Abstract
Globally, average dietary sodium intake is double the recommended amount, whereas potassium is often consumed in suboptimal amounts. High sodium diets are associated with increased cardiovascular and renal disease risk, while potassium may have protective properties. Consequently, patients at risk of cardiovascular and renal disease are urged to follow these recommendations, but dietary adherence is often low due to high sodium and low potassium content in processed foods. Adequate monitoring of intake is essential to guide dietary advice in clinical practice and can be used to investigate the relationship between intake and health outcomes. Daily sodium and potassium intake is often estimated with 24-h sodium and potassium excretion, but long-term balance studies demonstrate that this method lacks accuracy on an individual level. Dietary assessment tools and spot urine collections also exhibit poor performance when estimating individual sodium and potassium intake. Collection of multiple consecutive 24-h urines increases accuracy, but also patient burden. In this narrative review, we discuss current approaches to estimating dietary sodium and potassium intake. Additionally, we explore alternative methods that may improve test accuracy without increasing burden.
Highlights
IntroductionPatients with chronic kidney disease (CKD) are strongly advised to reduce their sodium intake, as sodium-induced increases in blood pressure and proteinuria accelerate CKD progression [1,2,3]
Patients with chronic kidney disease (CKD) are strongly advised to reduce their sodium intake, as sodium-induced increases in blood pressure and proteinuria accelerate CKD progression [1,2,3].dietary sodium intake averages around 4 g (g) per day in developed countries, which is twice the maximum daily intake of 2 g as recommended by the World Health Organization (WHO) [4,5].Reducing sodium consumption has been identified as one of the most cost-effective approaches to lower cardiovascular disease (CVD) incidence and related death [1,6]
The difference in accuracy between estimates of sodium and potassium intake may be explained by the fact that most sodium in Western diets comes from processed foods, which contain sodium in variable amounts, whereas sources of potassium, like fruits, vegetables, nuts and whole grains contain more consistent amounts of potassium
Summary
Patients with chronic kidney disease (CKD) are strongly advised to reduce their sodium intake, as sodium-induced increases in blood pressure and proteinuria accelerate CKD progression [1,2,3]. High potassium intake decreases blood pressure in individuals with hypertension, an effect that may even be strongest at higher levels of sodium consumption [7]. An increasing body of evidence has linked high potassium intake with lower all-cause mortality in CKD populations and a reduced risk for CKD progression and incident CVD [8,9,10]. Inaccurate estimation of sodium or potassium intake may result in incorrect dietary advice and increase the risk for CKD and CVD. In this narrative review, we discuss the value of current approaches to estimating dietary sodium and potassium intake on population scale and on an individual level. We explore alternative methods that may improve test accuracy without increasing patient burden
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