Sodium Restriction Research Articles

Bilateral renal artery stenosis in pediatric patient with Post-Streptococcal Glomerulonephritis in children: A case report

The immune-complex mediated inflammation known as post-streptococcal glomerulonephritis (PSGN) was once thought to be one of the most common causes of acute nephritis in children. In this case, we present a 12-year-old girl experiencing symptoms of cough phlegm, congested breath, change of urine color, decreased urine production, as well swelling in the area face and legs after experiencing fever, pain swallowing, cough, and runny nose 3 weeks before admission. On physical examination, the pressure blood was 130/80 mmHg. In addition, the palpebral and extremity were edema bilateral, hyperemia of the tonsil and pharynx, enlarged tonsils T2/T3, and detritus were found. Laboratory and Imaging Tests: hematology; leukocytes 12,930, albumin 2.4 g/dl, on urinalysis, obtained urine cloudy, brownish, leukocyturia, hematuria, and proteinuria, there was also an increase in ASTO titers, abdominal ultrasound found bilateral renal artery stenosis and nephritis bilateral acute. The patient in this case presented with bilateral renal artery stenosis, which is a rare finding in PSGN cases. Management of PSGN include bed rest, low salt diet, fluid balance, as well supportive treatment with IVFD D5 ½ NS 15 drops/min (micro), Antibiotics injection of Ceftriaxone 1 gram/12 hours on the first day and continued with oral Erythromycin 4x500mg, injection prednisolone 3x1, injection Furosemide 1x1 amp, oral spironolactone and sublingual nifedipine, and hypoalbuminemia correction. Prognosis in patients with the given GNAPS governance optimally will give good results.

Effects of polygenic risk score and sodium and potassium intake on hypertension in Asians: A nationwide prospective cohort study

Genetic factors, lifestyle, and diet have been shown to play important roles in the development of hypertension. Increased salt intake is an important risk factor for hypertension. However, research on the involvement of genetic factors in the relationship between salt intake and hypertension in Asians is lacking. We aimed to investigate the risk of hypertension in relation to sodium and potassium intake and the effects of genetic factors on their interactions. We used Korean Genome and Epidemiology Study data and calculated the polygenic risk score (PRS) for the effect of systolic and diastolic blood pressure (SBP and DBP). We also conducted multivariable logistic modeling to evaluate associations among incident hypertension, PRSSBP, PRSDBP, and sodium and potassium intake. In total, 41,351 subjects were included in the test set. The top 10% PRSSBP group was the youngest of the three groups (bottom 10%, middle, top 10%), had the highest proportion of women, and had the highest body mass index, baseline BP, red meat intake, and alcohol consumption. The multivariable logistic regression model revealed the risk of hypertension was significantly associated with higher PRSSBP, higher sodium intake, and lower potassium intake. There was significant interaction between sodium intake and PRSSBP for incident hypertension especially in sodium intake ≥2.0 g/day and PRSSBP top 10% group (OR 1.27 (1.07–1.51), P = 0.007). Among patients at a high risk of incident hypertension due to sodium intake, lifestyle modifications and sodium restriction were especially important to prevent hypertension.

Apical tubular complement activation and the loss of kidney function in proteinuric kidney diseases.

Many kidney diseases are associated with proteinuria. Since proteinuria is independently associated with kidney function loss, anti-proteinuric medication, often in combination with dietary salt restriction, comprises a major cornerstone in the prevention of progressive kidney failure. Nevertheless, complete remission of proteinuria is very difficult to achieve, and most patients with persistent proteinuria slowly progress toward kidney failure. It is well-recognized that proteinuria leads to kidney inflammation and fibrosis via various mechanisms. Among others, complement activation at the apical side of the proximal tubular epithelial cells is suggested to play a crucial role as a cause of progressive loss of kidney function. However, hitherto limited attention is given to the pathophysiological role of tubular complement activation relative to glomerular complement activation. This review aims to summarize the evidence for tubular epithelial complement activation in proteinuric kidney diseases in relation to loss of kidney function.

