Validation and comparison of three formulae to estimate sodium and potassium excretion from a single morning fasting urine compared to 24-h measures in 11 countries

Mente, Andrew; O’Donnell, Martin J.; Dagenais, Gilles R.; Wielgosz, Andy; Lear, Scott A.; McQueen, Matt J.; Jiang, Ying; Wang, Xingyu; Jiang, Bo; Calik, Kbt; Akalın, Ayşe; Mony, Prem; Devanath, Anitha; Yusufali, Afzalhussein; López‐Jaramillo, Patricio; Avezum, Álvaro; Yusoff, Khaled; Rosengren, Annika; Kruger, Iolanthé M.; Orlandini, Andrés; Rangarajan, Sumathi; Teo, Koon; Yusuf, Salim

doi:10.1097/hjh.0000000000000122

Cited by 188 publications

(151 citation statements)

References 24 publications

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“…417 In the Prospective Urban Rural Epidemiology (PURE) study, which used samples from 11 countries, including many Asians, the Kawasaki equation instead was the best fit. 418 Most investigators [418][419][420] found that although corrected spot urines may be sufficient to estimate mean population sodium excretion levels, there was substantial disagreement between the measures for individuals. Hence, spot urines, which exhibit increased variability compared with actual 24-hour measurements, should be considered inadequate for the assessment of sodium excretion in research studies dealing with SSBP.…”

Section: Measurement Of Sodium Intake/excretion and Assessment Of Ssbpmentioning

confidence: 99%

Salt Sensitivity of Blood Pressure

Elijovich¹,

Weinberger²,

Anderson³

et al. 2016

Hypertension

386

230

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The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on January 23, 2016, and the American Heart Association Executive Committee on February 23, 2016. A copy of the document is available at http://professional.heart.org/statements by using either "Search for Guidelines & Statements" or the "Browse by Topic" area. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@ wolterskluwer.com.The American Heart Association requests that this document be cited as follows: Elijovich F, Weinberger MH, Anderson CAM, Appel LJ, Bursztyn M, Cook NR, Dart RA, Newton-Cheh CH, Sacks FM, Laffer CL; on behalf of the American Heart Association Professional and Public Education Committee of the Council on Hypertension; Council on Functional Genomics and Translational Biology; and Stroke Council. Salt sensitivity of blood pressure: a scientific statement from the American Heart Association. Hypertension. 2016;68:e7-e46. doi: 10.1161/HYP.0000000000000047.Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://professional.heart.org/statements. Select the "Guidelines & Statements" drop-down menu, then click "Publication Development."Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/CopyrightPermission-Guidelines_UCM_300404_Article.jsp. A link to the "Copyright Permissions Request Form" appears on the right side of the page. Figure 2 shows the major effect of aging in increasing the prevalence of SSBP in both normotensive and hypertensive subjects. An important and encouraging observation is that the multiple phenotypic characteristics described in pure SS strains of rodents reproduce those observed in humans, indicating that the phenotypic cluster of SSBP can be brought out in humans by the current techniques used in carefully controlled research. Additionally, despite the unquestionable influence of environmental factors in the determination of SSBP in humans, estimates of its heritability have been as high as 74% in blacks 9 and 50% in Chinese subjects, 10 both higher than those for hypertension. Salt Sensitivity of Blood PressureAn important issue is the clinical significance of the SSBP phenotype. There was increasing understanding that it represents an abnormality. The reasons w...

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Section: Measurement Of Sodium Intake/excretion and Assessment Of Ssbpmentioning

confidence: 99%

Salt Sensitivity of Blood Pressure

Elijovich¹,

Weinberger²,

Anderson³

et al. 2016

Hypertension

386

230

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“…24 When using a fasting urine sample, the Kawasaki formula-derived estimates produce the least biased estimates of sodium intake (intraclass correlation of 0.71 for Kawasaki formula estimated 24-hour sodium excretion compared with actual 24-hour urinary collections), based on an international validation study in 11 countries. 25 In other settings, for example, when using a nonfasting sample, that Kawasaki formula is associated with more biased estimates than other formula which were developed for use of spot random samples. 24 Therefore, the type of sample collected (time and fasting status), population included, and formula used are important considerations.…”

