24-hour Urinary Sodium Excretion Research Articles

Prediction of 24-Hour Urinary Sodium Excretion Using Machine-Learning Algorithms.

Accurate quantification of sodium intake based on self-reported dietary assessments has been a persistent challenge. We aimed to apply machine-learning (ML) algorithms to predict 24-hour urinary sodium excretion from self-reported questionnaire information. We analyzed 3454 participants from the NHS (Nurses' Health Study), NHS-II (Nurses' Health Study II), and HPFS (Health Professionals Follow-Up Study), with repeated measures of 24-hour urinary sodium excretion over 1 year. We used an ensemble approach to predict averaged 24-hour urinary sodium excretion using 36 characteristics. The TOHP-I (Trial of Hypertension Prevention I) was used for the external validation. The final ML algorithms were applied to 167 920 nonhypertensive adults with 30-year follow-up to estimate confounder-adjusted hazard ratio (HR) of incident hypertension for predicted sodium. Averaged 24-hour urinary sodium excretion was better predicted and calibrated with ML compared with the food frequency questionnaire (Spearman correlation coefficient, 0.51 [95% CI, 0.49-0.54] with ML; 0.19 [95% CI, 0.16-0.23] with the food frequency questionnaire; 0.46 [95% CI, 0.42-0.50] in the TOHP-I). However, the prediction heavily depended on body size, and the prediction of energy-adjusted 24-hour sodium excretion was modestly better using ML. ML-predicted sodium was modestly more strongly associated than food frequency questionnaire-based sodium in the NHS-II (HR comparing Q5 versus Q1, 1.48 [95% CI, 1.40-1.56] with ML; 1.04 [95% CI, 0.99-1.08] with the food frequency questionnaire), but no material differences were observed in the NHS or HPFS. The present ML algorithm improved prediction of participants' absolute 24-hour urinary sodium excretion. The present algorithms may be a generalizable approach for predicting absolute sodium intake but do not substantially reduce the bias stemming from measurement error in disease associations.

24-hour urinary sodium and potassium excretions, plasma metabolomic profiles, and cardiometabolic biomarkers in US adults: A cross-sectional study

BackgroundHigh sodium and low potassium intakes are associated with a higher risk of hypertension and cardiovascular disease (CVD), but there are limited data on the circulating metabolomics profiles of 24-hour urinary sodium and potassium excretions in free-living individuals. ObjectivesTo characterize metabolomics signatures of a high-sodium and low-potassium diet in a cross-sectional study. MethodsIn 1,028 healthy older adults from the Women’s and Men’s Lifestyle Validation Studies, we investigated the association of habitual sodium and potassium intakes measured by 2-4 24-hour urine samples with plasma metabolites (quantified using liquid chromatography-tandem mass spectrometry) and metabolomic pathways. Our primary exposures were energy-adjusted 24-hour urinary sodium excretion, potassium excretion, and sodium-to-potassium ratio, calculated based on energy expenditure derived from the Doubly Labelled Water method. Then we assessed the partial correlations of their metabolomics scores, derived from elastic net regressions, with cardiometabolic biomarkers. ResultsHigher sodium excretion was associated with 38 metabolites including higher piperine, phosphatidylethanolamine, and C5:1 carnitine. In pathway analysis, higher sodium excretion was associated with enhanced biotin and propanoate metabolism, and enhanced degradation of lysine and branched-chain amino acids (BCAAs). Metabolites associated with higher potassium and lower sodium-to-potassium ratio included quinic acid and proline-betaine. After adjusting for confounding factors, the metabolomics score for sodium-to-potassium ratio positively correlated with fasting insulin (Spearman's rank correlation coefficient ρ=0.27), C-peptide (ρ=0.30), and triglyceride (ρ=0.46), and negatively with adiponectin (ρ=-0.40), and high-density lipoprotein (HDL) cholesterol (ρ=-0.42). ConclusionsWe discovered metabolites and metabolomics pathways associated with a high-sodium diet, including metabolites related to biotin, propanoate, lysine, and BCAA pathways. The metabolomics signature for a higher sodium-low potassium diet is associated with multiple components of elevated cardiometabolic risk.