Dietary Sodium Intake and Outcomes: a Secondary Analysis From Sodium-HF

This post hoc analysis of SODIUM-HF (Study of Dietary Intervention under 100 mmol in Heart Failure) assessed the association between baseline dietary sodium intake and change at 6 months with a composite of cardiovascular (CV) hospitalizations, emergency department visits and all-cause death at 12 and 24 months. Dietary sodium restriction is common advice for patients with heart failure (HF). Randomized clinical trials have not shown a beneficial effect of dietary sodium restriction on clinical outcomes. A multivariable Cox proportional hazard regression model was used to assess the association of dietary sodium intake measured at randomization with primary and secondary endpoints. The study included 792 participants. Baseline sodium intake was ≤ 1500 mg/day in 19.9% (n = 158), 1501-3000 mg/day in 56.5% (n = 448) and > 3000 mg/day in 23.4% (n = 186) of participants. The factors associated with higher baseline sodium intake were higher calorie consumption, higher body mass index and recruitment from Canada. Multivariable analyses showed no association between baseline sodium intake nor magnitude of 6-month change or 12- or 24-month outcomes. In a responder analysis, participants achieving a sodium intake < 1500 mg at 6 months showed an association with a decreased risk for the composite outcome (adjusted HR 0.52 [95% CI 0.25, 1.07] P = 0.08) and CV hospitalization (adjusted HR 0.51 [95% CI 0.24, 1.09] P = 0.08) at 12 months. There was no association between dietary sodium intake and clinical outcomes over 24 months in patients with HF. Responder analyses suggest the need for further investigation of the effects of sodium reduction in those who achieve the targeted dietary sodium-reduction level.

Influence of Potassium Intake on the Renoprotective Response to Sodium Restriction and Hydrochlorothiazide in Patients with Diabetic Nephropathy

Influence of Potassium Intake on the Renoprotective Response to Sodium Restriction and Hydrochlorothiazide in Patients with Diabetic Nephropathy

Spontaneous vascular dysfunction in Dahl salt-sensitive male rats raised without a high-salt diet.

Dahl salt-sensitive (SS) rats fed a high-salt diet, but not low-salt, exhibit vascular dysfunction. Several substrains of SS rats exist that differ in their blood pressure phenotypes and salt sensitivity. The goal of this study was to investigate whether the John-Rapp-derived SS rat (SS/Jr), which exhibits spontaneous hypertension on a low-salt diet, presents with hallmarks of vascular dysfunction observed in another experimental model of hypertension independent of dietary salt, the spontaneously hypertensive rat (SHR). Endothelium-intact aortic rings and mesenteric resistance arteries were isolated from low-salt fed adult male SS/Jr rats and SHRs, or their respective controls, for isometric wire myography. Vessels were challenged with cumulative concentrations of various vasoactive substances, in the absence or presence of nitric oxide synthase or cyclooxygenase inhibitors. Despite showing some differences in their responses to various vasoactive substances, both SS/Jr rats and SHRs exhibited key features of vascular dysfunction, including endothelial dysfunction and hyperresponsiveness to vasocontractile agonists. In conclusion, this study provides evidence to support the utility of the SS/Jr rat strain maintained on a low-salt diet as a valid experimental model for vascular dysfunction, a key feature of human hypertension.

Prevalence and Associated Factors of Uncontrolled Hypertension Among Patients Attending Primary Healthcare Centers in Riyadh, Saudi Arabia.

Background Hypertension (HTN) is a global health issue as it causes significant mortality and morbidity among the worldwide population. Various treatments are available, but many patients are unable to control the disease. There are various factors like medication non-adherence and lifestyle habits that contribute to this problem. There is a need for evidence-based interventions to address HTN effectively, especially in regions like Saudi Arabia, where there is limited data on uncontrolled HTN. This study aimed to assess the prevalence of uncontrolled HTN and contributing factors to poor blood pressure control among patients in Primary Health Centers (PHCs) in Riyadh, Saudi Arabia. Methodology An analytical cross-sectional study was conducted using an interviewer-administered questionnaire among all patients aged 18 years and above who have uncontrolled HTN and who visited the PHCsof Riyadh's first health cluster in Saudi Arabia. Data was cleaned in Microsoft Excel and analyzed using IBM SPSS 29. Results The study comprised 516 patients with HTN. The majority were males (53.1%, n=274) compared to females (46.9%, n=242), with an average age of 58 years (SD=10.5). Notably, most patients were obese (63.2%, n=326), and 62.4% (n=322) had uncontrolled HTN. Multivariate analysis identified sociodemographic factors like higher education (p-value = 0.013, adjusted odds ratio (AOR) = 0.795) as protective against uncontrolled HTN, while employment (p-value = 0.031, AOR = 1.786) increased the risk of uncontrolled HTN. Risk factors such as smoking (p-value = 0.001, AOR = 3.011) and salt restriction (p-value = 0.021, AOR = 0.643) significantly influenced HTN control. Management-related predictors like stopping medication after feeling better (p-value = 0.001, AOR = 3.196) were also found significant. Conclusion This study revealed a high prevalence of uncontrolled HTN, especially among males and obese individuals. Sociodemographic factors like higher education were protective, while employment increased the risk of the disease. Further, smoking, salt restriction, and medication adherence significantly impacted HTN control, highlighting the importance of tailored interventions.

