Higher Sodium Excretion Research Articles

24-h urinary sodium and potassium excretions, plasma metabolomic profiles, and cardiometabolic biomarkers in the United States adults: a cross-sectional study

BackgroundHigh-sodium and low-potassium intakes are associated with a higher risk of hypertension and cardiovascular disease, but there are limited data on the circulating metabolomics profiles of 24-h urinary sodium and potassium excretions in free-living individuals. ObjectivesWe aimed to characterize the metabolomics signatures of a high-sodium and low-potassium diet in a cross-sectional study. MethodsIn 1028 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 to 4 24-h urine samples with plasma metabolites (quantified using liquid chromatography-tandem mass spectrometry) and metabolomic pathways. Our primary exposures were energy-adjusted 24-h urinary sodium excretion, potassium excretion, and sodium-to-potassium ratio, calculated based on energy expenditure derived from the doubly labeled water method. We then 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 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.

Blood pressure variability in acute stroke: Risk factors and association with functional outcomes at 1 month.

Blood pressure variability, in acute stroke, may be an important modifiable determinant of functional outcome after stroke. In a large international cohort of participants with acute stroke, it was sought to determine the association of blood pressure variability (in the early period of admission) and functional outcomes, and to explore risk factors for increased blood pressure variability. INTERSTROKE is an international case-control study of risk factors for first acute stroke. Blood pressure was recorded at the time of admission, the morning after admission and the time of interview in cases (median time from admission 36.7 h). Multivariable ordinal regression analysis was employed to determine the association of blood pressure variability (standard deviation [SD] and coefficient of variance) with modified Rankin score at 1-month follow-up, and logistic regression was used to identify risk factors for blood pressure variability. Amongst 13,206 participants, the mean age was 62.19 ± 13.58 years. When measured by SD, both systolic blood pressure variability (odds ratio 1.13; 95% confidence interval 1.03-1.24 for SD ≥20 mmHg) and diastolic blood pressure variability (odds ratio 1.15; 95% confidence interval 1.04-1.26 for SD ≥10 mmHg) were associated with a significant increase in the odds of poor functional outcome. The highest coefficient of variance category was not associated with a significant increase in risk of higher modified Rankin score at 1 month. Increasing age, female sex, high body mass index, history of hypertension, alcohol use, and high urinary potassium and low urinary sodium excretion were associated with increased blood pressure variability. Increased blood pressure variability in acute stroke, measured by SD, is associated with an increased risk of poor functional outcome at 1 month. Potentially modifiable risk factors for increased blood pressure variability include low urinary sodium excretion.

Association between sodium-to-potassium ratio in spot urine and hospitalization due to heart failure in high-risk Japanese patients

BackgroundIn Japanese cardiovascular (CV) high-risk patients, the ESPRIT (Evaluation of Sodium Intake for the Prediction of Cardiovascular Events in Japanese High-risk Patients) study showed that high sodium excretion (≥4.0 g/day) was associated with a composite CV events of heart failure (HF) hospitalization, acute coronary syndrome, cerebrovascular events, and CV deaths. In this context, the sodium-to-creatinine (Na/Cr) ratio in spot urine was found to be significantly associated with HF hospitalizations. Since a stable potassium balance plays a particularly relevant role for CV patients, this post-hoc study was designed to investigate the extent to which consideration of the sodium-to-potassium (Na/K) ratio represents a better predictor of HF hospitalizations in the ESPRIT study population. MethodsThis is a post-hoc analysis of a previously reported ESPRIT study (n = 520, 60 HF hospitalizations). ResultsReceiver operating curve analysis yielded optimal Na/K ratio cut-off value of 2.9 for detecting HF hospitalization. Kaplan–Meier curve showed that high Na/K ratio in spot urine was associated with increased HF hospitalization (p < 0.001). Cox proportional hazards model analysis revealed that high Na/K ratio was associated with HF hospitalization with a hazard ratio of 2.97 (confidence interval: 1.67–5.61). An association between high Na/K ratio and HF hospitalization remained after adjustments for Na/Cr ratio in spot urine or the use of diuretics. ConclusionThe Na/K ratio in spot urine is associated with HF hospitalization in high-risk Japanese patients.

