Abstract
BackgroundData regarding the association between 24h urinary sodium and potassium excretion with kidney outcomes in patients with diabetes mellitus is currently scarce.MethodsWe conducted a single-center, retrospective cohort study in which 1230 patients with diabetes who had undergone a 24h urinary sodium and potassium excretion test were analyzed. Patients with incomplete urine collection were excluded based on 24h urinary creatinine excretion. Outcomes were the composite of a 30% decline in eGFR or death. Multivariate cox regression analysis was used to investigate the association between urinary sodium and potassium excretion and outcomes.ResultsWith a mean follow up period of 5.47 years, 130 patients reached the outcomes (30% decline in eGFR: 124, death: 6). Mean (SD) eGFR and 24h urinary sodium and potassium excretion at baseline were 78.6 (19.5) ml/min/1.73m2, 4.50 (1.64) g/day, and 2.14 (0.77) g/day. Compared with sodium excretion < 3.0 g/day, no significant change in risk of outcomes was observed with increased increments of 1.0 g/day. Compared with potassium excretion of < 1.5 g/day, 2.0–2.5 g/day, and 2.5–3.0 g/day were significantly associated with a lower risk of outcomes (hazard ratio [HR], 0.49 and 0.44; 95% confidence interval [CI], 0.28 to 0.84 and 0.22 to 0.87).Conclusions24h urinary sodium excretion was not significantly associated with a risk of 30% decline in eGFR or death in patients with diabetes. However, an increased risk of 30% decline in eGFR or death was significantly associated with 24h urinary potassium excretion < 1.5 g/day than with 2.0–2.5 g/day and 2.5–3.0 g/day.
Highlights
The prevalence of chronic kidney disease (CKD) is a major public health issue worldwide[1]
Compared with potassium excretion of < 1.5 g/day, 2.0–2.5 g/day, and 2.5–3.0 g/day were significantly associated with a lower risk of outcomes
We evaluated the association between 24h urinary sodium excretion and the primary outcome based on the Cox model as a restricted cubic spline function with 4 knots[21]
Summary
The prevalence of chronic kidney disease (CKD) is a major public health issue worldwide[1]. Previous studies have shown that high sodium intake leads to hypertension or incidence of cardiovascular disease (CVD) in healthy individuals, patients with hypertension, and those with a history of CVD and diabetes[2,3,4]. Several observational or prospective studies have reported that not all patients (such as those with high cardiovascular risk or diabetes) benefit from sodium restriction[2,6,7,8,9]. Several studies have shown that the amount of urinary sodium excretion (as a substitute for intake) is not significantly associated with kidney outcomes[8,10,11,12]. Data regarding the association between 24h urinary sodium and potassium excretion with kidney outcomes in patients with diabetes mellitus is currently scarce
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