Estimation of Daily Sodium and Potassium Excretion Using Spot Urine and 24‐Hour Urine Samples in a Black Population (Benin)

Mizéhoun-Adissoda, Carmelle; Houéhanou, Corine; Chianea, Thierry; Dalmay, François; Bleich, André; Preux, Pierre‐Marie; Bovet, Pascal; Houinato, Dismand Stéphan; Desport, Jean‐Claude

doi:10.1111/jch.12722

Cited by 23 publications

(19 citation statements)

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“…13 However, most of these studies were conducted in high-income countries and there is little evidence about the usefulness of spot urine in low-or middle-income countries. 45,47,48 In the recently published SHAKE Package for Salt Reduction, WHO recommends that if resources and capacity permit, countries should collect 24-hour urine samples, but in cases where this is not possible, countries may obtain spot urine samples to measure population salt consumption. 3 The usefulness of spot urine in estimating mean change in population salt intake over time has also been recently explored.…”

Section: Discussionmentioning

confidence: 99%

The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (March–August 2016)

Santos

Trieu

Thout

et al. 2017

J of Clinical Hypertension

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This review aims to identify, summarize, and appraise studies reporting on the implementation of salt reduction interventions that were published between March and August 2016. Overall, 40 studies were included: four studies evaluated the impact of salt reduction interventions, while 36 studies were identified as relevant to the design, assessment, and implementation of salt reduction strategies. Detailed appraisal and commentary were undertaken on the four studies that measured the impact of the interventions. Among them, different evaluation approaches were adopted; however, all demonstrated positive health outcomes relating to dietary salt reduction. Three of the four studies measured sodium in breads and provided consistent evidence that sodium reduction in breads is feasible and different intervention options are available.None of the studies were conducted in low-or lower middle-income countries, which stresses the need for more resources and research support for the implementation of salt reduction interventions in these countries. | INTRODUCTIONHigh salt intake is one of the main contributors to premature death from cardiovascular diseases globally. of countries (China, Finland, France, England, and Ireland) had already achieved significant reductions in population salt intake. | METHODOLOGYA detailed description of the search strategy used to identify and screen studies in this review has been previously reported. In the current review, studies evaluating the impact of salt reduction interventions were appraised for risk of bias by two independent reviewers using a modified Cochrane risk of bias tool for nonrandomized trials of intervention studies. 4,7 Detailed appraisal and commentary were also performed on these studies. Other types of studies that provided information pertinent to the design, implementation, and assessment of salt reduction interventions were summarized in a table.These include (1) studies on monitoring and surveillance of salt intake;(2) salt content in foods; (3) consumers' knowledge, attitudes, and behaviors toward salt; (4) economic evaluation or modeling studies of salt reduction strategies; and (5) other studies related to implementation of salt reduction initiatives. | RESULTSThe MEDLINE search identified 3675 citations, of which 85 were considered potentially eligible for full review on the basis of their findings relevant to salt reduction interventions. Ultimately, a total of 40 studies met the inclusion criteria: four studies evaluated the impact of salt reduction interventions, 21 were surveillance or monitoring studies, five were modeling studies relating to salt reduction, and 10 other studies related to the implementation of salt reduction interventions (Figure 1). conducted at a community level, 8,11 one assessed the impact of salt substitution in breads employed at a community level, 10 and one evaluated the changes in sodium levels in foods achieved through voluntary sodium reduction targets implemented at a national level. 9The method for evaluating the impact ...

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Section: Discussionmentioning

confidence: 99%

The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (March–August 2016)

Santos

Trieu

Thout

et al. 2017

J of Clinical Hypertension

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“…Two of these formulas, developed for both sodium and potassium by Kawasaki et al [7] and Tanaka et al [8], were validated in healthy Asian populations. A simpler formula has been proposed by PAHO [9] and used in a number of previous studies [11,16,17]. Other formulas were also developed specifically for sodium but not potassium, such as the INTERSALT formula [18].…”

Section: Discussionmentioning

confidence: 99%

“…In our study, spot urine sample was collected in the morning, at the time of initiation of 24-hour urine collection, similarly to some other studies [17] and also reflecting the routine diagnostic procedures in our hospital unit.…”

