Journal Mobile Options
Table of Contents
Vol. 36, No. 5, 2012
Issue release date: November 2012
Am J Nephrol 2012;36:397–404
(DOI:10.1159/000342966)

Urinary Sodium Is a Potent Correlate of Proteinuria: Lessons from the Chronic Renal Insufficiency Cohort Study

Weir M.R. · Townsend R.R. · Fink J.C. · Teal V. · Sozio S.M. · Anderson C.A. · Appel L.J. · Turban S. · Chen J. · He J. · Litbarg N. · Ojo A. · Rahman M. · Rosen L. · Steigerwalt S. · Strauss L. · Joffe M.M. · on behalf of the CRIC study Investigators
aUniversity of Maryland School of Medicine, Baltimore, Md., bUniversity of Pennsylvania, Philadelphia, Pa., cJohns Hopkins Medical Institutions, Baltimore, Md., dTulane University School of Medicine, New Orleans, La., eUniversity of Illinois School of Medicine, Chicago, Ill., fUniversity of Michigan School of Medicine, Ann Arbor, Mich., gCase Western Reserve School of Medicine, Cleveland, Ohio, and hSt. Claire Specialty Center, Lakewood, Wash., USA

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Background: While higher blood pressure is known to increase proteinuria, whether increased dietary sodium as estimated from 24-hour urinary excretion correlates with increased proteinuria in patients with chronic kidney disease (CKD) is not well studied. Methods: We measured 24-hour urinary sodium, potassium and protein excretion in 3,680 participants in the Chronic Renal Insufficiency Cohort study, to determine the relationship between urinary sodium and potassium and urinary protein excretion in patients with CKD. We stratified our data based on the presence or absence of diabetes given the absence of any data on this relationship and evidence that diabetics had greater urinary protein excretion at nearly every level of urinary sodium excretion. Multiple linear regressions were used with a stepwise inclusion of covariates such as systolic blood pressure, demographics, hemoglobin A1c and type of antihypertensive medications to evaluate the relationship between urinary electrolyte excretion and proteinuria. Results: Our data demonstrated that urinary sodium (+1 SD above the mean), as a univariate variable, explained 12% of the variation in proteinuria (β = 0.29, p < 0.0001), with rising urinary sodium excretion associated with increasing proteinuria. The significance of that relationship was only partially attenuated with adjustment for demographic and clinical factors and the addition of 24-hour urinary potassium to the model (β = 0.13, R2 = 0.35, p < 0.0001). Conclusions: An understanding of the relationship between these clinical factors and dietary sodium may allow a more tailored approach for dietary salt restriction in patients with CKD.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Bibbins-Domingo K, Chertow GM, Coxson PG, Moran A, Lightwood JM, Pletcher MJ, et al: Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med 2010;362:590–599.
  2. Graudal NA, Galloe AM, Garred P: Effects of sodium restriction on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride: a meta-analysis. JAMA 1998;279:1383–1391.
  3. Midgley JP, Matthew AG, Greenwood CM, Logan AG: Effect of reduced dietary sodium on blood pressure: a meta-analysis of randomized controlled trials. JAMA 1996;275:1590–1597.
  4. Smith-Spangler CM, Juusola JL, Enns EA, Owens DK, Garber AM: Population strategies to decrease sodium intake and the burden of cardiovascular disease: a cost-effectiveness analysis. Ann Intern Med 2010;152:481–483.

