Effect of sodium intake on renin level: Analysis of general population and meta-analysis of randomized controlled trials

Ok-Jin, Rhee; Rhee, Moo Yong; Oh, Sang-Woo; Shin, Sung Joon; Gu, Namyi; Nah, Deuk Young; Kim, S. W.; Lee, Jae Hang

doi:10.1016/j.ijcard.2016.04.109

Cited by 19 publications

(10 citation statements)

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“…These shorter studies are likely to have influenced the finding of increases in renin and aldosterone in response to lowering sodium intake, although these findings are unlikely to have long‐term physiological implications. Rhee et al conducted a meta‐regression including 74 studies and found that per day increase in the duration of the sodium reduction intervention renin was reduced by 0.04 (standardized mean difference; 95% CI: −0.05, −0.02), indicating that an increase in renin is an adaptive acute effect of sodium reduction but normalization is achieved after acclimation to the sodium content of the diet occurs. Thus, the results of the meta‐analysis by Graudal et al should be interpreted with caution since this finding is unlikely to be relevant to long‐term public health efforts to reduce dietary sodium.…”

Section: Resultsmentioning

confidence: 99%

Paucity of high‐quality studies reporting on salt and health outcomes from the science of salt: A regularly updated systematic review of salt and health outcomes (April 2017 to March 2018)

Petersen

Rae

Venos

et al. 2018

J of Clinical Hypertension

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The purpose of this review is to identify, summarize, and critically appraise studies on dietary salt and health outcomes that were published from April 2017 to March 2018. The search strategy was adapted from a previous systematic review on dietary salt and health. Identified studies were screened based on a priori defined criteria to identify publications eligible for detailed critical appraisals. Overall, 6747 citations were identified by the search strategy, and 42 health outcome studies were identified. Three of the 42 studies met the criteria for methodological quality and health outcomes and underwent detailed critical appraisals and commentary. In addition, a systematic review and meta-analysis was critically appraised, although it did not strictly meet our methodological criteria. All four of the studies critically appraised found that sodium reduction improved blood pressure, especially in individuals with hypertension. In addition, sodium reduction reduced albuminuria in patients with stage 1-3 chronic kidney disease. Examination of the time course of blood pressure responses to sodium reduction revealed lowering sodium in the context of an average American diet may not produce maximal blood pressure reductions within a 4week intervention period. This review provides further evidence of the benefit of sodium reduction for blood pressure lowering and gives insights into the subgroups of the population that may derive the greatest benefit from sodium reduction and the

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Section: Resultsmentioning

confidence: 99%

Paucity of high‐quality studies reporting on salt and health outcomes from the science of salt: A regularly updated systematic review of salt and health outcomes (April 2017 to March 2018)

Petersen

Rae

Venos

et al. 2018

J of Clinical Hypertension

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“…The conclusion that there is no value in non-hypertensive individuals is dependent upon the results from very short term studies in which sodium reduction had a limited effect on blood pressure and in which there were adverse effects on other markers of cardiovascular risk. The responses of the renin-angiotensin system and sympathetic nervous system as well as adverse metabolic effects associated with acute large falls in dietary sodium do not, however, appear to be present in longer term interventions21165 and it is unlikely that short term unfavourable metabolic effects would override the long term benefits anticipated from sustained blood pressure lowering of moderate magnitude. Our review identifies an approximate doubling of the effect of sodium reduction on blood pressure in studies of longer than two weeks’ duration versus shorter studies, indicating that the full effects of dietary sodium reduction require several weeks to become apparent.…”

