CrossRef Markowitz GS, Lin J, Valeri AM, Avila C, Nasr SH, D’agati VD. Idiopathic nodular glomerulosclerosis is a distinct clinicopathologic entity linked to hypertension and smoking. Hum Pathol. 2002;33(8):826–35.CrossRef
36.
go back to reference Judge C, Narula S, Mente A, Smyth A, Yusuf S, O’Donnel MJ. Measuring sodium intake: research and clinical applications. J Hypertens. 2021;39(12):2344–52.CrossRef Judge C, Narula S, Mente A, Smyth A, Yusuf S, O’Donnel MJ. Measuring sodium intake: research and clinical applications. J Hypertens. 2021;39(12):2344–52.CrossRef
Metadata
Title
Association between urinary sodium excretion and hard outcomes in non-dialysis chronic kidney disease patients
Authors
Cecília Malheiro Cury
Vanessa Burgugi Banin
Pamela Falbo dos Reis
Jacqueline Costa Teixeira Caramori
Pasqual Barretti
Luís Gustavo Modelli de Andrade
Luis Cuadrado Martin
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2022
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-022-02911-7

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