A multiple 24-hour urine collection study indicates that kidney function decline is related to urinary sodium and potassium excretion in patients with chronic kidney disease

Ogata, Soshiro; Akashi, Yuumi; Sakusabe, Takaya; Yoshizaki, Shigehito; Maeda, Yuko; Nishimura, Kunihiro; Maeda, Kenji; Nakai, Shigeru

doi:10.1016/j.kint.2021.10.030

Cited by 18 publications

(13 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Unfortunately, nephrologists are facing the same debate in the field of cardiology because the causal relationship between salt intake and adverse kidney outcomes remains controversial in patients with CKD. 17 , 18 , 19 , 20 , 21 , 33 Nevertheless, many guidelines for CKD care have adopted the recommendation of salt restriction, as suggested by the World Health Organization and other European and American cardiology guidelines. 16 , 34 , 35…”

Section: Discussionmentioning

confidence: 99%

“… 17 Recent studies by our cohort investigators and a Japanese study group showed that high urinary sodium excretion was associated with a significantly increased risk of CKD progression. 18 , 19 However, other studies showed no relationship between urinary sodium excretion and kidney function decline. 20 , 21 , 22 Notably, recent randomized controlled trials (RCTs) with salt restriction showed some positive results regarding BP control and changes in proteinuria; however, these studies were limited by small sample sizes and short-term observations.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Proteinuria Modifies the Relationship Between Urinary Sodium Excretion and Adverse Kidney Outcomes: Findings From KNOW-CKD

Kim¹,

Jung²,

Kim³

et al. 2023

Kidney International Reports

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Proteinuria Modifies the Relationship Between Urinary Sodium Excretion and Adverse Kidney Outcomes: Findings From KNOW-CKD

Kim¹,

Jung²,

Kim³

et al. 2023

Kidney International Reports

View full text Add to dashboard Cite

“…The urinary sodium-to-potassium ratio has recently attracted attention as an indicator of dietary sodium intake [12,13], due to some potential advantages over the gold standard of repeated measurements for 24-h urinary sodium excretion [14,15]. For example, although a single time point of 24-h urinary sodium excretion may still be susceptible to intrinsic or random variations, the 24-h urinary sodium-to-potassium ratio may be less susceptible because such variations in both the numerator and the denominator may be canceled out.…”

Section: Introductionmentioning

confidence: 99%

Associations of Urinary and Dietary Sodium-To-Potassium Ratios with Albuminuria in Community-Dwelling Japanese Adults: A Cross-Sectional Study

Kabasawa

Takachi

Nakamura

et al. 2022

Kidney Blood Press Res

View full text Add to dashboard Cite

Introduction: The urinary sodium-to-potassium ratio is an indicator of dietary sodium intake and has been associated with reduced kidney function. However, less is known about its association with albuminuria, the other key component of chronic kidney disease, in the community-dwelling adult population. We examined the association of the spot urinary sodium-to-potassium ratio with albuminuria and compared spot urinary and dietary sodium-to-potassium ratios. Methods: We quantified the association of the urinary sodium-to-potassium ratio with albuminuria in 6,274 Japanese adults (age, 40–97 years; 50.9% women) based on spot urine samples. We performed linear and logistic regression modeling to account for potential confounders. Elevated albuminuria was defined as a spot urinary albumin-to-creatinine ratio (ACR) ≥ 30 mg/g. We secondarily evaluated the dietary sodium-to-potassium ratio based on a food-frequency questionnaire. Results: The median spot urinary and dietary sodium-to-potassium ratios were 2.70 (interquartile interval, 1.87–3.83) and 1.50 (1.21–1.84), respectively. The median ACR was 11.0 (6.0–24.0) mg/g. In a multivariable linear regression model, the spot urinary sodium-to-potassium ratio (per increment) was significantly associated with the natural logarithm of the ACR (regression coefficient, 0.023 [95% confidence interval [95% CI], 0.007–0.038]). This result was consistent in a multivariable logistic regression model (adjusted odds ratio, 1.08 [95% CI, 1.04–1.12]). The corresponding estimates for the dietary sodium-to-potassium ratio were 0.139 (95% CI, 0.087–0.191) and 1.28 (95% CI, 1.14–1.45), respectively. Conclusions: Both spot urinary and dietary sodium-to-potassium ratios were associated with elevated albuminuria in community-dwelling Japanese adults. Our findings further support the potential usefulness of the spot urinary sodium-to-potassium ratio as an indicator of sodium intake and suggest a link between sodium intake and kidney damage.