Abstract MP09: Population Level 24-Hour Urinary Sodium and Potassium Associations With Blood Pressure Differs by Sex: Findings From the New York City Heart Follow-Up Study 2010 and 2018

Introduction: Hypertension (HTN) is a leading cause of heart disease and stroke amongst New York City (NYC) residents, with notable sex-based disparities in prevalence and cardiovascular (CV) outcomes. While prior 24-hour urinary population-based studies in other populations have shown that the association between sodium and potassium and blood pressure (BP) is primarily driven by hypertensive adults, the studies did not adequately evaluate how these associations may differ by sex. Hypothesis: Our study examined whether the relationship between sodium, potassium, and the sodium/potassium ratio and BP varies significantly by sex assigned at birth, stratified by HTN status, in the NYC population. Methods: The Heart Follow-Up Study (HFUS) is a cross-sectional survey conducted in 2010 and 2018 among NYC residents ages 18 and older. Study data included BP measurements, sodium and potassium urinary analytes, and self-reported information about CV health. Analyses were based on 1,606 and 2,327 participants, respectively, and weighted to the NYC population. HTN was defined as per the National Health and Nutrition Survey criteria: systolic BP≥140, diastolic BP≥90, or current use of HTN medication. We applied t -tests to detect differences in mean age-adjusted electrolyte excretions between hypertensive and normotensive adults, stratified by sex. Furthermore, we used multivariable linear regression models, which included sex as an interaction term, to assess the association between sodium and potassium intake and BP at the two time points, and to evaluate potential effect modifications by sex. Results: In 2018, we observed no substantial difference between the mean age-adjusted 24-hour urinary excretion of sodium, potassium, and sodium/potassium ratio and HTN status among NYC males or females ( p >.05). From multivariable models, we observed a consistent positive association between sodium/potassium ratio and mean BP in normotensive males; the relationship was stronger in 2010 (2.060, 95% CI: 0.865-3.255) compared to 2018 (0.312, 95% CI: 0.101-0.523). However, this association was not evident in normotensive females at both time points. We did not observe a consistent association between sodium, potassium, and sodium/potassium ratio and BP within the HTN group in males or females at either time point. Conclusions: The association between sodium/potassium levels and BP differs by sex. This association was evident exclusively in normotensive males, although we noted that the magnitude of this association was smaller in 2018 than in 2010. This suggests that sodium/potassium excrement may be a stronger indicator for BP variations within this subgroup. Recognizing that sex-based variations exist, our results suggest conducting intra-sex analysis to better understand CV health disparities and develop tailored public health strategies that will reduce adverse CV outcomes.

Sex-Specific Association between Sodium Intake Estimated by 24-Hour Urinary Sodium Excretion and Nonalcoholic Fatty Liver Disease: The Community-Based Prospective Cohort Study.

Evidence for the association between high sodium intake and the onset of nonalcoholic fatty liver disease (NAFLD) is insufficient. This study examined the sex-specific association between sodium intake and the risk of NAFLD. This study included 2582 adults (aged 40-69 years; 1011 males and 1571 females). The total sodium excreted over 24 h was estimated from spot urine specimens using Tanaka's equation. Based on these estimates, participants were categorized into three groups according to their 24-h urinary sodium excretion levels: lowest (T1), middle (T2), and highest (T3). In addition, the participants were divided into non-NAFLD (≤36) and NAFLD (>36) groups based on the hepatic steatosis index. During the follow-up period (14 years), NAFLD was observed in 551 participants. The estimated 24-h urinary sodium excretion levels were positively associated with the incidence of NAFLD in all subjects. Upon sex stratification, females in the T2 and T3 groups exhibited adjusted hazard ratios of 1.35 and 1.51, respectively, compared with the T1 group. However, a significant relationship was not observed in males. High intake of sodium, especially among females, may be an important factor contributing to the development of NAFLD. Individuals with high sodium intake should be appropriately counselled and monitored for the risk of NAFLD.

Evaluation of three prediction formulas of 24-hour urinary sodium excretion in Chinese residents: a systematic review and meta-analysis.