Renal transplant hastalarında idrar sodyum atılımının metabolik sendrom, hipertansiyon ve greft fonksiyonu ile ilişkisinin değerlendirilmesi

Aim: To evaluate the relationship between high sodium intake determined by spot urinary sodium excretion with metabolic syndrome, hypertension, and graft function in renal transplant (RT) recipients.&#x0D; Materials and methods: 152 RT recipients were enrolled. The demographic characteristics, office blood pressure (BP) values, height, weight, body mass index, waist and hip measurements, immunesuppressive drugs, other medications and biochemical parameters of the patients were recorded. Spot urinary sodium and spot urinary protein excretions were measured in the first morning urine in all the RT recipients. The patients were grouped as low sodium excretion (≤57) and high sodium excretion (≥58) based on the median value of 57 in spot urinary sodium.&#x0D; Results: In the low sodium group; creatinine values were found to be significantly lower (p

PS-C35-5: URINARY SODIUM EXCRETION AND THE RISK OF CARDIOVASCULAR DISEASE: A COMMUNITY-BASED COHORT STUDY IN TAIWAN

Urinary sodium excretion is a potential risk factor for cardiovascular diseases (CVD). However, the underlying biological mechanisms and effects of salt sensitivity are unclear. The purpose of this study was to characterize the relative contribution of biological factors to the sodium-CVD association. A total of 2112 participants were enrolled in this study. Structured questionnaires and blood and urine samples were obtained. Twenty-four-hour sodium excretion was estimated using a single overnight urine sample. Hypertension, metabolic syndrome, and overweight status were considered to indicate salt sensitivity. Cox proportional hazard models were used to investigate the effects of salt sensitivity on urinary sodium excretion and CVD risk. The traditional mediation approach was used to calculate the proportion of mediation. The mean age (standard deviation) of the 2112 participants was 54.5 (12.2) years, and they were followed up for a mean of 14.1 [8.1] years. Compared with those in the lowest quartile, the highest baseline urinary sodium excretion (&gt; 4.2 g/24 hours) was associated with a 43% higher CVD risk (hazard ratio, 1.43; 95% confidence interval, 1.02–1.99). Participants with high urinary sodium excretion, hypertension, or metabolic syndrome had a significantly high risk of CVD. The carotid intima-media thickness had the largest mediating effect (accounting for 35% of the sodium-CVD association), followed by systolic blood pressure (33%), left ventricular mass (28%), and diastolic blood pressure (14%). Higher urinary sodium excretion increased the risk of CVD, which was explained largely by carotid media-thickness and systolic blood pressure.

The Severity of Obesity Promotes Greater Dehydration in Children: Preliminary Results.

The state of hydration of the body depends on the balance between the amount of water and salt consumed and excreted (the urinary extraction of excess sodium requires water). Inappropriate nutrition, particularly consuming too much processed food, causes obesity in children and additionally causes excessive sodium consumption, thus increasing the risk of excessive water loss. The aim of this study was to assess the hydration status of children with obesity and the relation between hydration, body composition, urinary sodium extraction, and nutrient intake. The study group consisted of 27 patients with obesity, with a mean age of 12.89 ± SD 2.79. Each patient's height, weight, body composition (electrical bioimpedance (BIA)), diet (7-day record), and biochemical tests were assessed. The hydration status was assessed using 24-hour urine collection, 24-hour urine osmolality, and an ultrasound of the vena cava (IVC/Ao index). Overall, 55% of children (n = 15) had urine osmolality values above 800 mOsm/kgH2O, which indicates significant dehydration, and 53% (n = 14) were dehydrated, based on the IVC/Ao index. Children with obesity and dehydration had a significantly higher BMI (31.79 vs. 27.32; p = 0.0228), fat mass percentage (37.23% vs. 30.07% p = 0.0051), and fat mass in kg (30.89 vs. 20.55; p = 0.0158), and significantly higher sodium intake from their diet (3390.0 mg vs. 2921.0 mg; p = 0.0230), as well as their sodium/potassium ratio (2.4 vs. 2.0; p = 0.0043). The 24-hour urinary sodium excretion and osmolality values were directly related to fat-mass percentage and fat-mass (in kg) in a simple linear correlation analysis. Our preliminary results confirm that obesity is related to dehydration. The overall high sodium excretion in children with obesity indicates an excessive salt intake along with low potassium intake, which is a significant predictor of dehydration, regardless of the total water intake (TWI).