Section: Discussionmentioning

confidence: 99%

“…In the study by Doenyas-Barak et al [26] using a modification of the PAHO formula, the mean bias estimated using the Bland-Altman method was +11 mmol/d, with 95% limits of agreement from -33 mmol/d to +55 mmol/d. In the study by Mizéhoun-Adissoda et al [17], the mean bias for the PAHO formula was -13.4 mmol/d, with 95% limits of agreement from -53 to +23 mmol/d. The authors of these studies concluded that this approach could be used to estimate 24-hour urinary potassium excretion.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic value of potassium level in a spot urine sample as an index of 24-hour urinary potassium excretion in unselected patients hospitalized in a hypertension unit

et al. 2017

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BackgroundPrimary hyperaldosteronism may be associated with elevated 24-hour urinary potassium excretion. We evaluated the diagnostic value of spot urine (SU) potassium as an index of 24-hour urinary potassium excretion.MethodsWe measured SU and 24-hour urinary collection potassium and creatinine in 382 patients. Correlations between SU and 24-hour collections were assessed for potassium levels and potassium/creatinine ratios. We used the PAHO formula to estimate 24-hour urinary potassium excretion based on SU potassium level. The agreement between estimated and measured 24-hour urinary potassium excretion was evaluated using the Bland-Altman method. To evaluate diagnostic performance of SU potassium, we calculated areas under the curve (AUC) for SU potassium/creatinine ratio and 24-hour urinary potassium excretion estimated using the PAHO formula.ResultsStrongest correlation between SU and 24-hour collection was found for potassium/creatinine ratio (r = 0.69, P<0.001). The PAHO formula underestimated 24-hour urinary potassium excretion by mean 8.3±18 mmol/d (95% limits of agreement -28 to +44 mmol/d). Diagnostic performance of SU potassium/creatinine ratio was borderline good only if 24-hour urinary potassium excretion was largely elevated (AUC 0.802 for 120 mmol K+/24 h) but poor with lower values (AUC 0.696 for 100 mmol K+/24 h, 0.636 for 80 mmol K+/24 h, 0.675 for 40 mmol K+/24 h). Diagnostic performance of 24-hour urinary potassium excretion estimated by the PAHO formula was excellent with values above 120 mmol/d and good with lower values (AUC 0.941 for 120 mmol K+/24 h, 0.819 for 100 mmol K+/24 h, 0.823 for 80 mmol K+/24 h, 0.836 for 40 mmol K+/24 h).ConclusionsSpot urine potassium/creatinine ratio might be a marker of increased 24-hour urinary potassium excretion and a potentially useful screening test when reliable 24-hour urine collection is not available. The PAHO formula allowed estimation of the 24-hour urinary potassium excretion based on SU measurements with reasonable clinical accuracy.

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“…However, this method is still not the standard for estimating sodium intake. Many prior studies have used dietary recall or spot urine samples to estimate sodium consumption, but these techniques are not considered reliable . Urine collection over 24 hours is the gold standard for estimating sodium intake, but collection of samples for a 24‐hour period in large population studies is difficult.…”

Section: Introductionmentioning

confidence: 99%

Associations of urinary sodium and sodium to potassium ratio with hypertension prevalence and the risk of cardiovascular events in patients with prehypertension

Zhao

Zhang

et al. 2017

J of Clinical Hypertension

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The aim of this study was to investigate the effects of urinary sodium and sodium to potassium ratio on inflammatory cytokines, hypertension, and cardiovascular disease in patients with prehypertension. The authors observed 627 patients with prehypertension in the General Hospital of Shenyang Military Region. Rank correlation analysis revealed that interleukin 6 expression exhibited significant positive correlations with urinary sodium (R = .13) and sodium to potassium ratio (R = .13). The multivariate‐adjusted hazard ratio of 24‐hour urinary sodium was 1.01 (95% confidence interval, 1.00 – 1.01) for hypertension and 1.01 (95% confidence interval, 1.00 – 1.02) for cardiovascular disease, whereas the hazard ratio for 24‐hour urinary sodium to potassium ratio was 1.13 (95% confidence interval, 1.08 – 1.19) for hypertension and 1.10 (95% confidence interval, 1.04 – 1.17) for cardiovascular disease. The study suggests that a high‐salt diet may lead to increased interleukin 6 levels and may contribute to hypertension. In addition, a high sodium to potassium ratio and high sodium levels are associated with increased risks of cardiovascular disease and hypertension in patients with prehypertension.

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Estimation of Daily Sodium and Potassium Excretion Using Spot Urine and 24‐Hour Urine Samples in a Black Population (Benin)

Cited by 23 publications

References 25 publications

The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (March–August 2016)

The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (March–August 2016)

Diagnostic value of potassium level in a spot urine sample as an index of 24-hour urinary potassium excretion in unselected patients hospitalized in a hypertension unit

Associations of urinary sodium and sodium to potassium ratio with hypertension prevalence and the risk of cardiovascular events in patients with prehypertension

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