To determine the appropriateness of three widely used formulas estimating 24-h urinary Na (24hUNa) from spot urine samples in the Chinese population. Systematic review and meta-analysis. Literature review was conducted to identify studies for estimating 24hUNa using the Kawasaki, Tanaka and INTERSALT formulas simultaneously in PubMed, Embase and the Cochrane library databases. The mean difference (MD) and correlation coefficients (r) between measures and estimates from different formulas were assessed. Information extraction and quality assessment were performed in thirteen studies involving 8369 subjects. Two studies which affected the overall robustness were excluded in the 'leave-one-out' sensitivity analyses. Within the final meta-analysis included eleven studies and 7197 participants, 36·07 mmol/d (95 %CI 16·89, 55·25) of MD was observed in the Kawasaki formula, and -19·62 mmol/d (95 %CI -37·37, -1·87) in the Tanaka formula and -35·78 mmol/d (95 %CI -50·76, -20·80) in the INTERSALT formula; a pooled r-Fisher's Z of 0·39 (95 %CI 0·32, 0·45) in the Kawasaki formula, 0·43 (95 %CI 0·37, 0·49) in the Tanaka formula and 0·36 (95 %CI 0·31, 0·42) in the INTERSALT formula. Subgroup analyses were conducted to explore the possible factors affecting the accuracy of the formula estimation from three mainly aspects: population types, Na intake levels and urine specimen types. The meta-analysis suggested that the Tanaka formula performed a more accurate estimate in Chinese population. Time of collecting spot urine specimens and Na intake level of the sample population might be the main factors affecting the accuracy of the formula estimation.

Estimation of 24-hour urinary sodium and potassium excretion among Chinese adults: a cross-sectional study from the China National Nutrition Survey

BackgroundHigh-sodium intake is one of the most important risk factors for hypertension and cardiovascular disease, yet reliable national estimates of sodium intake in Chinese adults have not been reported. ObjectivesWe estimated 24-h urinary sodium and potassium excretion and population daily sodium and potassium intake of Chinese adults for the first time at a national level. MethodsA nationally representative cross-sectional survey was conducted to collect 24-h urine specimens from Chinese adults aged ≥18 y as part of the China National Nutrition Survey 2015. Finally, 10,114 participants (4932 males and 5182 females) with complete 24-h urine specimens were included in the analysis. Estimates of mean urinary electrolyte excretion and demographic, socioeconomic, and health characteristics were used with weighted coefficients that accounted for sample selection probabilities, poststratification weighting, and nonresponse rates. ResultsThe estimation of overall weighted mean 24-h urinary sodium excretion was 4121 mg (95% confidence interval [CI]: 3993, 4250), 4155 mg (95% CI: 3993, 4317) in males and 4081 mg (95% CI: 3953, 4209) in females (P for sex difference = 0.36). Overall mean 24-h urinary potassium excretion was 1534 mg (95% CI: 1492, 1577), 1468 mg (95% CI: 1424, 1513) in males and 1614 mg (95% CI: 1569–1660) in females (P for sex difference <0.001). Mean 24-h urinary sodium excretion was significantly higher in rural adults (4350 mg; 95% CI: 4217, 4483) than in urban residents (3909 mg; 95% CI: 3739, 4080; P < 0.001), and in northern residents (4388 mg; 95% CI: 4237, 4539) than in southern residents (3998 mg; 95% CI: 3832, 4163; P = 0.002). ConclusionsThe first nationwide survey with 24-h urine collection confirmed that mean sodium intake in Chinese adults was more than twice the upper limit, whereas mean potassium intake was <60% of the lower limit, recommended by the World Health Organization. Urgent measures should be taken to reduce sodium intake and increase potassium intake in China.

24-hour urine sodium excretion among renal donors in India: a cross-sectional study

24-hour urine sodium excretion among renal donors in India: a cross-sectional study

Calcitriol reverses age-related hypertension via downregulating renal AP1/AT1R pathway through regulating mitochondrial function

ABSTRACT Background The vitamin D level in the blood is associated with the incidence of hypertension. The present study investigated whether or not calcitriol, an active form of vitamin D, reverses age-related hypertension. Methods Young (3-month-old) and aged (12-month-old) C57BL/6 male mice were administered with or without calcitriol at 150 ng/kg per day by oral gavage for 8 weeks. Blood pressure was measured by tail-cuff plethysmography and telemetry, and superoxide production in renal tissue was assessed by fluorescence imaging, and the protein expression of AP1/AT1R signaling pathway was examined by Western blot. Results We showed that 24-hour renal sodium excretion was impaired and blood pressure was increased in aged mice, which was related to the enhancement of renal AT1R expression and function. In addition, the expression of transcription factor AP1 (a dimer of c-Fos and c-Jun) and the binding of AP1 to the AT1R promoter region was significantly enhanced, accompanied by decreased nuclear translocation of Nrf2, abnormal mitochondrial function including decreased ATP production, NAD+/NADH ratio and mtDNA copy numbers, and increased reactive oxygen species. Calcitriol increased 24-hour urinary sodium excretion and reduced blood pressure in aged mice. Mechanically, calcitriol increased the nuclear translocation of Nrf2, improved mitochondrial function, reduced AP1 binding ability to AT1R promoter, which reversed enhanced AT1R expression and function, and lowered blood pressure in aged mice. Conclusions Our findings indicated that calcitriol reversed age-related hypertension via downregulating renal AP1/AT1R pathway through regulating mitochondrial function. Thus, calcitriol may be a valuable therapeutic strategy for age-related hypertension.

