Spot Urine-guided Salt Reduction in Chronic Kidney Disease Patients

Uchiyama, Kiyotaka; Yanai, Akane; Ishibashi, Yoshitaka

doi:10.1053/j.jrn.2017.04.005

Cited by 7 publications

(4 citation statements)

References 17 publications

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“…Identified studies were meta‐analyses (n = 1), RCTs (n = 3), prospective cohort studies (n = 4), retrospective case–control studies (n = 1), cross‐sectional studies (n = 27), case–control studies (n = 1), post hoc analyses of RCTs (n = 2), and quasi‐experimental studies (n = 3). Three studies assessed morbidity outcomes, two studies assessed outcomes related to symptoms/quality of life/functional status, 31 studies assessed clinically relevant surrogate outcomes, including 26 that assessed blood pressure outcomes, and six studies assessed physiologic outcomes . Of these studies, only three studies met the minimum methodological criteria for detailed critical appraisal (Table ).…”

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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“…Urinary volume (mL) and Uosm (mOsm) were measured using 24-h urine samples collected at 4, 8, and 12 weeks of each trial. In daily clinical practice, salt intake of the patients was strictly controlled via a spot urine-guided method, which included informing patients of their spot urine-estimated salt intake at every visit to the outpatient clinic 40 and performing periodical 24-h urine collections to accurately determine salt intake. Additionally, to assess the validity of the 24-h urine samples in the present trial, we ensured that the variation of 24-h urinary creatinine excretion was within 0.2 g/day and that none of the patients missed any urine sample collections.…”

Section: Methodsmentioning

confidence: 99%

The effect of trichlormethiazide in autosomal dominant polycystic kidney disease patients receiving tolvaptan: a randomized crossover controlled trial

Uchiyama

Kitayama

Yanai

et al. 2021

Sci Rep

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The vasopressin V2 receptor antagonist tolvaptan delays the progression of autosomal dominant polycystic kidney disease (ADPKD). However, some patients discontinue tolvaptan because of severe adverse aquaretic events. This open-label, randomized, controlled, counterbalanced, crossover trial investigated the effects of trichlormethiazide, a thiazide diuretic, in patients with ADPKD receiving tolvaptan (n = 10) who randomly received antihypertensive therapy with or without trichlormethiazide for 12 weeks. The primary and secondary outcomes included amount and osmolarity of 24-h urine and health-related quality-of-life (HRQOL) parameters assessed by the Kidney Disease Quality of Life-Short Form questionnaire, renal function slope, and plasma/urinary biomarkers associated with disease progression. There was a significant reduction in urine volume (3348 ± 584 vs. 4255 ± 739 mL; P < 0.001) and a significant increase in urinary osmolarity (182.5 ± 38.1 vs. 141.5 ± 38.1 mOsm; P = 0.001) in patients treated with trichlormethiazide. Moreover, trichlormethiazide improved the following HRQOL subscales: effects of kidney disease, sleep, emotional role functioning, social functioning, and role/social component summary. No significant differences were noted in renal function slope or plasma/urinary biomarkers between patients treated with and without trichlormethiazide. In patients with ADPKD treated with tolvaptan, trichlormethiazide may improve tolvaptan tolerability and HRQOL parameters.

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“…33,34 Spot urine-based assessments have been proposed as a more practical alternative, based on urinary sodium-to-creatinine (uNa/ Cr) or sodium-to-potassium (uNa/K) ratios. 9,31,35,36 Whether spot uNa/K is more informative than spot uNa/Cr or uK/Cr alone for assessing the impact on BP and hypertension control in patients with CKD has not yet been investigated. We therefore tested the hypothesis that uNa/K excretion is a stronger predictor of BP level and hypertension control status than either urinary sodium or potassium excretion alone in patients with moderate or severe CKD, using spot urine samples.…”

mentioning

confidence: 99%

Urinary Sodium-to-Potassium Ratio and Blood Pressure in CKD

Pinho¹,

Kaboré²,

Laville³

et al. 2020

Kidney International Reports

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Introduction: In the general population, urinary sodium-to-potassium (uNa/K) ratio associates more strongly with high blood pressure (BP) than either urinary sodium or potassium alone. Whether this is also the case among patients with chronic kidney disease (CKD) is unknown. Methods: We studied the associations of spot urine sodium-to-creatinine (uNa/Cr), potassium-tocreatinine (uK/Cr), and uNa/K ratios with a single office BP reading in 1660 patients with moderate to severe CKD at inclusion in the CKD-REIN cohort. Results: Patients' median age was 68 (interquartile range [IQR], 59-76) years; most were men (65%), had moderate CKD (57%), and albuminuria (72%). Mean systolic and diastolic BP was 142/78 mm Hg. Spot uNa/ Cr and uNa/K ratios were positively associated with systolic, mean arterial, and pulse pressures. The mean adjusted difference in systolic BP between the highest and the lowest quartile (Q4 vs. Q1) was 4.24 (95% confidence interval [CI], 1.53-6.96) mm Hg for uNa/Cr and 4.79 (95% CI, 2.18-7.39) mm Hg for uNa/K. Quartiles of spot uK/Cr were not associated with any BP index. The higher the quartile of uNa/K, the higher the prevalence ratio of uncontrolled (Q4 vs. Q1, 1.43; 95% CI, 1.19-1.72) or apparently treatment-resistant hypertension (Q4 vs. Q1, 1.35; 95% CI, 1.14-1.60). Findings were consistent in a subset of 803 individuals with 2 BP readings. Conclusion: In patients with CKD, higher urinary sodium excretion is associated with higher BP, but unlike in general population, lower potassium excretion is not. Urinary Na/K does not add significant value in assessing high BP risk, except perhaps for hypertension control assessment.

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Spot Urine-guided Salt Reduction in Chronic Kidney Disease Patients

Cited by 7 publications

References 17 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)

The effect of trichlormethiazide in autosomal dominant polycystic kidney disease patients receiving tolvaptan: a randomized crossover controlled trial

Urinary Sodium-to-Potassium Ratio and Blood Pressure in CKD

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