Section: Methods Of Measuring Sodium Intakementioning

confidence: 99%

Sodium Intake and Cardiovascular Health

O’Donnell

Mente

Yusuf

2015

Circulation Research

Self Cite

173

109

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Sodium is an essential nutrient. Increasing sodium intake is associated with increasing blood pressure, whereas low sodium intake results in increased renin and aldosterone levels. Randomized controlled trials have reported reductions in blood pressure with reductions in sodium intake, to levels of sodium intake <1.5 g/d, and form the evidentiary basis for current population-wide guidelines recommending low sodium intake. Although low sodium intake (<2.0 g/d) has been achieved in short-term feeding clinical trials, sustained low sodium intake has not been achieved by any of the longer term clinical trials (>6-month duration). It is assumed that the blood pressure-lowering effects of reducing sodium intake to low levels will result in large reductions in cardiovascular disease globally. However, current evidence from prospective cohort studies suggests a J-shaped association between sodium intake and cardiovascular events, based on studies from >300 000 people, and suggests that the lowest risk of cardiovascular events and death occurs in populations consuming an average sodium intake range (3-5 g/d). The increased risk of cardiovascular events associated with higher sodium intake (>5 g/d) is most prominent in those with hypertension. A major deficit in the field is the absence of large randomized controlled trials to provide definitive evidence on optimal sodium intake for preventing cardiovascular events. Pending such trials, current evidence would suggest a recommendation for moderate sodium intake in the general population (3-5 g/d), with targeting the lower end of the moderate range among those with hypertension. (Circ Res.

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“…3 The PURE study did attempt to validate spot urine sodium to 24-hour urine sodium and found a moderate association; however, that validation study also had concerning methodological and quality control issues. 4,5 The study included 24-hour urine samples within 25% of predicted 24-hour excretion of creatinine as being complete even though the original method called for excluding urine that exceeded 15% of predicted creatinine excretion. 6 There was no rationale provided for revising the criteria for assessing complete urine collection but, even with the revised criteria, only 50% of 24-hour urine samples were "complete."…”

mentioning

confidence: 99%

Is Reducing Dietary Sodium Controversial? Is It the Conduct of Studies With Flawed Research Methods That Is Controversial? A Perspective From the World Hypertension League Executive Committee

Campbell

Lackland

Niebylski

et al. 2014

J of Clinical Hypertension

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There were two recent publications from the New England Journal of Medicine (NEJM) relating to dietary sodium that are likely to generate controversy. One study reported that sodium intake <3000 mg/d was associated with an increase in mortality and cardiovascular disease while confirming the health risks of dietary sodium >6000 mg/d. 1 The other study largely confirmed the association between sodium intake and increased blood pressure (BP) but, unlike rigorous randomized controlled trials, found less of an impact of sodium intake <3000 mg/d on BP.2 Both studies confirmed that lower dietary potassium is associated with both increased BP and adverse health outcomes. The studies were based on the Prospective Urban Rural Epidemiology (PURE) cohort of more than 100,000 people in 17 countries.The PURE study, however, used weak research methodology in assessing dietary sodium. A single spot urine sample (first or second morning void) was used to estimate a person's sodium intake. Single spot urine samples simply are not a reliable method of sodium intake. In a systematic review comparing spot urine samples vs 24-hour urine samples, there was a very wide range of correlations found between spot and 24-hour urine sodium (from 0.17 to 0.92), with no known scientific basis for the variation. The PURE study did attempt to validate spot urine sodium to 24-hour urine sodium and found a moderate association; however, that validation study also had concerning methodological and quality control issues. 4,5The study included 24-hour urine samples within 25% of predicted 24-hour excretion of creatinine as being complete even though the original method called for excluding urine that exceeded 15% of predicted creatinine excretion.6 There was no rationale provided for revising the criteria for assessing complete urine collection but, even with the revised criteria, only 50% of 24-hour urine samples were "complete." Because the revised standards likely included many incomplete 24-hour urine samples, it would have overestimated the association between spot urine samples and 24-hour urine sodium samples and also resulted in the assessment of bias being unreliable. Further, single 24-hour urine samples are not a reliable estimate of usual salt intake as salt intake generally varies day to day in many settings.Based on a currently unpublished meta-analysis and review of the literature, a World Health Organization expert group concluded that although more research was required, 300 to 400 spot urine sodium samples from individuals selected to be representative of the population could reflect the average sodium intake in a population (N. Campbell, personal communication, September 2, 2014). It has not been established how many spot urine samples are required to accurately reflect an individual's sodium intake.The BP indicators from the PURE study also do not align well with several rigorous national BP surveys. For example, in Canada, the PURE study reported an ageadjusted hypertension prevalence of 30% and an uncontrolled BP (stage 1-3 hy...

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Validation and comparison of three formulae to estimate sodium and potassium excretion from a single morning fasting urine compared to 24-h measures in 11 countries

Abstract: In a diverse population, the Kawasaki formula is the most valid and least biased method of estimating 24-h sodium excretion from a single MFU and is suitable for population studies.

Cited by 188 publications

References 24 publications

Salt Sensitivity of Blood Pressure

Salt Sensitivity of Blood Pressure

Sodium Intake and Cardiovascular Health

Is Reducing Dietary Sodium Controversial? Is It the Conduct of Studies With Flawed Research Methods That Is Controversial? A Perspective From the World Hypertension League Executive Committee

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