Sodium and potassium consumption in Jamaica: National estimates and associated factors from the Jamaica Health and Lifestyle Survey 2016-2017.

This study aimed to estimate dietary sodium and potassium consumption among Jamaicans and evaluate associations with sociodemographic and clinical characteristics. A cross-sectional study was conducted using data from the Jamaica Health and Lifestyle Survey 2016-2017. Participants were noninstitutionalized Jamaicans aged ≥15 years. Trained staff collected sociodemographic and health data via interviewer-administered questionnaires and spot urine samples. The Pan American Health Organization formula was used to estimate 24-hour urine sodium and potassium excretion. High sodium level was defined as ≥2000 mg/day, and low potassium levels as <3510 mg/day (World Health Organization criteria). Associations between these outcomes and sociodemographic and clinical characteristics were explored using multivariable ANOVA models using log-transformed 24-hour urine sodium and potassium as outcome variables. Analyses included 1009 participants (368 males, 641 females; mean age 48.5 years). The mean sodium excretion was 3582 mg/day (males 3943 mg/day, females 3245 mg/day, P < .001). The mean potassium excretion was 2052 mg/day (males, 2210 mg/day; females, 1904 mg/day; P = .001). The prevalence of high sodium consumption was 66.6% (males 72.8%, females 60.7%, P < .001) and that of low potassium intake was 88.8% (85.1% males, 92.3% females, P < .001). Sodium consumption was inversely associated with older age, higher education, and low glomerular filtration rate but was directly associated with being male, current smoking, and obesity. Overall, males had higher sodium consumption than women, with the effect being larger among hypertensive men. Women with hypertension had lower sodium consumption than nonhypertensive women; however, hypertensive men had higher sodium consumption than nonhypertensive men. Potassium consumption was higher among men, persons with obesity, and those with high total cholesterol but was lower among men with "more than high school" education compared to men with "less than high school" education. We conclude that most Jamaican adults have diets high in sodium and low in potassium. In this study, sodium consumption was directly associated with male sex, obesity, and current smoking but was inversely associated with older age and higher education. High potassium consumption was associated with obesity and high cholesterol levels. These associations should be further explored in longitudinal studies and population-based strategies should be developed to address these cardiovascular risk factors.

Reducing the Sodium Intake of Patients With Chronic Kidney Disease Through Education and Estimating Salt Excretion: A Propensity Score Matching Analysis.

Japanese people traditionally consume high quantities of salt. This study aimed to investigate the effects of educating patients with chronic kidney disease (CKD) on simple methods for reducing their daily dietary salt intake. This single-center, retrospective observational study included 115 outpatients with CKD at Kawashima Hospital (Tokushima, Japan). One physicianroutinely recommended that patients should reduce their salt intake and provided tips for salt restriction. The physician estimated the patients' daily salt intake using spot urine samples at each medical examination (education group; n = 61). The other physicians' outpatients only received dietary guidance on recommended salt intake (control group; n = 54). The estimated 24-hour urinary sodium excretion (24hUNaV) and 24-hour potassium excretion (24hUKV) were calculated using Tanaka's equation. Estimated 24hUNaV was positively correlated with body mass index (BMI), estimated 24hUKV, and urinary Na/K ratio. The patients in the education group were younger and had a lower BMI, higher estimated glomerular filtration rate, and lower systolic blood pressure (SBP). Using 38 pairs of patients obtained by propensity score matching with these variables, estimated 24hUNaV, estimated 24hUKV, and diastolic blood pressure (DBP) after one year were significantly reduced in the education group. A simple salt reduction education may reduce salt intake in outpatients with CKD.