THE RELATIONSHIP OF FAMILY SUPPORT WITH COMPLIANCE WITH A LOW SALT DIET IN HYPERTENSION PATIENTS IN POSBINDU KEMUNING, MARGAHAYU DISTRICT, BEKASI CITY, 2023

Hypertension or high blood pressure is a condition in which blood pressure is above the normal limit of 120/80 mmHg. The normal limit of blood pressure is less than 130/85 mmHg. If the blood pressure is more than 140/90 mmHg then it is declared hypertension. This study aims to determine the relationship between family support and low-salt diet adherence in hypertensive patients at Posbindu Kemuning, Margahayu Village, Bekasi City in 2023. The research method used is quantitative with crossectional analytical research type.The population in this study was hypertensive patients at productive age, aged 15-64 years at Posbindu Kemuning, Margahayu Village, totaling 90 people. Data collection technique using a simple type of random sampling based on inclusion criteria and obtained a sample of 73 respondents. The results of the study found that with a significant level of 95% or a value of α 5% (0.05) the Chi Square test results obtained p-value (0.000 ) &lt; a value of α (0.05). This indicates that H0 is rejected. The conclusion of the study is that there is a relationship between family support and adherence to a low-salt diet in people with hypertension at Posbindu Kemuning, Margahayu Village, Bekasi City in 2023.

Assessment of Nutritional Intake in Patients With Kidney Failure Treated by Haemodialysis on Dialysis and Non-dialysis Days

Introduction/Aims/ObjectiveInadequate nutritional intake in haemodialysis (HD) patients increases the risk of muscle wasting, nutrient deficiencies, leading to an increased risk of additional morbidity and mortality. We aimed to assess nutritional intake on the dialysis and non-dialysis day of patients established on HD. MethodsWe employed a two-day dietary record, one on the day of dialysis and one on the non-dialysis day, and then determined nutritional intake using the Nutritics software. Muscle strength was assessed by hand grip strength (HGS) and body composition determined using multifrequency bioelectrical impedance recorded post-dialysis. ResultsWe recruited 51 established HD patients dialysing between May-July 2022, mean age 60±15 years, 52.9% male, and 51% diabetic. Only 25% achieved the calorie and protein intake recommended by Kidney Disease Outcomes Quality Initiative (KDOQI). Most patients had inadequate consumtion of fibre (96%), calcium (86%), iron (80%), zinc (82%), selenium (92%), folate (82%), vitamin A (88%), and (100%) vitamin D. On the other hand, the great majority followed the restriction guidelines for potassium (96%), phosphorus (86%), and sodium (84%), repectively. However, consumption was greater for potassium (P=0.007), phosphorus (P=0.015), and zinc (P=0.032) on non-dialysis vs dialysis days, but there was no difference in protein or calorie intake between days. ConclusionOur results suggest that many of our HD patients do not achieve the recommended nutritional targets. Patient compliance with restricting sodium, potassium and phosphate limits protein and calorie intake. HD patients are at increased risk of sarcopenia, so failure to achieve dietary protein intake will further increase this risk.

Associations of E-proteinoid 3 receptor genetic polymorphisms with salt sensitivity, longitudinal blood pressure changes, and hypertension incidence in Chinese adults.

