The efficacy of quantitative and qualitative chloride titrators in the estimation of human salt intake

Abstract

We evaluated the utility of chloride titrator sticks for facilitating the assessment of dietary salt intake, in a systematic series of clinical trials. These inexpensive devices were applied daily to 24-h or nocturnal urine specimens, thereby avoiding the inter- and intra-subject variability in salt excretion which confounds the use of occasional 24-h urine collections. Chloride and sodium concentrations in urine were highly correlated (r greater than 0.92) in either nocturnal, diurnal, or 24-h collections. The quantitative chloride titrator estimates and measured chloride concentrations were highly correlated as well (r greater than 0.99). The qualitative chloride titrator was graded on a simple scale, and was successfully employed by outpatients attempting to limit their salt intake. Commonly used antihypertensive medications did not interfere with the determinations. Additional chloride intake, such as supplemental potassium chloride, interfered with estimates of salt ingestion, but if the daily amount of potassium chloride supplement was constant, adjustments in interpretation could be made. Renal insufficiency introduced a systematic over-estimation of salt intake by the qualitative chloride tirator, but only at high salt intakes. Relative estimates of salt intake in subjects with renal failure were still possible. We conclude that chloride titrators can facilitate the management of patients who require a prescribed salt intake.

Report of the Working Group for Dietary Salt Reduction of the Japanese Society of Hypertension: (2) Assessment of Salt Intake in the Management of Hypertension

“…This method, by which salt intake is estimated by measuring the salt concentration in spot urine or overnight urine using test paper or an electronic salt sensor, is the simplest (22,23). The test paper or salt sensor usually detects chloride (Cl) rather than Na, and the results of examination of overnight urine using a test paper have been shown to be correlated with salt intake estimated by a nutritional survey (23).…”

Trial design: Blood pressure control and weight gain prevention in prehypertensive and hypertensive smokers: The treatment and prevention study

“…This is accomplished by measuring urinary chloride excretion. The vast majority of sodium in the diet is ingested in the form of sodium chloride [41]. Because urinary sodium and urinary chloride levels are very highly correlated (typically in the range of r = 0.9) [41][42][43][44], chloride levels provide a good index of dietary sodium intake.…”

“…The vast majority of sodium in the diet is ingested in the form of sodium chloride [41]. Because urinary sodium and urinary chloride levels are very highly correlated (typically in the range of r = 0.9) [41][42][43][44], chloride levels provide a good index of dietary sodium intake. Overnight urinary chloride levels are assessed using chloride titrator sticks [41,[43][44][45].…”

“…Because urinary sodium and urinary chloride levels are very highly correlated (typically in the range of r = 0.9) [41][42][43][44], chloride levels provide a good index of dietary sodium intake. Overnight urinary chloride levels are assessed using chloride titrator sticks [41,[43][44][45]. Chloride titrators correlate very highly with measures of urinary sodium excretion [41,[45][46], and discriminate well among patients consuming diets containing different levels of sodium intake [41,46].…”

“…Overnight urinary chloride levels are assessed using chloride titrator sticks [41,[43][44][45]. Chloride titrators correlate very highly with measures of urinary sodium excretion [41,[45][46], and discriminate well among patients consuming diets containing different levels of sodium intake [41,46].…”