The effects of renal dopaminergic system on the development of hypertension with high salt diet and L-NNA administration

Objective: We aimed to investigate the intrarenal dopamine synthesis efficiency, blood pressure changes and the effects of this system on hypertension developed by NOS inhibition and high salt diet. Method: Wistar Albino male rats were administered water containing 50mg/L or 100mg/L concentrations of L-NNA, standard rat feed containing 0.8%salt, or 4%high salt alone or with L-NNA for 7days. Blood pressure measurements were made with the tail-cuff method. 24-hour water intake and urine volume were also measured. Results: Administration of L-NNA or high-salt diet alone for 7days did not cause a change in blood pressure, while their combined administration resulted in a significant increase in blood pressure. Blood pressures were found to be higher in the L-NNA100+HS group compared to the other groups. While the amount of water intake in 24hours did not change, the amount of 24-hour urine was reduced. 24-hour urinary sodium excretion, sodium clearance and GFR was decreased, and 24-hour urine dopamine concentrations were increased. Conclusion: Co-administration of nitric-oxide inhibitor and high-salt diet failed to prevent renal dopaminergic system blood pressure increase. Despite the increase in dopamine synthesis, intrarenal dopamine activity could not be realized by receptor interaction and it is thought that the increase in blood pressure is caused by the development of renal oxidative stress.

Application of selected biochemical parameters in prediction of acute kidney injury risk at the early stage of burn disease

Introduction and objectiveAcute kidney injury (AKI) is a common, severe complication of burn disease, developing in the first days after a massive thermal injury and worsening the prognosis of patients. Early diagnosis of AKI plays a crucial role in improving health of patients and therapeutic results. Detection of AKI based on the standard parameters of renal function is insufficient due to too late changes in their values. The aim of the study is to evaluate the relationship between the selected non-renal biochemical parameters and the risk of AKI in this group of patients.Material and methodsThe prospective study involved a group of 33 adult patients (22 men, 11 women) hospitalized after massive burns. The patients were intensively monitored for the first 7 days after the injury, daily assessing the parameters of renal function. The selected parameters were also measured: platelet count (PLT), sodium (Na), potassium (K), albumin (ALB), aspartate aminotransferase (AST), creatine kinase (CK), arterial blood pH, arterial blood bicarbonate (HCO3-), 24-hour urinary sodium excretion (24hUNa) and fractional excretion of sodium (FENa).ResultsAKI was diagnosed in 15 (45.5%) patients. Statistical differences in the obtained average values of selected parameters between the AKI and non-AKI groups were confirmed. A significant univariate relationship was found between CK, AST and ALB in the blood serum and an increased risk of developing AKI in the following days. However, after adjustment for The Abbreviated Burn Severity Index score, only CK remained significant.ConclusionsThe potential clinical benefit of monitoring AST and ALB in blood serum and especially CK was confirmed. The other routine parameters did not seem to be related to the risk of AKI and require further analysis.

#4412 URINARY SODIUM-TO-POTASSIUM RATIO DOES NOT ACCURATELY REFLECT DIETARY SODIUM-TO-POTASSIUM RATIO

Abstract Background and Aims Low sodium intake is associated with a lower blood pressure and less proteinuria, which are important therapeutic targets in chronic kidney disease. In contrast, a low potassium intake has been associated with higher blood pressure and a higher incidence of chronic kidney disease and cardiovascular events. Counselling of patients regarding their sodium and potassium intake requires accurate estimation of their intake, but 24-hour urinary sodium and potassium excretion can deviate substantially from actual intake. Urinary sodium-to-potassium (Na/K) ratio is a promising alternative as it is less affected by incomplete urine collections and additionally captures both the effect of sodium and potassium. Our study aimed to assess whether the Na/K ratio in 24-hour urine reflects dietary intake more accurately than separate measurement of sodium or potassium in 24-hour urine. Method We performed a post-hoc analysis on data from the long-term sodium balance studies Mars105 and Mars520. Ten healthy participants consumed a diet with a known sodium and potassium content and collected 24-hour urine samples for 105 or 205 days. We calculated the log fold difference between dietary intake and urinary excretion of sodium, potassium and Na/K ratio. A mixed-effects model with a random intercept per subject was used to compare these estimates of accuracy. Subsequently, we performed a subgroup analysis per salt intake level (i.e. 6, 9 or 12 grams per day) and assessed the effect of increasing the number of 24-hour urine collections. Results Overall, the urinary Na/K ratio underestimated dietary Na/K ratio with a median difference of -0.21 (IQR -0.47 to 0.09). Estimation of dietary Na/K ratio intake using the urinary Na/K ratio was significantly less accurate compared to using urinary sodium or potassium measurement for estimation of sodium or potassium intake (Figure 1A). Only during a salt intake of 6 grams per day, the urinary Na/K ratio did not perform significantly worse than sodium measurements. Although increasing the number of 24-hour urine measurements to three or seven improved the accuracy of the urinary Na/K ratio, it remained inferior to separate assessment of urinary sodium and potassium excretion (Figure 1B). Conclusion The 24-hour urinary Na/K ratio is less accurate than 24-hour urinary sodium or potassium excretion for estimation of dietary intake in a controlled setting in healthy volunteers.

