Abstract
Background. A clear evidence on the benefits of reducing salt in people with chronic kidney disease (CKD) is still lacking. Salt restriction in CKD may allow better control of blood pressure (BP) as shown in a previous systematic review while the effect on proteinuria reduction remains poorly investigated. Methods. We performed a meta-analysis of randomized controlled trials (RCTs) evaluating the effects of low versus high salt intake in adult patients with non-dialysis CKD on change in BP, proteinuria and albuminuria. Results. Eleven RCTs were selected and included information about 738 CKD patients (Stage 1–4); urinary sodium excretion was 104 mEq/day (95%CI, 76–131) and 179 mEq/day (95%CI, 165–193) in low- and high-sodium intake subgroups, respectively, with a mean difference of −80 mEq/day (95%CI from −107 to −53; p <0.001). Overall, mean differences in clinic and ambulatory systolic BP were −4.9 mmHg (95%CI from −6.8 to −3.1, p <0.001) and −5.9 mmHg (95%CI from −9.5 to −2.3, p <0.001), respectively, while clinic and ambulatory diastolic BP were −2.3 mmHg (95%CI from −3.5 to −1.2, p <0.001) and −3.0 mmHg (95%CI from −4.3 to −1.7; p <0.001), respectively. Mean differences in proteinuria and albuminuria were −0.39 g/day (95%CI from −0.55 to −0.22, p <0.001) and −0.05 g/day (95%CI from −0.09 to −0.01, p = 0.013). Conclusion. Moderate salt restriction significantly reduces BP and proteinuria/albuminuria in patients with CKD (Stage 1–4).
Highlights
Non-dialysis chronic kidney disease (CKD) is recognized as a major global public health problem because of the widespread prevalence in the world, of about 10%, and the natural fate of progression to end-stage kidney disease (ESKD) in those that do not die before as consequence of the extraordinarily high cardiovascular (CV) and mortality risk [1,2,3].the poor prognosis of CKD patients is modifiable
In this meta-analysis of randomized clinical trial (RCT) in patients with CKD stage 1–4, we demonstrate the efficacy of dietary sodium restriction per se in producing a meaningful improvement in clinic and ambulatory systolic and diastolic blood pressure (BP) and in proteinuria/albuminuria
This meta-analysis showed that a moderate dietary sodium restriction from 179 to 104 mEq/day significantly decreased systolic/diastolic BP measured as clinic and ambulatory BP, by 5/2 mmHg and 6/3 mmHg, respectively
Summary
Non-dialysis chronic kidney disease (CKD) is recognized as a major global public health problem because of the widespread prevalence in the world, of about 10%, and the natural fate of progression to end-stage kidney disease (ESKD) in those that do not die before as consequence of the extraordinarily high cardiovascular (CV) and mortality risk [1,2,3].the poor prognosis of CKD patients is modifiable. Extensive research in animal models and human studies suggest that dietary sodium restriction may slow the progression of renal disease and albuminuria [6,7,8,9]. Previous studies have shown that a low sodium diet can potentiate the effects of the renin–angiotensin–aldosterone system (RAAS) blockade and, decrease proteinuria and blood pressure (BP) as well [10,11]. Salt restriction in CKD may allow better control of blood pressure (BP) as shown in a previous systematic review while the effect on proteinuria reduction remains poorly investigated. We performed a meta-analysis of randomized controlled trials (RCTs) evaluating the effects of low versus high salt intake in adult patients with non-dialysis CKD on change in BP, proteinuria and albuminuria. Eleven RCTs were selected and included information about 738 CKD patients (Stage 1–4); urinary sodium excretion was 104 mEq/day (95%CI, 76–131)
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