ODP270 Prevalence of Primary Hyperaldosteronism in Patients with Resistant Hypertension - An Outpatient Cross-Sectional Clinic-Based Study

Abstract Background Primary hyperaldosteronism is the non-suppressible over secretion of aldosterone caused either by an adenoma or bilateral adrenal hyperplasia. Although its reported prevalence is 8-10% in recent studies, intraindividual variability for aldosterone levels poses diagnostic challenges during the screening of these patients. In this study, we aim to assess the prevalence of primary hyperaldosteronism in patients presenting with drug-resistant hypertension, with or without hypokalemia, at a general endocrinology practice with an emphasis on the variability of renin and aldosterone levels in the screening tests used to detect primary hyperaldosteronism. Method: We included participants presenting at our outpatient clinic from June 2020 until January 2022 with blood pressure&amp;gt;140/90mm Hg despite the use of three antihypertensive medications including a diuretic. The screening tests used were morning (8-9 AM) plasma aldosterone concentration (PAC) and plasma renin (PR) level. Aldosterone was measured using L iquid Chromatography-Tandem Mass Spectrometry assay determined by Mayo Clinic. The screening was considered positive when PAC was&amp;gt;10 ng/dL (277 pmol/l) and PR was &amp;lt;1 ng/ml/hr. The tests were repeated if PAC was between 5-10 ng/dL and PR was between 1-2 ng/ml/hr without any medication changes. If the repeat PR was &amp;gt;2 ng/ml/hr, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were stopped and changed to calcium channel blockers, and the patient was tested again after 2 weeks. Positive results were further tested with 24-hour urinary aldosterone excretion during high dietary salt ingestion with 24-hour urine sodium and creatinine. Primary hyperaldosteronism was confirmed if plasma renin activity was &amp;lt;1. 0 ng/mL per hour and urinary aldosterone was &amp;gt;12 mcg/24-hour during high urinary sodium excretion (&amp;gt;200 mEq/24-hour). Results We studied a total of 138 patients during this study period. Mean age was 58.7 years and BMI 33.7 kg/m 2, out of which 95 participants had type 2 diabetes mellitus, 7 had obstructive sleep apnea, and 20 had chronic kidney disease stage 3 or higher. We found 3 patients were positive on screening tests and two patients were confirmed to have primary hyperaldosteronism, making prevalence 2/138(1.45%). Conclusion Hyperaldosteronism is the most common cause of secondary hypertension, especially resistant hypertension. Repeat testing of aldosterone levels with intraindividual variability can be very challenging, and time-consuming resulting in repeated follow-up visits and multiple communications with providers posing challenges for effective care coordination, and financial burden on patients. Further large-scale studies are recommended to re-analyze the protocols for screening hyperaldosteronism and treatment initiation without extensive confirmatorytesting. We also suggest health care providers emphasize on effective management of other secondary causes of hypertension such as obesity and Metabolic Syndrome with diabetes for a greater impact on blood pressure control on these patients. Presentation: No date and time listed

Nephrogenic syndrome of inappropriate antidiuresis – a case report in pediatric age

Syndrome of inappropriate antidiuresis (SIAD) results in hyponatremia, low plasma osmolality, euvolemia and inappropriately concentrated urine with high sodium excretion. In most cases, there is an inappropriate secretion of arginine vasopressin (AVP); however, in a minority of cases, there is a gain-of-function mutation in the AVP receptor 2 -nephrogenic SIAD

Urinary Sodium Excretion Enhances the Effect of Alcohol on Blood Pressure.

