Abstract
The average dietary salt (i.e., sodium chloride) intake in Western society is about 10 g per day. This greatly exceeds the lifestyle recommendations by the WHO to limit dietary salt intake to 5 g. There is robust evidence that excess salt intake is associated with deleterious effects including hypertension, kidney damage and adverse cardiovascular health. In patients with chronic kidney disease, moderate reduction of dietary salt intake has important renoprotective effects and positively influences the efficacy of common pharmacological treatment regimens. During the past several years, it has become clear that besides influencing body fluid volume high salt also induces tissue remodelling and activates immune cell homeostasis. The exact pathophysiological pathway in which these salt-induced fluid-independent effects contribute to CKD is not fully elucidated, nonetheless it is clear that inflammation and the development of fibrosis play a major role in the pathogenic mechanisms of renal diseases. This review focuses on body fluid-independent effects of salt contributing to CKD pathogenesis and cardiovascular health. Additionally, the question whether better understanding of these pathophysiological pathways, related to high salt consumption, might identify new potential treatment options will be discussed.
Highlights
IntroductionCurrent international guidelines for Chronic kidney disease (CKD) treatment recommend dietary and lifestyle modifications to delay progression and to reduce disease-specific mortality in addition to the standard CKD treatment [1]
Chronic kidney disease (CKD) is a worldwide global health burden
In non-diabetic CKD patients, receiving stable ACE-inhibiting therapy, high salt intake is associated with a higher incidence of end stage renal disease and this effect has shown to be mediated by the waned antiproteinuric effect, independently of blood pressure (BP) control [8]
Summary
Current international guidelines for CKD treatment recommend dietary and lifestyle modifications to delay progression and to reduce disease-specific mortality in addition to the standard CKD treatment [1]. Regarding salt consumption, these guidelines propose a dietary intake of sodium chloride (NaCl), commonly known as table salt, of less than 5 g daily, which is equivalent to 2 g sodium (Na+ ). Studies revealed an association between high salt intake and both immune cell activation and tissue remodeling [11,12]
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