#4949 COMBINED ORAL DIURETICS: A BETTER ALTERNATIVE FOR NEPHROTIC EDEMA THAN INTRAVENOUS FUROSEMIDE?

Abstract Background and Aims Edema is a serious complication of nephrotic syndrome and is the main reason why patients usually address to a doctor. There is no guideline on managing nephrotic edema. Besides non pharmacological interventions such as sodium and water restrictions, most doctors would choose high doses of intravenous furosemide as the first option, but still many patients fail to properly decrease their volume overload, as they become diuretic resistant. Amiloride, an ENaC mediated diuretic, is an optimistic management option, especially when used with other diuretics. The aim of the present study was to assess the non inferiority of the combined oral diuretics furosemide and the fixed combination of hydrochlorothiazide/amiloride diuretics with intravenous furosemide in diuretic resistant nephrotic edema. Method We conducted a prospective randomized trial in 22 patients with diuretic resistant nephrotic edema. Based on a computer-generated randomization we assigned patients to receive either intravenous furosemide (40 mg bolus and then continuous administration of 5 mg/h) or oral furosemide (40 mg/day) and hydrochlorothiazide/amiloride (50/5 mg/day). Clinical and laboratory measurements were performed daily, for five days (body weight, urinary output, blood pressure and hydration status by bioimpedance twice, creatinine, urea, albumin, hematocrit, Na, K, Ca, Mg, bicarbonate, pH). The primary outcome was weight and hydration status change from baseline to day 5. Secondary outcomes were safety outcomes (low blood pressure, severe dyselectrolytemia, acute kidney injury or aggravated hypervolemia). Results The patients were equally distributed between the two groups. Mean age was 47,77±15,97 (54,5% females and 45,5% males). Half of the patients had membranous nephropathy (45,5%), followed by minimal change disease (22,7%) and lupus nephritis (9,1%). 86,4% of patients had their first episode of nephrotic edema. The mean weight decrease was of significantly larger magnitude in the combined oral diuretics group compared with the intravenous furosemide group (-7,97±2,83 [SD] vs -4,5±2,6 [SD] kg; p = 0,018). Although the increase in 24-hour urine sodium excretion was higher in combined oral diuretics as compared to intravenous furosemide group, this increment was not statistically significant different (26,79±33,48 [SD] vs 16,04±42,81 mmol/24 h [SD]; p = 0,5). Mean values for changes in systolic and diastolic BP, 24-hour urine volume, hydration status measured by bioimpedance were not significantly different between the two groups. A total of 5 patients could not be followed through, 4 in the intravenous furosemide (two patients experienced low blood, one patient had no response to iv furosemide and one patient suffered from insomnia due to iv pump) and one patient in the oral combination of diuretics group had severe hyperkalemia (&amp;gt;6,5 mmol/l). Conclusion Combined oral diuretics with furosemide, amiloride and hydrochlorothiazide is more effective and safer than intravenous furosemide for the treatment of refractory nephrotic edema. These results make amiloride a promising diuretic and further trials with larger sample sizes and longer follow-up are needed in this regard.

