Altered dietary salt intake for people with chronic kidney disease

McMahon, Emma; Campbell, Katrina L.; Bauer, Judith; Mudge, David W.; Kelly, Jennifer

doi:10.1002/14651858.cd010070.pub3

Cited by 53 publications

(38 citation statements)

References 115 publications

(16 reference statements)

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“…Salt restriction with adequate protein and calorie intake is important in all stages of CKD, and in dialysis patients in particular. Recent reviews and meta-analyses support the benefits of salt reduction [94][95][96]. Nutritional (salt) management needs to be adjusted for individual lifestyle, dietary habits, and available food types [97], as the elderly population is increasing rapidly in both Japan and Korea.…”

Section: Discussionmentioning

confidence: 99%

Nutrition and quality of life in chronic kidney disease patients: a practical approach for salt restriction

Iseki

2022

Kidney Res Clin Pract

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The clinical practice guidelines (CPGs) for nutrition in chronic kidney disease (CKD) were updated after 20 years from the previous guidelines by the Kidney Disease Outcomes Quality Initiative (KDOQI). During this period, the severity of CKD was defined by eGFR and albuminuria by the organization Kidney Disease: Improving Global Outcomes (KDIGO). Main risk factors for CKD such as hypertension, hyperlipidemia, obesity, metabolic syndrome, and diabetes mellitus are closely related to lifestyle. Nutritional management is important to prevent and retard the progression of CKD. Members of the International Society of Renal Nutrition and Metabolism (IS-RNM) reviewed the KDOQI CPG draft. ISRNM is an international scientific society comprising members of multiple subspecialties. IS-RNM proposed the medical term protein-energy wasting (PEW), which is a keyword in renal nutrition. The prevalence of PEW among dialysis patients is high. The success of dietary therapy depends on adherence to the diet. It has to be palatable, otherwise eating habits will not change. To prevent the development and progression of CKD and PEW, regular consultation with an expert dietitian is required, especially regarding salt and protein restriction. Our cluster-randomized trial showed that intervention by a dietician was effective at retarding the progression of stage 3 CKD. In this review, I focus on salt (sodium) restriction and introduce tips for salt restriction and Japanese kidney-friendly recipes. Due to the lack of randomized controlled trials, nutritional management of CKD inevitably relies on expert opinion. In this regard, well-designed observational studies are needed. Too strict salt restriction may decrease quality of life and result in PEW.

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Section: Discussionmentioning

confidence: 99%

Nutrition and quality of life in chronic kidney disease patients: a practical approach for salt restriction

Iseki

2022

Kidney Res Clin Pract

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“…We estimate that achieving the NPHS and SDT for sodium intake could reduce average systolic BP of adult Australians by 1.7 mmHg and 2.1 mmHg respectively. High certainty evidence from a recent Cochrane meta-analysis showed that salt reduction of 4.2g/day (1,640mg of sodium) in people with CKD decreased systolic BP by 6.9 mmHg, and also reduced albuminuria by 36% (10). Studies have shown that the effect of high sodium intake on BP are greater in people with CKD compared to the general non-CKD population, due to decreased renal excretion of the excess sodium (8, 33).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, we account for the differential impact of salt reduction in people with and without hypertension in line with evidence of the stronger effects of sodium on BP in those with hypertension (4, 7, 26). Third, there is limited empirical evidence on the longterm effects of sodium intake on CKD, echoed in a recent Cochrane meta-analysis (10). Our modelling compliments this evidence gap by projecting beyond intermediate outcomes (blood pressure) to CKD for the first time in Australia.…”

Section: Discussionmentioning

confidence: 99%

“…A recent Cochrane meta-analysis of randomized trials in people with CKD demonstrated that a reduction in salt intake by 4.2g (1,690mg sodium) per day lowered systolic and diastolic BP by 6.91 (4.99 -8.82) mmHg and 3.91 (3.02 -4.80) mmHg, respectively. In addition, for people with early stages of CKD, this salt reduction led to a 36% (26 -44) reduction in albuminuria, a potent marker of poor kidney function (10). Therefore, decreasing average population sodium consumption could play a significant role in reducing the morbidity and mortality associated with CKD in Australia. In 2019, an estimated 62% of the CKD deaths and 56% of CKD-related DALYs lost in Australia were due to hypertension (11).…”