The E-proteinoid 3 receptor (PTGER3), a member of the prostaglandin E2 (PGE2) subtype receptor, belongs to the G-protein-coupled superfamily of receptors. Animal studies have demonstrated its involvement in salt sensitivity by regulating sodium reabsorption. This study aimed to investigate the association between genetic variants of PTGER3 and salt sensitivity, longitudinal blood pressure (BP) changes, and the incidence of hypertension in Chinese adults. A chronic salt intake intervention was conducted involving 514 adults from 124 families in the 2004 Baoji Salt-Sensitivity Study Cohort in northern China. These participants followed a 3-day regular baseline diet, followed by a 7-day low-salt diet (3.0g/d) and a 7-day high-salt diet (18g/d), and were subsequently followed for 14years. The findings revealed a significant relationship between the single nucleotide polymorphism (SNP) rs17482751 of PTGER3 and diastolic blood pressure (DBP) response to high salt intervention. Additionally, SNPs rs11209733, rs3765894, and rs2268062 were significantly associated with longitudinal changes in systolic blood pressure (SBP), DBP, and mean arterial pressure (MAP) during the 14-year follow-up period. SNP rs6424414 was significantly associated with longitudinal changes in DBP over 14years. Finally, SNP rs17482751 showed a significant correlation with the incidence of hypertension over 14years. These results emphasize the significant role of PTGER3 gene polymorphism in salt sensitivity, longitudinal BP changes, and the development of hypertension in the Chinese population.

Inadequate Dietary Education and Poor Adherence to a High Protein, Low Sodium Diet in Cirrhosis: Mixed Methods Approach.

Malnutrition in cirrhosis is associated with poor outcomes, leading to guidelines for a high protein, low sodium diet; however, there is no guidance regarding the implementation of diet education in clinical practice. A mixed methods study enrolled 21 patients with cirrhosis and their caregivers. Semi-structured interviews on barriers and facilitators of dietary education and adherence were conducted. Demographic and clinical data were obtained, along with quantitative measures of dietary adherence, including 24-h food recall and spot urine sodium. Combined deductive and inductive coding was used to identify qualitative themes, along with a quantitative assessment of interviews. Quantitative data was reported using descriptive statistics with frequencies, mean and confidence intervals. Participants were mostly male (16/21) with a mean age 57.8years (SE 2.8) and MELD-Na 9 (SE 1.2). 4 themes emerged: 1. More than 50% of participants and caregivers endorsed no or inadequate diet education 2. They reported mostly negative experiences with dietary adherence with largest impact on social life 3. Facilitators of adherence included the presence of household support and fear of complications of cirrhosis 4. Overwhelmingly desired non-generic handouts and information. Dietary adherence was poor with only one participant meeting protein and sodium requirements based on food recall. Four participants who adhered to < 2000mg sodium had inadequate daily caloric intake. Dietary education is inadequate, and adherence to dietary recommendations is poor in patients with cirrhosis. Future studies should use these barriers and facilitators for intervention development.

Salt versus no salt restriction in heart failure a review.

For decades standard teaching recommended salt intake (sodium) reduction in patients suffering from heart failure. Neurohumoral activation with subsequent fluid retention provided a solid rationale for this long-standing recommendation. Until recently no large randomized clinical trial of sodium restriction was available, while some observational studies and metanalyses even suggested a worse outcome with strict sodium restriction in patients with heart failure. In this narrative review we aimed to extricate from the literature whether strict sodium restriction is beneficial in patients with heart failure. We searched PubMed indexed articles between 2000 and 2023 for these terms: heart failure, salt, sodium, fluid intake. Most randomized trials were small and showed a wide heterogeneity of interventions. A single large, randomized clinical trial was stopped early due to futility. Overall, there is no evidence that severe sodium restriction reduces the incidence of mortality and hospitalization in patients with heart failure. Quality of life and functional class may improve slightly with sodium restriction. Morbidity and mortality are not reduced with sodium restriction in patients with heart failure, although some symptomatic improvement may be expected.

Interdialytic weight gain and low-salt diet in patients on chronic hemodialysis: A systematic review and meta-analysis

ObjectiveThe present systematic review and meta-analysis aims to determine the difference in the interdialytic weight gain (IDWG) between low salt intake diet and normal/high salt intake diet or between nutritional counseling aimed at reducing diet salt intake and no nutritional counseling in patients on chronic hemodialysis. MethodsMedline, PubMed, Web of Science, and the Cochrane Library were searched. Randomized, crossover or parallel studies and observational studies were considered for inclusion and: 1) included adult patients on chronic hemodialysis since at least 6 months; 2) compared normal salt intake diet with low salt intake diet on IDWG; 3) compared nutritional counseling aimed at reducing diet salt intake with no intervention on IDWG; 4) reported on IDWG. ResultsEight articles (783 patients) were fully assessed for eligibility and included in the investigation. Meta-analysis showed frequencies of patients that increased their weight after dialysis more than 2.5 Kg (events) over total enrolled subjects for each group (control and experimental). As no significant heterogeneity was observed (I2 =8%; p=0.36), the pooled analysis was performed using a fixed-effect model. Funnel plot was generated and no obvious asymmetry was observed. The Overall Odds Ratio to get an event in the experimental group, in respect to controls, is 0.57 (0.33-0.97) (p=0.04] with single studies OR ranging between 0.11 to 1.08. ConclusionThe present systematic review and meta-analysis suggest that the use of a low salt diet sodium or a nutritional counseling aimed at reducing diet salt intake is associated with a statistically significant reduction of the IDWG in patients on chronic hemodialysis.