URINE SODIUM-TO-POTASSIUM RATIO DOES NOT ACCURATELY REFLECT DIETARY SODIUM-TO-POTASSIUM RATIO

Objective: High sodium intake is associated with an increased risk of cardiovascular disease, whereas a high potassium intake is associated with a reduced risk. Dietary counselling requires accurate estimation of sodium and potassium intake, but 24-hour urine sodium and potassium excretion demonstrated not to reflect actual intake. Urine sodium-to-potassium (Na/K) ratio is a promising alternative as it may be less affected by aldosterone-induced rhythmic changes in total body sodium and potassium content, is less influenced by incomplete urine collections, and incorporates both the effect of sodium and potassium. Our study assesses whether 24-hour urine Na/K ratio is superior in predicting dietary intake compared to 24-hour urine sodium or potassium excretion. Design and method: A post-hoc analysis was performed on data from the long-term sodium balance studies Mars105 and Mars520. Ten healthy participants received a diet with a known sodium and potassium content and collected 24-hour urine samples for 105 or 205 days. We calculated the log fold difference between dietary intake and urine content of sodium, potassium and Na/K ratio. We compared these estimates of accuracy using a mixed-effects model with a random intercept per subject. We analysed whether the accuracy differed among 6, 9 and 12 grams salt intake or was affected by the number of 24-hour urine collections. Results: Urine Na/K ratio underestimated dietary Na/K ratio with a median difference of -0.21 (IQR -0.47 to 0.09). Compared to sodium and potassium assessment, the Na/K ratio was significantly less accurate in predicting intake (Figure 1A). Only for the 6 gram salt phase the Na/K ratio did not perform significantly worse than sodium measurements. Increasing the number of 24-hour urine measurements to three or seven improved accuracy of the Na/K ratio, although it remained inferior to separate assessment of sodium and potassium excretion (Figure 1B). Conclusions: The 24-hour urine Na/K ratio is less accurate than 24-hour urine sodium excretion for estimation of dietary intake in a controlled setting.

Comparison of Urinary Sodium and Potassium Excretion between Hypertensive and Normotensive Individuals

Background: Sodium and potassium intake is known to be a modifiable determinant of hypertension. Also, daily intake of these electrolytes is subject to much geographical and ethnic variation. The impact of sodium and potassium intake on blood pressure in Bangladeshi subjects in incompletely known. Our objective was to determine the relationship between urinary sodium and potassium excretion, and blood pressure in Bangladeshi subjects. Methods: Patients attending the Outpatient Department of the Department of Cardiology, SSMC &amp; MH, who fulfilled the inclusion and exclusion criteria, were taken as study sample. Hypertensive individuals were considered as group 1 and apparently healthy individuals who did not have hypertension were considered as group 2 for the study. Estimates of 24-hour sodium and potassium excretion were made from a single spot urine specimen and were used as surrogates for intake. We assessed the relationship between sodium and potassium excretion and blood pressure. Results: The spot urinary sodium excretion was significantly higher in hypertensive group than in normotensive group (98.03 ± 71.13 mmol/L vs. 77.11 ± 41.71 mmol/L) (p=0.011). On the other hand, the spot urinary potassium excretion was lower in hypertensive group than normotensive group (33.95 ± 41.03 mmol/L vs. 39.43 ± 31.47 mmol/L), but the differences did not reach statistical significance (p=0.679). The estimated 24-hour urinary sodium excretion was higher in hypertensive group than in normotensive group (8.84 ± 3.57 gm vs. 7.67 ± 3.16 gm) and the difference was statistically significant (p = 0.015). Estimated 24-hour urinary potassium excretion was lower in hypertensive group (4.15 ± 1.37 gm) than in normotensive group (4.48 ± 1.56 gm), but the difference between 2 values did not reach statistical significance (p=0.114). Conclusion: Compared to the normotensive counterparts, sodium intake is significantly higher and potassium intake is lower in hypertensive Bangladeshi subjects. Cardiovasc j 2023; 15(2): 118-123

Estimated 24-Hour urinary sodium and potassium excretion in adults in the Northwest Region of Morocco, 2017