Section: Discussionmentioning

confidence: 99%

Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials

Huang

Trieu

Yoshimura

et al. 2020

BMJ

281

224

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ObjectiveTo examine the dose-response relation between reduction in dietary sodium and blood pressure change and to explore the impact of intervention duration.DesignSystematic review and meta-analysis following PRISMA guidelines.Data sourcesOvid MEDLINE(R), EMBASE, and Cochrane Central Register of Controlled Trials (Wiley) and reference lists of relevant articles up to 21 January 2019.Inclusion criteriaRandomised trials comparing different levels of sodium intake undertaken among adult populations with estimates of intake made using 24 hour urinary sodium excretion.Data extraction and analysisTwo of three reviewers screened the records independently for eligibility. One reviewer extracted all data and the other two reviewed the data for accuracy. Reviewers performed random effects meta-analyses, subgroup analyses, and meta-regression.Results133 studies with 12 197 participants were included. The mean reductions (reduced sodium v usual sodium) of 24 hour urinary sodium, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were 130 mmol (95% confidence interval 115 to 145, P<0.001), 4.26 mm Hg (3.62 to 4.89, P<0.001), and 2.07 mm Hg (1.67 to 2.48, P<0.001), respectively. Each 50 mmol reduction in 24 hour sodium excretion was associated with a 1.10 mm Hg (0.66 to 1.54; P<0.001) reduction in SBP and a 0.33 mm Hg (0.04 to 0.63; P=0.03) reduction in DBP. Reductions in blood pressure were observed in diverse population subsets examined, including hypertensive and non-hypertensive individuals. For the same reduction in 24 hour urinary sodium there was greater SBP reduction in older people, non-white populations, and those with higher baseline SBP levels. In trials of less than 15 days’ duration, each 50 mmol reduction in 24 hour urinary sodium excretion was associated with a 1.05 mm Hg (0.40 to 1.70; P=0.002) SBP fall, less than half the effect observed in studies of longer duration (2.13 mm Hg; 0.85 to 3.40; P=0.002). Otherwise, there was no association between trial duration and SBP reduction.ConclusionsThe magnitude of blood pressure lowering achieved with sodium reduction showed a dose-response relation and was greater for older populations, non-white populations, and those with higher blood pressure. Short term studies underestimate the effect of sodium reduction on blood pressure.Systematic review registrationPROSPERO CRD42019140812.

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“…[6][7][8][9][10][11][12][13] However, restriction in dietary sodium intake also activates the renin-angiotensinaldosterone system (RAAS) and sympathetic nervous system. [14][15][16] Aggravation of insulin resistance has also been reported in subjects consuming low dietary sodium. 17 Accordingly, a recent investigation showed that survival of patients with type 1 diabetes can be reduced not only by high urinary sodium excretion but also low excretion.…”

mentioning

confidence: 92%

High and low sodium intakes are associated with incident chronic kidney disease in patients with normal renal function and hypertension

Yoon

Noh

Lee

et al. 2018

Kidney International

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The association between salt intake and renal outcome in subjects with preserved kidney function remains unclear. Here we evaluated the effect of sodium intake on the development of chronic kidney disease (CKD) in a prospective cohort of people with normal renal function. Data were obtained from the Korean Genome and Epidemiology Study, a prospective community-based cohort study while sodium intake was estimated by a 24-hour dietary recall Food Frequency Questionnaire. A total of 3,106 individuals with and 4,871 patients without hypertension were analyzed with a primary end point of CKD development [a composite of estimated glomerular filtration rate (eGFR) under 60 mL/min/1.73 m and/or development of proteinuria during follow-up]. The median ages were 55 and 47 years, the proportions of males 50.9% and 46.3%, and the median eGFR 92 and 96 mL/min/1.73 m in individuals with and without hypertension, respectively. During a median follow-up of 123 months in individuals with hypertension and 140 months in those without hypertension, CKD developed in 27.8% and 16.5%, respectively. After adjusting for confounders, multiple Cox models indicated that the risk of CKD development was significantly higher in people with hypertension who consumed less than 2.08 g/day or over 4.03 g/day sodium than in those who consumed between 2.93-4.03 g/day sodium. However, there was no significant difference in the incident CKD risk among each quartile of people without hypertension. Thus, both high and low sodium intakes were associated with increased risk for CKD, but this relationship was only observed in people with hypertension.

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Effect of sodium intake on renin level: Analysis of general population and meta-analysis of randomized controlled trials

Cited by 19 publications

References 92 publications

Paucity of high‐quality studies reporting on salt and health outcomes from the science of salt: A regularly updated systematic review of salt and health outcomes (April 2017 to March 2018)

Paucity of high‐quality studies reporting on salt and health outcomes from the science of salt: A regularly updated systematic review of salt and health outcomes (April 2017 to March 2018)

Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials

High and low sodium intakes are associated with incident chronic kidney disease in patients with normal renal function and hypertension

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