Association between Daily Urinary Sodium Excretion, Ratio of Extracellular Water-to-Total Body Water Ratio, and Kidney Outcome in Patients with Chronic Kidney Disease.

Kaori Kohatsu,Tsutomu Sakurada,Sayaka Shimizu,Yugo Shibagaki

doi:10.3390/nu13020650

Kaori Kohatsu, Tsutomu Sakurada + Show 2 more

Open Access

https://doi.org/10.3390/nu13020650

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Abstract

Whether dietary salt intake affects chronic kidney disease (CKD) progression remains unclear. We conducted a retrospective cohort study to analyze the effects of both daily salt intake (DSI) and volume status on renal outcomes in 197 CKD patients. DSI was estimated by 24-h urinary sodium excretion and volume status was assessed by the ratio of extracellular water (ECW) to total body water (TBW) measured by bioelectrical impedance analysis (BIA). We divided patients into two groups according to DSI (6 g/day) or median ECW/TBW (0.475) and compared renal outcomes of each group. Furthermore, we classified and analyzed four groups according to both DSI and ECW/TBW. The higher DSI group showed a 1.69-fold (95% confidence interval (CI) 1.12–2.57, p = 0.01) excess risk of outcome occurrence compared to the lower group. Among the four groups, compared with Group 1 (low DSI and low ECW/TBW), Group 3 (high DSI and low ECW/TBW) showed a 1.84-fold (95% CI 1.03–3.30, p = 0.04) excess risk of outcome occurrence; however, Group 2 (low DSI and high ECW/TBW) showed no significant difference. High salt intake appears to be associated with poor renal outcome independent of blood pressure (BP), proteinuria, and volume status.

Highlights

High intake of dietary salt is reportedly associated with various adverse health outcomes, such as stomach cancer [1], osteoporosis [2], and kidney stones [3]
Several studies have reported that high salt intake as calculated by measuring 24-h urinary sodium excretion or as estimated from spot urine excretion was associated with hypertension, increased urinary protein, and occurrence of cardiovascular disease (CVD) [7,8,9]
daily salt intake (DSI) estimated from 24-h urinary sodium excretion was 5.88 g (IQR 4.35–8.24 g), and mean extracellular water (ECW)/total body water (TBW) was 0.48 (SD 0.04)

Summary

Introduction

High intake of dietary salt is reportedly associated with various adverse health outcomes, such as stomach cancer [1], osteoporosis [2], and kidney stones [3]. Strict salt restriction has been associated with improvements in hypertension and urinary protein reduction [5,6]. Several studies have reported that high salt intake as calculated by measuring 24-h urinary sodium excretion or as estimated from spot urine excretion was associated with hypertension, increased urinary protein, and occurrence of cardiovascular disease (CVD) [7,8,9]. Few studies have evaluated the long-term effects of salt restriction on renal outcomes

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