BackgroundExcessive sodium (Na) and insufficient potassium (K) intake contribute to a high risk of cardiovascular events. Morocco lacks data on actual Na and K intake in adults. We estimated mean Na and K intake in a Moroccan population of adults residing in the Northwest region using 24-h urinary excretion and examined their association with blood pressure (BP).MethodsA total of 371 adults from this region, who were recruited for the STEPs Survey Morocco 2017, completed demographic, anthropometric as well as BP data and provided a valid 24-h urine collection according to the standard World Health Organization (WHO) protocol. Multiple Linear Regression analysis was used to examine the association between 24-h urinary sodium (24-hUNa) and 24-h potassium excretion (24-hUK) with BP.ResultsMean Na excretion was 2794 mg/day and mean K excretion was 1898 mg/day. Overall, only 114 (30.7%) adults met the WHO recommendation for Na intake (< 2000 mg/d) and 31 (8.4%) met the adequate level for K intake (⩾3510 mg/d). There was no association between 24-hUNa and 24-hUK with BP (P > 0.05 for all).ConclusionNa intake was higher and K intake was lower than WHO recommendations in the study population. There was no association between estimated Na and K intake levels with BP in this population.

Impact of urinary sodium excretion on the prevalence and incidence of metabolic syndrome: a population-based study

ObjectiveTo evaluate the association of metabolic syndrome (MetS) risk with 24-hour urinary sodium excretion (24hUNaE) estimated from spot urine samples.DesignSerial cross-sectional studies were conducted, and those with multiple repeated examinations...

MP03-09 PHENOTYPING NOCTURIA IN HYPERTENSIVES ACCORDING TO 24-HOUR URINE COMPOSITION

You have accessJournal of UrologyCME1 Apr 2023MP03-09 PHENOTYPING NOCTURIA IN HYPERTENSIVES ACCORDING TO 24-HOUR URINE COMPOSITION Joseph Boroda, Susan Gong, Frederick Okoye, Syed Rahman, Matthew Moy, Alla Akivis, Jason Lazar, and Jeffrey Weiss Joseph BorodaJoseph Boroda More articles by this author , Susan GongSusan Gong More articles by this author , Frederick OkoyeFrederick Okoye More articles by this author , Syed RahmanSyed Rahman More articles by this author , Matthew MoyMatthew Moy More articles by this author , Alla AkivisAlla Akivis More articles by this author , Jason LazarJason Lazar More articles by this author , and Jeffrey WeissJeffrey Weiss More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003214.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are numerous comorbidities correlated with nocturia, among the most clinically significant of these being hypertension. Elevation in blood pressure (BP) suppresses serum arginine vasopressin levels, lending evidence to the idea that hypertension is associated pathophysiologically with nocturnal polyuria, which may cause nocturia. Greater nighttime BP and lower nocturnal BP dipping have been associated with more frequent nocturnal voiding. The aim of this study is to assess the impact of non-dipping orthostatic BP in hypertensives on nighttime and daytime urine production. METHODS: Participants with a diagnosis of essential hypertension had in-office supine and standing BP recordings and completed 24-hour urine collection and voiding diaries. Urine was collected in 3 containers; one for the first nighttime void, a second for all subsequent nighttime voids and first morning void, and a third for all daytime voids. Participants whose systolic BP decreased with supine positioning were placed in the orthostatic dip group, and participants whose systolic BP increased or was unchanged upon supine positioning were placed in the no orthostatic dip group. RESULTS: There were 12 (9 female) individuals in the dipping group and 19 (13 female) in the non-dipping group. The non-dipping group tended to produce greater volumes of urine both day and night, and had greater 24-hour urine sodium excretion. The sodium concentration of the first nighttime void was significantly higher in the non-dipping group (median: 102; IQR: 76-105 mEq/L) than the dipping group (median: 51; IQR: 32.5 - 65 mEq/L) (p=.024). This urine sodium concentration for the remainder of the night was significantly higher in the non-dipping group (median: 92; IQR: 62-117 mEq/L) than the dipping group (median: 59.5; IQR: 48-77.25 mEq/L) (p=.012). Subjects in the non-dipping group were 79% more likely to experience 2 or more nighttime voids compared to the dipping group (RR: 1.79; 95% CI: 1 – 3.2; p=.052). CONCLUSIONS: An in-office BP measurement that does not dip with supine positioning is associated with more frequent nighttime voiding as well as higher urine concentrations of sodium in both early and late-night voids. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e24 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Boroda More articles by this author Susan Gong More articles by this author Frederick Okoye More articles by this author Syed Rahman More articles by this author Matthew Moy More articles by this author Alla Akivis More articles by this author Jason Lazar More articles by this author Jeffrey Weiss More articles by this author Expand All Advertisement PDF downloadLoading ...

Assault on salt Intake

Assault on salt Intake