Self-Performed Dietary Sodium Reduction and Blood Pressure in Patients With Essential Hypertension: A Randomized Clinical Trial.

Hypertension is the leading risk factor for cardiovascular disease worldwide. Patients with blood pressure (BP) response to dietary sodium reduction are referred to as "salt sensitive." Salt sensitivity (SS) might be due to differences in sodium storage capacity and the erythrocyte SS examines this capacity of the red blood cells. This study aimed to test the effect of a self-performed sodium reduced diet on BP in patients with essential hypertension and examine whether erythrocyte SS predicts SS. Seventy-two patients with hypertension were included and randomized 2:1 to either sodium reduction or a control group for 4 weeks. Blood samples, 24-hour BP measurement, and 24-hour urine collection were performed before and after. The intervention group received advice on how to lower sodium intake. Urinary sodium excretion decreased 66 mmol (95% CI, -96 to -37 mmol) in the intervention group compared with the control group. Systolic 24-hour BP decreased 9 mm Hg after low-sodium diet compared with the control group (95% CI, -13 to -4 mm Hg). Similarly, the difference in reduction in diastolic BP between the groups was 5 mm Hg (95% CI, -8 to -1 mm Hg). We found no correlation between erythrocyte SS at baseline and decrease in 24-hour BP, neither systolic nor diastolic (P=0.66 and P = 0.84). Self-performed sodium reduction was feasible and led to decrease in 24-hour BP of 9/5 mm Hg compared with a control group. The erythrocyte SS did not correlate to the change in BP after lowering sodium intake. URL: https://clinicaltrials.gov; Unique Identifier: NCT05165823.

A Retrospective Study of Whether Sacubitril–Valsartan Improves Cardiac Function in Patients with Acute Coronary Syndrome and Hypertension after Percutaneous Coronary Intervention

Objectives: This study aimed to explore the effect of sacubitril–valsartan on cardiac function in patients with acute coronary syndrome (ACS) and hypertension after percutaneous coronary intervention (PCI). Methods: The study was conducted on 166 patients with ACS and hypertension who underwent PCI at our hospital from July 2022 to June 2023. The patients were divided into two groups: an observation group and a control group, with 83 cases in each group. The observation group was given sacubitril–valsartan, and the control group was given enalapril. The treatment period was 3 months. The cardiac function indexes, biochemical indexes, adverse reactions, and the occurrence of new cardiovascular and cerebrovascular events were compared between the two groups before and after medication. Results: We found no statistically dramatic differences between the two groups in gender, age, body mass index, diabetes, hyperlipidemia, family history of ACS, family history of hypertension, smoking history, drinking history, regular exercise history, low-salt and low-fat diet, New York Heart Association cardiac function classification, number of vessels involved in coronary artery disease, stent length, stent inner diameter, number of stent implants, duration of hypertension, medication time, use of antihypertensive drugs, systolic blood pressure (SBP), and diastolic blood pressure (DBP). The observation group had lower left ventricular end-diastolic internal diameter (LVEDD) levels, higher left ventricular ejection fraction (LVEF) levels, and lower left ventricular end-systolic internal diameter (LVESD) levels compared with the control group. The levels of N-terminal pro-brain B-type natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), and creatine kinase isoenzyme MB (CK-MB) in the observation group decreased compared with those in the control group. Compared with the pre-medication period, LVEDD levels decreased, LVEF levels increased, and LVESD levels decreased in the observation and control groups, whereas NT-proBNP, cTnI, and CK-MB levels decreased in the observation and control groups. The total incidence rates of adverse reactions and new cardiovascular and cerebrovascular events in the observation group were found to be lower than those in the control group. Conclusion: The application of sacubitril–valsartan in patients with ACS complicated with hypertension after PCI can effectively improve patients' cardiac function, reduce biochemical indexes related to myocardial injury, and lower the incidence of adverse cardiovascular events. It features good safety, providing a new treatment strategy and method for patients with ACS complicated with hypertension.