Alcohol consumption is linked to urinary sodium excretion and both of these traits are linked to hypertension and cardiovascular diseases (CVDs). The interplay between alcohol consumption and sodium on hypertension, and cardiovascular diseases (CVDs) is not well-described. Here, we used genetically predicted alcohol consumption and explored the relationships between alcohol consumption, urinary sodium, hypertension, and CVDs. Methods: We performed a comparative analysis among 295,189 participants from the prospective cohort of the UK Biobank (baseline data collected between 2006 and 2010). We created a genetic risk score (GRS) using 105 published genetic variants in Europeans that were associated with alcohol consumption. We explored the relationships between GRS, alcohol consumption, urinary sodium, blood pressure traits, and incident CVD. We used linear and logistic regression and Cox proportional hazards (PH) models and Mendelian randomization in our analysis. Results: The median follow-up time for composite CVD and stroke were 6.1 years and 7.1 years respectively. Our analyses showed that high alcohol consumption is linked to low urinary sodium excretion. Our results showed that high alcohol GRS was associated with high blood pressure and higher risk of stroke and supported an interaction effect between alcohol GRS and urinary sodium on stage 2 hypertension (Pinteraction = 0.03) and CVD (Pinteraction = 0.03), i.e., in the presence of high urinary sodium excretion, the effect of alcohol GRS on blood pressure may be enhanced. Conclusions: Our results show that urinary sodium excretion may offset the risk posed by genetic risk of alcohol consumption.

Study on the Correlation between Urinary Sodium and Potassium Excretion and Blood Pressure in Adult Hypertensive Inpatients of Different Sexes

Objective This study aims to understand the difference in the influence of urinary sodium and potassium excretion on blood pressure in patients of different sexes with hypertension by analyzing the relationship between urinary sodium and potassium excretion and blood pressure. Methods In this cross-sectional study, 606 hospitalized patients with essential hypertension were recruited from 16 hospitals in the Shanxi Province between June 2018 and December 2019. These patients were grouped by sex, with 368 males and 238 females. Basic information and relevant serum biochemical indexes of patients in the two groups were recorded. The 24-hour urinary sodium and potassium excretion were measured, and 24-hour ambulatory blood pressure monitoring was performed simultaneously. This was done to analyze and compare the relationship between urinary sodium and urinary potassium excretion and blood pressure in adult hospitalized patients of different sexes with hypertension. Results The 24-hour urinary sodium excretion in male patients with hypertension was significantly higher than that in female patients (P < 0.001). There was no significant difference in 24-hour urinary potassium excretion between male patients with hypertension and female patients. Spearman correlation analysis showed that 24-hour urinary sodium excretion was positively correlated with 24-hour SBP and nSBP in male patients (P < 0.05), while 24-hour urinary potassium excretion was negatively correlated with 24-hour SBP and nSBP in male patients (P < 0.05). The 24-hour urinary sodium in female patients was significantly positively correlated with 24-hour SBP, 24-hour DBP, SBP, dDBP, nSBP, and nDBP (P < 0.01). The 24-hour urinary potassium was significantly negatively correlated with nSBP (P < 0.05). Multiple stepwise linear regression showed that 24-hour urinary sodium excretion was still significantly positively correlated with 24-hour SBP and nSBP in male patients with hypertension after adjusting for various confounding factors. Conclusion High urinary sodium and low urinary potassium excretion are closely related to elevated blood pressure in adult patients with hypertension, and there are sex differences.