    External Resources

  5. Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerova J, Richart T, et al: Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA 2011;305:1777–1785.
  6. Heeg JE, de Jong PE, van der Hem GK, de Zeeuw D: Efficacy and variability of the antiproteinuric effect of ACE inhibition by lisinopril. Kidney Int 1989;36:272–279.
  7. Vogt L, Waanders F, Boomsma F, de ZD, Navis G: Effects of dietary sodium and hydrochlorothiazide on the antiproteinuric efficacy of losartan. J Am Soc Nephrol 2008;19:999–1007.
  8. Messerli FH, Schmieder RE, Weir MR: Salt. A perpetrator of hypertensive target organ disease? Arch Intern Med 1997;157:2449–2452.
  9. Tobian L, Hanlon S: High sodium chloride diets injure arteries and raise mortality without changing blood pressure. Hypertension 1990;15:900–903.
  10. Weir MR, Dengel DR, Behrens MT, Goldberg AP: Salt-induced increases in systolic blood pressure affect renal hemodynamics and proteinuria. Hypertension 1995;25:1339–1344.
  11. Jones-Burton C, Mishra SI, Fink JC, Brown J, Gossa W, Bakris GL, et al: An in-depth review of the evidence linking dietary salt intake and progression of chronic kidney disease. Am J Nephrol 2006;26:268–275.
  12. Perry IJ, Beevers DG: Salt intake and stroke: a possible direct effect. J Hum Hypertens 1992;6:23–25.
  13. Feldman HI, Appel LJ, Chertow GM, Cifelli D, Cizman B, Daugirdas J, et al: The Chronic Renal Insufficiency Cohort (CRIC) Study: design and methods. J Am Soc Nephrol 2003;14(7 suppl 2):S148–S153.

    External Resources

  14. Peterson JC, Adler S, Burkart JM, Greene T, Hebert LA, Hunsicker LG, et al: Blood pressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease Study. Ann Intern Med 1995;123:754–762.
  15. D’Elia L, Barba G, Cappuccio FP, Strazzullo P: Potassium intake, stroke, and cardiovascular disease: a meta-analysis of prospective studies. J Am Coll Cardiol 2011;57:1210–1219.

    External Resources

  16. Astor BC, Matsushita K, Gansevoort RT, van d, V, Woodward M, Levey AS, et al: Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts. Kidney Int 2011;79:1331–1340.
  17. de Zeeuw D, Remuzzi G, Parving HH, Keane WF, Zhang Z, Shahinfar S, et al: Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: lessons from RENAAL. Kidney Int 2004;65:2309–2320.
  18. Jafar TH, Stark PC, Schmid CH, Landa M, Maschio G, Marcantoni C, et al: Proteinuria as a modifiable risk factor for the progression of non-diabetic renal disease. Kidney Int 2001;60:1131–1140.
  19. de Zeeuw D, Remuzzi G, Parving HH, Keane WF, Zhang Z, Shahinfar S, et al: Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation 2004;110:921–927.
  20. Myrvang H: Progression of renal disease: high salt intake blunts the benefit of ACE inhibitors and accelerates renal function decline. Nat Rev Nephrol 2012;8:61.

    External Resources

  21. Vegter S, Perna A, Postma MJ, Navis G, Remuzzi G, Ruggenenti P: Sodium intake, ACE inhibition, and progression to ESRD. J Am Soc Nephrol 2012;23:165–173.
  22. Yu W, Luying S, Haiyan W, Xiaomei L: Importance and benefits of dietary sodium restriction in the management of chronic kidney disease patients: experience from a single Chinese center. Int Urol Nephrol 2012;44:549–556.

    External Resources

  23. Nakamura T, Kataoka K, Tokutomi Y, Nako H, Toyama K, Dong YF, et al: Novel mechanism of salt-induced glomerular injury: critical role of eNOS and angiotensin II. J Hypertens 2011;29:1528–1535.
  24. Liu K, Dyer AR, Cooper RS, Stamler R, Stamler J: Can overnight urine replace 24-hour urine collection to asses salt intake? Hypertension 1979;1:529–536.
  25. Krikken JA, Laverman GD, Navis G: Benefits of dietary sodium restriction in the management of chronic kidney disease. Curr Opin Nephrol Hypertens 2009;18:531–538.
  26. Wright JA, Cavanaugh KL: Dietary sodium in chronic kidney disease: a comprehensive approach. Semin Dial 2010;23:415–421.

    External Resources



Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50