Effective management of Meniere’s disease through Ayurveda- A case report

Meneirs disease is inner ear disease characterized by episodic vertigo, fluctuating hearing loss and tinnitus. The pathophysiology of the disease is obscure but theories postulated and stated that, due to decreased absorption or increased secretion of endolymphatic fluid in membranous labyrinth of the inner ear leads to pressure increase thus manifests the disease. There is no promising cure to this disease in conventional science only with life style adjustments, low salt diet, diuretics and surgery are used to manage the condition. The present case study patient with meniers disease was successfully managed with ayurveda treatment. A 55yrs old male patient complained of giddiness, reduced hearing and tinnitus since 9months which was hampering his daily activities was treated with panchakarma procedures and internal medicines. The exact meniers disease is not mentioned in samhitas but on the basis of symptoms and dosha predominance it is considered as vata-pitta pradhana tridoshaja vyadhi. As per dosha predominance it is treated with virechana (Purgation), Pratimarsha nasya (nasal medication) and internal medicines with Dhanadhanyadi kashaya, Cap ksheerabala and cap palsineuron, Tab Kamaduga rasa was administered. On functional scale level the stage 5 was reduced to 1 which shows good improvement. Meniers disease may satisfactory be managed with Ayurveda treatment.

Hold the salt for kidney regeneration.

The macula densa (MD) is a distinct cluster of approximately 20 specialized kidney epithelial cells that constitute a key component of the juxtaglomerular apparatus. Unlike other renal tubular epithelial cell populations with functions relating to reclamation or secretion of electrolytes and solutes, the MD acts as a cell sensor, exerting homeostatic actions in response to sodium and chloride changes within the tubular fluid. Electrolyte flux through apical sodium transporters in MD cells triggers release of paracrine mediators, affecting blood pressure and glomerular hemodynamics. In this issue of the JCI, Gyarmati and authors explored a program of MD that resulted in activation of regeneration pathways. Notably, regeneration was triggered by feeding mice a low-salt diet. Furthermore, the MD cells showed neuron-like properties that may contribute to their regulation of glomerular structure and function. These findings suggest that dietary sodium restriction and/or targeting MD signaling might attenuate glomerular injury.

Salt and Cardiovascular Disease

Heart disease is a leading cause of mortality and morbidity globally. Sedentary lifestyle, bad eating habits, and little to no exercise have led to an alarming rise of lifestyle-mediated diseases in recent times. Table salt is one of the staples of all our kitchens and dining tables. Salt contains almost 98% sodium chloride. The unregulated amount of salt in our diet has led to adverse cardiovascular consequences. Fast foods such as salted French fries and Chinese cuisine may contain as much as 7,000 mg of sodium in a single meal! The American Heart Association (AHA) recommends a daily intake of not more than 2.3 g of salt per day (roughly one teaspoon). For patients with hypertension, heart failure, or kidney disease, a lower daily cut-off of 1.5 g of salt has been proposed but is still under debate. There is conflicting evidence of going too low with salt restriction as recent studies have shown increased adverse events when salt was restricted to beyond the recommended per-day threshold. The DASH (dietary approaches to stop hypertension) diet is a novel dietary pattern that is recommended for patients with hypertension. The DASH diet is not a restrictive or short-term diet but rather a sustainable and balanced approach to eating. It promotes a wide variety of foods, focusing on whole, unprocessed options, and encourages portion control. Adhering to a DASH eating pattern by itself can lower the systolic blood pressure by 6–11 mm Hg. Reducing salt intake can be challenging, as salt is present in many processed and packaged foods, restaurant meals, and fast food. More than 70% of the salt we eat, according to the AHA, comes from processed, prepackaged, and restaurant foods. “Salt Lite” is often marketed as a healthier alternative for individuals looking to lower their sodium intake. It typically contains a blend of potassium chloride with sodium chloride and is hence not totally “sodium free.” Individuals considering the use of “Salt Lite” should be aware of its higher potassium content and should not use it if they have a kidney disease or are on drugs that can cause hyperkalemia. There is a common misconception that pink Himalayan salt is lower in sodium than regular table salt. However, both types consist of approximately 98% sodium chloride. Research has not shown that Himalayan salt has any unique health benefits compared to other dietary salts. It is hence imperative for all individuals to restrict dietary salt intake to the recommended levels—as a measure toward a healthy lifestyle as well as a therapeutic modality for those with established cardiovascular diseases.