VARIABILITY OF 24-HOUR URINE SODIUM EXCRETION AND LONG-TERM CARDIOVASCULAR AND RENAL OUTCOME

Objective: High sodium intake is an important risk factor for cardiovascular disease, and is often monitored by measuring 24-hour urine sodium excretion. Besides sodium intake, the variability in 24-hour urine sodium excretion has been shown to be mediated by infradian aldosterone and cortisol rhythms. Considering the detrimental cardiovascular and renal effects of aldosterone excess, one may hypothesize that 24-hour urine sodium excretion variability may be associated with long-term cardiovascular and renal disease. Design and method: In a retrospective cohort study, we included adult subjects with an estimated glomerular filtration rate (eGFR) &gt; 60 ml/min/1.73 m2 who collected an outpatient 24-hour urine sample between 1998 and 2000, and had collected at least 6 additional 24-hour urine collections during follow-up. We quantified the proportional variability among 7 consecutive 24-hour sodium excretion measurements by calculating the coefficient of variation (CV). We assessed the association between 24-hour sodium excretion variability and cardiovascular (coronary, cerebrovascular event, ospitalised heart failure or mortality) and renal (60% eGFR reduction, dialysis, kidney transplantation or mortality) outcome, using Cox regression analyses with correction for traditional cardiorenal risk factors. Results: We included 316 subjects with an average age of 44 years and a mean eGFR of 90 ml/min/1.73 m2. 46% were male, 50% had hypertension and 30% had diabetes. Median follow-up was 16.4 years during which 85 cardiovascular and 131 renal endpoints occurred. The CV for 24-hour urine sodium excretion was 8.3% (SD 1.6). Subjects with a high variability in 24-hour sodium excretion were more often female, had less often diabetes and a lower 24-hour urine sodium-to-potassium ratio. High 24-hour urine sodium excretion variability was associated with worse long-term renal outcome (p = 0.03), which was observed in the female subgroup (p = 0.02) but not in males (p = 0.65) (Figure). No linear association was found for cardiovascular outcome (p = 0.89), but the middle tertile was associated with an increased risk (OR 2.29, 95% CI 1.24–4.25). Conclusions: High 24-hour urine sodium excretion variability is associated with an increased risk for long-term renal disease.

24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk

BackgroundThe relation between sodium intake and cardiovascular disease remains controversial, owing in part to inaccurate assessment of sodium intake. Assessing 24-hour urinary excretion over a period of multiple days is considered to be an accurate method.MethodsWe included individual-participant data from six prospective cohorts of generally healthy adults; sodium and potassium excretion was assessed with the use of at least two 24-hour urine samples per participant. The primary outcome was a cardiovascular event (coronary revascularization or fatal or nonfatal myocardial infarction or stroke). We analyzed each cohort using consistent methods and combined the results using a random-effects meta-analysis.ResultsAmong 10,709 participants, who had a mean (±SD) age of 51.5±12.6 years and of whom 54.2% were women, 571 cardiovascular events were ascertained during a median study follow-up of 8.8 years (incidence rate, 5.9 per 1000 person-years). The median 24-hour urinary sodium excretion was 3270 mg (10th to 90th percentile, 2099 to 4899). Higher sodium excretion, lower potassium excretion, and a higher sodium-to-potassium ratio were all associated with a higher cardiovascular risk in analyses that were controlled for confounding factors (P≤0.005 for all comparisons). In analyses that compared quartile 4 of the urinary biomarker (highest) with quartile 1 (lowest), the hazard ratios were 1.60 (95% confidence interval [CI], 1.19 to 2.14) for sodium excretion, 0.69 (95% CI, 0.51 to 0.91) for potassium excretion, and 1.62 (95% CI, 1.25 to 2.10) for the sodium-to-potassium ratio. Each daily increment of 1000 mg in sodium excretion was associated with an 18% increase in cardiovascular risk (hazard ratio, 1.18; 95% CI, 1.08 to 1.29), and each daily increment of 1000 mg in potassium excretion was associated with an 18% decrease in risk (hazard ratio, 0.82; 95% CI, 0.72 to 0.94).ConclusionsHigher sodium and lower potassium intakes, as measured in multiple 24-hour urine samples, were associated in a dose–response manner with a higher cardiovascular risk. These findings may support reducing sodium intake and increasing potassium intake from current levels. (Funded by the American Heart Association and the National Institutes of Health.)