show abstract

“…4 With regard to dietary salt intake, high dietary sodium chloride intake is a recognized contributor to negative outcomes in patients with CKD. [5][6][7][8] Less studied are the negative effects of low dietary potassium intake, which may contribute to hypertension and kidney injury (kaliopenic nephropathy). 9,10 Previous studies that analyzed urinary potassium excretion in the general population 11,12 and in patients with CKD 13 showed that dietary potassium intake is approximately half of the dietary reference values of 90-120 mmol/ day.…”

mentioning

confidence: 99%

“…In addition to a healthy lifestyle, renin-angiotensin inhibitors, and emerging pharmacologic approaches, 2 , 3 dietary approaches represent a complementary, and perhaps underutilized, approach to reduce cardiovascular risk in patients with CKD 4 . With regard to dietary salt intake, high dietary sodium chloride intake is a recognized contributor to negative outcomes in patients with CKD 5 – 8 . Less studied are the negative effects of low dietary potassium intake, which may contribute to hypertension and kidney injury (kaliopenic nephropathy) 9 , 10 .…”

mentioning

confidence: 99%

Effects of Short-Term Potassium Chloride Supplementation in Patients with CKD

Gritter

Wouda

Yeung

et al. 2022

JASN

View full text Add to dashboard Cite

BackgroundObservational studies suggest that adequate dietary potassium intake (90–120 mmol/day) may be renoprotective, but the effects of increasing dietary potassium and the risk of hyperkalemia are unknown.MethodsThis is a prespecified analysis of the run-in phase of a clinical trial in which 191 patients (age 68±11 years, 74% males, 86% European ancestry, eGFR 31±9 ml/min per 1.73 m2, 83% renin-angiotensin system inhibitors, 38% diabetes) were treated with 40 mmol potassium chloride (KCl) per day for 2 weeks.ResultsKCl supplementation significantly increased urinary potassium excretion (72±24 to 107±29 mmol/day), plasma potassium (4.3±0.5 to 4.7±0.6 mmol/L), and plasma aldosterone (281 [198–431] to 351 [241–494] ng/L), but had no significant effect on urinary sodium excretion, plasma renin, BP, eGFR, or albuminuria. Furthermore, KCl supplementation increased plasma chloride (104±3 to 105±4 mmol/L) and reduced plasma bicarbonate (24.5±3.4 to 23.7±3.5 mmol/L) and urine pH (all P<0.001), but did not change urinary ammonium excretion. In total, 21 participants (11%) developed hyperkalemia (plasma potassium 5.9±0.4 mmol/L). They were older and had higher baseline plasma potassium.ConclusionsIn patients with CKD stage G3b–4, increasing dietary potassium intake to recommended levels with potassium chloride supplementation raises plasma potassium by 0.4 mmol/L. This may result in hyperkalemia in older patients or those with higher baseline plasma potassium. Longer-term studies should address whether cardiorenal protection outweighs the risk of hyperkalemia.Clinical trial number:NCT03253172

show abstract

A multiple 24-hour urine collection study indicates that kidney function decline is related to urinary sodium and potassium excretion in patients with chronic kidney disease

Cited by 18 publications

References 43 publications

Proteinuria Modifies the Relationship Between Urinary Sodium Excretion and Adverse Kidney Outcomes: Findings From KNOW-CKD

Proteinuria Modifies the Relationship Between Urinary Sodium Excretion and Adverse Kidney Outcomes: Findings From KNOW-CKD

Associations of Urinary and Dietary Sodium-To-Potassium Ratios with Albuminuria in Community-Dwelling Japanese Adults: A Cross-Sectional Study

Effects of Short-Term Potassium Chloride Supplementation in Patients with CKD

Contact Info

Product

Resources

About