Abstract
Excess sodium intake is a leading but modifiable risk factor for mortality, with implications on hypertension, inflammation, cardiovascular disease, and chronic kidney disease (CKD). This review will focus mainly on the limitations of current measurement methods of sodium balance particularly in patients with CKD who have complex sodium physiology. The suboptimal accuracy of sodium intake and excretion measurement is seemingly more marked with the evolving understanding of tissue (skin and muscle) sodium. Tissue sodium represents an extrarenal influence on sodium homeostasis with demonstrated clinical associations of hypertension and inflammation. Measurement of tissue sodium has been largely unexplored in patients with CKD. Development and adoption of more comprehensive and dynamic assessment of body sodium balance is needed to better understand sodium physiology in the human body and explore therapeutic strategies to improve the clinical outcomes in the CKD population.
Highlights
Excess sodium is associated with increased mortality in patients with chronic kidney disease (CKD)
As sodium excretion progressively decreases with decline in kidney function, individuals with CKD are sensitive to excess sodium in tissues. is review explores current challenges in accurately evaluating sodium intake and excretion in the CKD population
Weight, height, and sex Equations developed from non-CKD populations to estimate 24-hour urinary sodium excretion from spot urine sodium samples in CKD populations
Summary
Excess sodium is associated with increased mortality in patients with chronic kidney disease (CKD). As sodium excretion progressively decreases with decline in kidney function, individuals with CKD are sensitive to excess sodium in tissues. Is review explores current challenges in accurately evaluating sodium intake and excretion in the CKD population. We advocate for a more comprehensive and dynamic assessment of total body sodium balance, with the shift in body sodium paradigm to include an appreciation of tissue (skin and muscle) sodium [1]. Innovative methods are needed to measure tissue sodium in addition to the extracellular component of osmotically active sodium that is conventionally reflected in sodium intake and excretion measurements
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