Abstract 10005: Sodium Intake and Risk of Cardiovascular Disease: A Pooled Analysis of Individual Data from Six Cohort Studies with Multiple 24-Hour Urine Collections

Background: The relationship between sodium intake and cardiovascular disease (CVD) remains controversial, in part, due to inaccurate assessment of sodium intake. 24-hour urinary excretion over multiple days is considered the optimal method. Methods: We included individual participant data from 6 prospective cohorts among generally healthy adults with sodium and potassium excretion assessed by at least two 24-hour urine collections. Out of 10,709 participants (54% women; mean [SD] age, 51.5 [12.6] years), 571 incident CVD events (including myocardial infarction, coronary revascularization, and stroke) were ascertained during a median follow-up of 8.8 years. We analyzed each cohort using consistent methods and combined the results using random-effects meta-analysis. Results: Median 24-hour urinary sodium excretion (10 th -90 th percentile) was 3,270 (2,099-4,899) mg. Higher sodium excretion, lower potassium excretion and higher sodium-to-potassium ratio were all associated with higher risk of CVD events after controlling for confounding factors (all P values for trend≤0.02); there was no evidence of nonlinearity. The hazard ratio [HR] comparing top with bottom quartiles was 1.67 [95% confidence interval [CI]: 1.21-2.30] for sodium, 0.77 [0.57-1.02] for potassium and 1.72 [1.27-2.32] for sodium-to-potassium ratio. Each 1,000 mg/d increment in sodium excretion was associated with an 18% increase in CVD risk (95%CI: 5%-32%) and each 1,000 mg/d increment in potassium excretion was associated with 18% lower risk (95%CI: 6%-28%). Conclusions: Higher sodium and lower potassium intakes, measured in multiple 24-hour urine samples, were associated with higher risk of CVD in a dose-response manner. These findings support current recommendations to reduce sodium and increase potassium intakes.

Salt-Sensitive Hypertension of the Renal Tubular Cell-Specific NFAT5 (Nuclear Factor of Activated T-Cells 5) Knockout Mice.

[Figure: see text].

Association of Urinary Sodium Excretion and Left Ventricular Hypertrophy in People With Type 2 Diabetes Mellitus: A Cross-Sectional Study

BackgroundIt has been well documented that left ventricular hypertrophy (LVH) is highly associated with the incidence of cardiovascular disease (CVD). Evidence indicated that high sodium intake was closely related with LVH in general population. However, information is not available regarding the association between urinary sodium excretion and LVH in patients with type 2 diabetes mellitus (T2DM). This study aimed to explore the association between urinary sodium excretion and LVH in patients with T2DM.MethodsThis cross-sectional analysis included baseline data from 1,556 individuals with T2DM enrolled in the NanFang Prospective Diabetes Study (NFPDS). Urinary sodium excretion levels were measured from 24-hour urine samples of inpatients and morning fasting urine samples of outpatients. Left ventricular dimensions were assessed by echocardiography. The associations between urinary sodium excretion and the risks of cardiovascular events, LVH and left ventricular mass index (LVMI) were examined using linear regression analysis, logistic regression and restricted cubic splines (RCS).ResultsUrinary sodium excretion levels were positively associated with cardiometabolic risk factors, including systolic blood pressure, body mass index, waist circumference and LVMI (All P<0.001). Odds ratios of the highest quartile of urinary sodium excretion compared with the lowest quartile were 1.80 (95% CI, 1.28-2.54; P=0.001) for LVH and 1.77 (95% CI, 1.06-2.94; P=0.028) for CVD, after adjusted for demographics, lifestyle risk factors and cardiovascular risk factors. Multivariable-adjusted RCS analysis of the association between urinary sodium excretion and LVMI showed a significant association (P=0.001) and lacked evidence of a nonlinear association (P=0.406).ConclusionThis study indicated that high urinary sodium excretion was independently associated with increased risk of LVH and CVD in patients with T2DM, suggesting that control of sodium intake may be valuable for the prevention of diabetic cardiovascular complications.