Section: Introductionmentioning

confidence: 99%

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Projected impact on blood pressure, chronic kidney disease burden and healthcare costs of achieving the Australian sodium reduction targets: a modelling study

Aminde

Wanjau

Cobiac

et al. 2022

Preprint

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Background: Excess sodium intake increases blood pressure and risk of vascular complications. Most studies have focused on heart disease and stroke, but the impact on chronic kidney disease (CKD) is less well-characterised. The aim of this study was to estimate the impact of sodium intake on CKD burden in Australia. Methods: A dynamic epidemiological model was developed to estimate the potential impact on CKD if the Australian Suggested Dietary Target (SDT) and the National Preventive Health Strategy 2021-2030 (NPHS) sodium target were achieved. Outcomes were estimated between 2019 (base year) and 2030, and lifetime. Findings: Achieving the SDT and NPHS target could lower overall mean systolic blood pressure by 2.1 mmHg and 1.7 mmHg respectively. Compared to current sodium intake levels, attaining the SDT could prevent 59,220 (95% UI, 53,140 to 65,500) incident CKD cases and 568 (95% UI, 479 to 652) CKD deaths by 2030. Over the lifetime, this is projected to generate 199,488 (95% UI, 180,910 to 218,340) HALYs and AU$ 644 million in CKD health expenditure savings. Similarly, if achieved, the NPHS is estimated to prevent 49,890 (95% UI, 44,377 to 55,569) incident CKD cases and 511 (95% UI, 426 to 590) CKD deaths by 2030. Over the lifetime, this could produce 170,425 (95% UI, 155,017 to 186,559) HALYs and AU$ 514 million in CKD health expenditure savings. Conclusion: Achieving the national sodium reduction targets could deliver substantial health and economic benefits for people with CKD in Australia. Robust government action is required in order to achieve the projected outcomes of these policy targets.

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“…Today, the potential benefits of restricting salt intake are still discussed. Nevertheless, several studies and some meta-analyses have suggested that lowering sodium intake delays renal disease progression [ 38 – 40 ]. Recently, an open-label, cluster-randomized trial, the SSaSS study, including older adults with a history of stroke or high BP, has demonstrated prospectively the benefits of reducing sodium and increasing potassium intake in terms of CV morbidity [ 41 , 42 ].…”

Section: Management Of Hypertension In Ckdmentioning

confidence: 99%

New Aspects in the Management of Hypertension in Patients with Chronic Kidney Disease not on Renal Replacement Therapy

Damianaki

Polychronopoulou

Wuerzner

et al. 2021

High Blood Press Cardiovasc Prev

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With chronic kidney disease (CKD) being a global arising health problem, strategies for delaying kidney disease progression and reducing the high cardiovascular risk inherent to CKD, are the main objectives of the actual management of patients with kidney diseases. In these patients, the control of arterial hypertension is essential, as high blood pressure (BP) is a strong determinant of worst cardiovascular and renal outcomes. Achieving target blood pressures recommended by international guidelines is mandatory and often demands a multiple levels management, including several pharmacological and lifestyle measures. Even in the presence of adequate BP control, the residual cardiovascular risk remains high. In this respect, the recent demonstration that novel agents such as sodium glucose transporter 2 (SGLT2) inhibitors or the new non-steroidal mineralocorticoid antagonist finerenone can retard the progression of kidney diseases and reduce cardiovascular mortality on top of standard of care treatment with renin-angiotensin system inhibitors represent enormous progresses. These studies also demonstrate that cardiovascular and renal protection can be obtained beyond blood pressure control. Other promising novelties are still to come such as renal denervation and endothelin receptor antagonists in the setting of diabetic and non-diabetic kidney diseases. In the present review, we shall discuss the classic and the new aspects for the management of hypertension in CKD, integrating the new data from recent clinical studies.

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Altered dietary salt intake for people with chronic kidney disease

Abstract: 2. Art. No.: CD010070. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.

Cited by 53 publications

References 115 publications

Nutrition and quality of life in chronic kidney disease patients: a practical approach for salt restriction

Nutrition and quality of life in chronic kidney disease patients: a practical approach for salt restriction

Projected impact on blood pressure, chronic kidney disease burden and healthcare costs of achieving the Australian sodium reduction targets: a modelling study

New Aspects in the Management of Hypertension in Patients with Chronic Kidney Disease not on Renal Replacement Therapy

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