Ascities after Liver Cirrhosis Diagnosis and Treatment

Ascites, the accumulation of fluid in the abdominal cavity, is a common complication in patients with cirrhosis. Approximately 50% of patients with compensated cirrhosis will develop ascites over a 10-year period, marking a significant milestone in the progression of end-stage liver disease. Survival rates decrease after the onset of ascites, with only 50% of patients surviving 2 to 5 years, depending on the underlying cause of cirrhosis, The management of ascites involves salt restriction and diuretic use, which are effective in about 90% of patients in reducing fluid accumulation and symptoms. In cases where ascites does not respond to these measures, additional interventions such as large-volume paracentesis may be necessary as a temporary solution or for symptomatic relief while awaiting liver transplantation, for patients with refractory ascites, the transjugular intrahepatic portosystemic shunt (TIPS) procedure can be considered. This involves creating a shunt between the portal vein and hepatic vein to reduce portal hypertension. TIPS can serve as a bridge to liver transplantation or provide long-term palliation, but careful monitoring for bacterial peritonitis is essential. Patients at high risk for bacterial peritonitis should receive antibiotic prophylaxis to prevent this serious infection. Prompt diagnostic paracentesis is necessary when spontaneous bacterial peritonitis is suspected, involving the removal and analysis of fluid from the abdominal cavity

#2906 Kidney immune cells and endothelial cells can be modulated by low-salt and high-salt diets

Abstract Background and Aims Kidney immune cells and endothelial cells are involved in pathogenesis of kidney ischemia-reperfusion injury and potential therapeutic targets to improve kidney transplant outcomes. We hypothesized that dietary salt intake can change kidney immune cells and endothelial cells. Method C57BL/6 mice were treated with normal diet, low-salt diet, or high-salt diet. After 6 weeks of allocated diets, mice were euthanized, and their kidneys were collected. Leukocyte infiltration was assessed with CD45 immunohistochemistry. Lymphocytes were isolated from kidneys and were studied by flow cytometry. Human kidney transplant tissues obtained by a protocol biopsy at 2 weeks after kidney transplantation were stained with CD45, CD3, CD20, and CD31. Expression of each marker was quantified using an automated imaging analysis system and analyzed per donors’ pre-donation 24 h urine sodium levels. Induced pluripotent stem cell-derived endothelial cells (iPSC-ECs) from healthy individuals and end-stage kidney disease (ESKD) patients were treated with different sodium concentrations, and their proliferation was assessed. Results Kidneys from mice fed with high-salt diet had higher kidney leukocytes (CD45+) than those fed with normal diet (1.9 ± 0.3% vs 0.9 ± 0.1%, P = .043). Effector-memory CD4+ T cells (normal 44.2 ± 2.6%; low-salt 57.1 ± 3.5%, P = .020; high-salt 62.1 ± 2.5% of CD4+ T cells, P = .002) and mature B cells (70.0 ± 1.5%; 79.1 ± 1.4%, P = .001; 76.7 ± 1.6% of CD19+ cells, P = .015) increased by low-salt and high-salt diets, whereas naïve CD4+ T cells deceased (45.9 ± 2.1%; 32.7 ± 3.2%, P = .016; 27.8 ± 3.1% of CD4+ T cells, P = .001) in kidneys. Human kidney transplants from donors under low-salt diet showed lower total leukocytes (CD45+, 0.3 ± 0.1% vs 0.9 ± 0.3%, P = .019) with lower T and B cells (CD3+, 1.8 ± 0.2% vs 3.5 ± 0.4%, P&amp;lt;.001; CD20+, 0.8 ± 0.1% vs 2.1 ± 0.6%, P = .011) and higher capillary density (CD31+, 29.0 ± 2.2% vs 16.1 ± 1.8%, P = .009) compared to those from donors under high-salt diet. The proliferation of iPSC-ECs from healthy individuals and ESKD patients after hypoxia was reduced under higher sodium concentrations. Conclusion High-salt and low-salt diets affect kidney immune cell compositions and numbers as well as endothelial cells. Reconstitution of kidney microenvironment by modifying dietary salt intake could be a novel approach to improve kidney transplant outcomes.