Association of urinary sodium excretion with fluid overload in patients with chronic kidney disease

Objective: To investigate the relationship between urinary sodium excretion and fluid overload (FO) in non-dialysis patients with chronic kidney disease (CKD). Methods: Patients with CKD stage 1-4 who underwent bioelectrical impedance (BIA) in the Department of Nephrology, Jiangsu Province Hospital from December 2019 to January 2021 were recruited. All enrolled patients were categorized into two groups according to whether or not they develop FO. Further, clinical parameters were compared between the two groups. Spearman correlation analysis was used to investigate the association between over hydration/extracellular water (OH/ECW) and clinical characteristics. Multivariate logistic regression analysis was performed to evaluate the relationship between urinary sodium excretion and FO (FO was defined as OH/ECW≥7%). Results: A total of 385 patients with CKD stage 1-4 were finally included in the study, with a mean age of (46±15) years. There were 216 male cases (56.1%), and 150 cases (39.0%) existed FO. Spearman correlation analysis indicated that OH/ECW positively correlated with urinary sodium excretion (r=0.147, P=0.004), urinary protein excretion (r=0.555, P<0.001) and systolic blood pressure (r=0.241, P<0.001), but inversely related to estimated glomerular filtration rate (eGFR) (r=-0.111, P=0.030) and serum albumin (r=-0.659, P<0.001). After adjusting for confounding factors including age, systolic blood pressure, diabetes, urinary protein excretion, serum albumin, serum sodium, serum chlorine, urinary calcium excretion, urinary phosphorus excretion and use of diuretics, multivariate logistic regression analysis demonstrated that higher level of urinary sodium excretion was associated with increased risk of FO in patients with CKD (OR=1.005, 95%CI: 1.000-1.011, P=0.048). Conclusion: High urinary sodium excretion is independently associated with fluid FO in non-dialysis patients with CKD.

The role of caloric intake in the association of high salt intake with high blood pressure

Since current recommendations call for a substantial reduction in overall sodium consumption, we tested whether or not these recommendations are implemented in common large subpopulations such as those with abnormal weight or hypertension in the current high sodium, high-calorie nutritional environment. In a national representative cross-sectional survey of the community-dwelling subjects aged 25–65 years conducted in Israel between 2015 and 2017, 582 randomly selected subjects completed health and dietary questionnaires, underwent blood pressure and anthropometric measurements and collected 24-h urine specimens, to assess dietary sodium intake. Overall mean 24-h sodium excretion was 3834 mg, more than double the recommended upper intake for adults < 1500 mg/day. Sodium excretion was directly related to caloric intake and blood pressure and linked to the presence of hypertension and overweight/obesity. The highest sodium excretion was seen in overweight/obese hypertensive subjects. This recent national survey shows a high consumption of sodium in the Israeli population and a dose–response association between caloric intake and urinary sodium excretion, independent of BMI and hypertension. Nevertheless, overweight/obese subjects with hypertension consume (excrete) more sodium than other BMI/ blood pressure-related phenotypes and may thus comprise a target subpopulation for future efforts to reduce sodium intake.

Assessment of Foods Associated with Sodium and Potassium Intake in Japanese Youths Using the Brief-Type Self-Administered Diet History Questionnaire.

The identification of sodium and potassium intake in youths is an important step to preventing the increase of blood pressure in childhood. We examined food intake and estimated mineral intake using a brief-type self-administered diet history questionnaire (BDHQ) to test its validity as a comparison with urinary excretion in Japanese youths. The subjects were 5th and 8th graders (n = 2377), who completed the BDHQ and permitted the use of their overnight urine specimens. Sodium intake was poorly associated with sodium excretion (Rho = 0.048), and the coefficients of dietary potassium and a sodium-to-potassium molar ratio were 0.091–0.130. Higher soybean paste (miso) intake and pickles were significantly associated with higher sodium excretion (p ≤ 0.005). However, these foods were positively associated with potassium excretion (p = 0.002–0.012), and not associated with an excreted sodium-to-potassium ratio. Fruits and dairy products were positively associated (p ≤ 0.048), whereas beverages were negatively associated with potassium excretion (p ≤ 0.004). The association of the sodium-to-potassium ratio was opposite to that of potassium (p ≤ 0.001). The choice of foods, potassium, and the sodium-to-potassium ratio assessed using the BDHQ are available as part of health education for youths, but the assessment of sodium intake in population levels should be carefully conducted.

