Measured sodium excretion is associated with CKD progression: results from the KNOW-CKD study.

Abstract

BACKGROUND:

Diet is a modifiable factor of chronic kidney disease (CKD) progression. However, the effect of dietary salt intake on CKD progression remains unclear. Therefore, we analyzed the effect of dietary salt intake on renal outcome in Korean patients with CKD.

METHODS:

We measured 24-h urinary sodium (Na) excretion as a marker of dietary salt intake in the prospective, multi-center, longitudinal KoreaN cohort study for Outcome in patients With CKD (KNOW-CKD). Data were analyzed from CKD patients at Stages G3a to G5 (n = 1254). We investigated the association between dietary salt intake and CKD progression. Patients were divided into four quartiles of dietary salt intake, which was assessed using measured 24-h urinary Na excretion. The study endpoint was composite renal outcome, which was defined as either halving the estimated glomerular filtration rate or developing end-stage renal disease.

RESULTS:

During a median (interquartile range) follow-up of 4.3 (2.8-5.8) years, 480 (38.7%) patients developed the composite renal event. Compared with the reference group (Q2, urinary Na excretion: 104.2 ≤ Na excretion < 145.1 mEq/day), the highest quartile of measured 24-h urinary Na excretion was associated with risk of composite renal outcome [Q4, urinary Na excretion ≥192.9 mEq/day, hazard ratio 1.8 (95% confidence interval 1.12-2.88); P = 0.015] in a multivariable hazards model. Subgroup analyses showed that high-salt intake was particularly associated with a higher risk of composite renal outcome in women, in patients <60 years of age, in those with uncontrolled hypertension and in those with obesity.

CONCLUSIONS:

High salt intake was associated with increased risk of progression in CKD.

• Authors: Minjung Kang, Eunjeong Kang, Hyunjin Ryu, Yeji Hong, Seung Seok Han, Sue K Park, Young Youl Hyun, Su Ah Sung, Soo Wan Kim, Tae-Hyun Yoo, Jayoun Kim, Curie Ahn, Kook-Hwan Oh
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 36 Issue 3 Pg. 512-519 (02 20 2021) ISSN: 1460-2385 [Electronic] England
• PMID: 32582942 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Chemical References

• Biomarkers
• Sodium Chloride, Dietary
• Sodium

Topics

• Adult
• Aged
• Biomarkers (urine)
• Diet
• Disease Progression
• Feeding Behavior
• Female
• Glomerular Filtration Rate
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Prospective Studies
• Renal Insufficiency, Chronic (diet therapy, pathology, urine)
• Risk Factors
• Sodium (urine)
• Sodium Chloride, Dietary (administration & dosage)
• Young Adult