EFFECTS OF DAPAGLIFLOZIN IN HIGH AND LOW DIETARY SALT INTAKE PATIENTS WITH ALBUMINURIC DIABETIC KIDNEY DISEASE: A SUBANALYSIS OF THE Y-AIDA STUDY

Objective: Current guidelines recommend the intensive control of BP as well as blood glucose to reduce albuminuria and prevent the development of diabetic kidney disease (DKD). We reported that improved home BP profile with dapagliflozin is independently associated with amelioration of albuminuria in Japanese patients with DKD (Kinguchi, et al. Cardiovasc Diabetol. 2019). The aim of this subanalysis was to investigate the differences in home BP lowering effects between high and low dietary salt intake patients with albuminuric DKD. Design and method: The Yokohama Add-on Inhibitory efficacy of Dapagliflozin on Albuminuria in Japanese patients with type 2 diabetes (Y-AIDA) study was a prospective, multicenter, single-arm study. A total of 86 T2DM (HbA1c 7.0–10.0%) individuals with albuminuric DKD (UACR &gt; = 30 mg/gCr, eGFR &gt; = 45 ml/min/1.73m2) were enrolled, and 85 participants were administered with add-on dapagliflozin for 24 weeks. Subgroup analysis, in which patients were classified into 2 groups according to their urinary sodium excretion at baseline, was conducted to determine the change from baseline in home BP profile at week 24. Results: At baseline, office systolic BP and morning, evening, and nocturnal home systolic BP were comparable between high urinary sodium excretion group (high group) and low urinary sodium excretion group (low group) (144.0 ± 19.7 vs 140.4 ± 18.4, P = 0.4044; 138.5 ± 12.1 vs 136.4 ± 16.6, P = 0.5179; 137.4 ± 17.6 vs 134.4 ± 17.3, P = 0.4481; 124.7 ± 14.8 vs 125.9 ± 14.9, P = 0.7267). The change in evening home systolic BP was greater in high group than in low group (-13.1 ± 12.0 vs -6.4 ± 11.4, P = 0.0203). The change in office BP, and morning and nocturnal home BP were comparable between high group and low group. Conclusions: In albuminuric DKD patients who have high dietary salt intake, add-on dapagliflozin treatment resulted in a greater decrease in evening home BP than in those who have low dietary salt intake.

The Correlation Between Urinary Sodium Excretion and Blood Pressure in Hospitalized Adult Patients with Hypertension.

This study was designed to understand the baseline salt intake of adult patients with hypertension in Shanxi Province, and to analyze the correlation between urinary sodium excretion and blood pressure. From June 2018 to December 2019, 16 hospitals with regional representativeness and experimental conditions in Shanxi Province were selected, and 643 eligible adult inpatients with primary hypertension were enrolled from these hospitals. The ages of patients ranged from 18 to 80years. A 24-h ambulatory blood pressure monitoring was performed, and morning urine sodium concentration and 24-h urine sodium excretion were measured. The correlation between urinary sodium excretion and blood pressure in adult patients with hypertension was analyzed. The baseline salt intake of the adult patient participants with hypertension in Shanxi Province was 11.51g/day. The average 24-h urinary sodium excretion of all observed subjects was 191.90±98.18mmol. The 24-h urinary sodium excretion and morning urinary sodium concentration were significantly positively correlated with systolic and diastolic blood pressure following adjustment of confounding factors, including gender, age, body weight, and smoking. The morning urine sodium concentration and 24-h urine sodium excretion were significantly positively correlated with blood pressure. High sodium excretion may be a risk factor for rhythm abnormalities in non-dipper pattern blood pressure. The control of urinary sodium concentration can thus be an important strategy for regulating abnormal blood pressure rhythm.