renal function decline; salt; sodium; urinary sodium-to-potassium ratio
Abstract :
[en] Background: The prevalence of chronic kidney disease (CKD) is increasing worldwide in part due to population ageing. Identifying risk factors for age-related kidney function decline could help in understanding mechanisms for kidney ageing. Sodium and potassium intakes are associated with CKD progression in the renal population, but little is known on their role in renal function decline [mean estimated glomerular filtration rate variation ([DELTA]eGFR)] in the general adult population.
Method: We therefore explored the association of urinary sodium and potassium excretions with [DELTA]eGFR in a longitudinal population-based cohort. We estimated 24-h urinary sodium (eUNa), potassium (eUK) and sodium-to-potassium ratio (eUNa/K) from spot urine using Kawasaki formulae. We performed multivariate linear regression models studying the association of eUNa, eUK and eUNa/K with yearly [DELTA]eGFR, taking several covariates into account, including baseline eGFR and albuminuria.
Results: There were 4141 white participants from which 54.3% were women. Median age was 51.5 [43.6-60.6] years and mean baseline eGFR 88 (SD 15) ml/min per 1.73 m2. During a median follow-up of 5.4 years, mean [DELTA]eGFR was -0.59 (SD 1.68) ml/min per 1.73 m2 per year. In the fully adjusted model, high eUNa and eUNa/K were associated with faster renal function decline with standardized coefficients [beta] = -0.07 (95% confidence interval: -0.11 to -0.04) and [beta] = -0.05 (95% confidence interval: -0.08 to -0.02), respectively. By contrast, eUK, taken alone, showed no association.
Conclusion: These results suggest that dietary sodium and potassium intakes may play a role in kidney function decline in the general adult population. Whether lowering sodium and increasing potassium in the diet may help in CKD prevention needs further exploration.
Disciplines :
Urology & nephrology
Author, co-author :
Dériaz, Denis ; Centre Hospitalier Universitaire Vaudois (Lausanne) > Institute of Social and Preventive Medicine (IUMSP)
Guessous, Idris; Hôpitaux Universitaires de Genève - HUG > Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine and Primary Care and Emergency Medicine
Vollenweider, Peter; Centre Hospitalier Universitaire Vaudois (Lausanne) > Department of General Internal Medicine
Devuyst, Olivier; Universität Zürich - UZH > Institute of Physiology
Burnier, Michel; Centre Hospitalier Universitaire Vaudois (Lausanne) > Service of Nephrology and Hypertension
Bochud, Murielle ✱; Centre Hospitalier Universitaire Vaudois (Lausanne) > Institute of Social and Preventive Medicine (IUMSP)
Belén, Ponte ✱; Hôpitaux Universitaires de Genève - HUG > Department of Nephrology
✱ These authors have contributed equally to this work.
Language :
English
Title :
Estimated 24-h urinary sodium and sodium-to-potassium ratio are predictors of kidney function decline in a population-based study
Mente A, O'Donnell MJ, Rangarajan S, McQueen MJ, Poirier P, Wielgosz A, et al. Association of urinary sodium and potassium excretion with blood pressure. N Engl J Med 2014; 371:601-611.
Elliott P, Stamler J, Nichols R, Dyer AR, Stamler R, Kesteloot H, et al. Intersalt revisited: Further analyses of 24 hour sodium excretion and blood pressure within and across populations. Intersalt Cooperative Research Group. BMJ 1996; 312:1249-1253.
O'Donnell M, Mente A, Rangarajan S, McQueen MJ, Wang X, Liu L, et al. Urinary sodium and potassium excretion, mortality, and cardiovascular events. N Engl J Med 2014; 371:612-623.
Aburto NJ, Hanson S, Gutierrez H, Hooper L, Elliott P, Cappuccio FP. Effect of increased potassium intake on cardiovascular risk factors and disease: Systematic review and meta-analyses. BMJ 2013; 346:f1378.
Yang Q, Liu T, Kuklina EV, Flanders WD, Hong Y, Gillespie C, et al. Sodium and potassium intake and mortality among US adults: Prospective data from the Third National Health and Nutrition Examination Survey. Arch Intern Med 2011; 171:1183-1191.
Cook NR, Obarzanek E, Cutler JA, Buring JE, Rexrode KM, Kumanyika SK, et al. Joint effects of sodium and potassium intake on subsequent cardiovascular disease: The Trials of Hypertension Prevention followup study. Arch Intern Med 2009; 169:32-40.
Stolarz-Skrzypek K. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA 2011; 305:1777.
Mente A, O'Donnell M, Rangarajan S, McQueen M, Dagenais G, Wielgosz A, et al. Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: A community-level prospective epidemiological cohort study. Lancet 2018; 392:496-506.
He J, Mills KT, Appel LJ, Yang W, Chen J, Lee BT, et al. Urinary sodium and potassium excretion and CKD progression. J Am Soc Nephrol 2016; 27:1202-1212.
Fan L, Tighiouart H, Levey AS, Beck GJ, Sarnak MJ. Urinary sodium excretion and kidney failure in nondiabetic chronic kidney disease. Kidney Int 2014; 86:582-588.
Nagata T, Sobajima H, Ohashi N, Hirakawa A, Katsuno T, Yasuda Y, et al. Association between 24 h urinary sodium and potassium excretion and estimated glomerular filtration rate (eGFR) decline or death in patients with diabetes mellitus and eGFR more than 30 ml/min/1.73m2. PLoS One 2016; 11:e0152306.
Smyth A, Dunkler D, Gao P, Teo KK, Yusuf S, O'Donnell MJ, et al. The relationship between estimated sodium and potassium excretion and subsequent renal outcomes. Kidney Int 2014; 86:1205-1212.
Kieneker LM, Bakker SJL, de Boer RA, Navis GJ, Gansevoort RT, Joosten MM. Low potassium excretion but not high sodium excretion is associated with increased risk of developing chronic kidney disease. Kidney Int 2016; 90:888-896.
Dunkler D, Dehghan M, Teo KK, Heinze G, Gao P, Kohl M, et al. Diet and kidney disease in high-risk individuals with type 2 diabetes mellitus. JAMA Intern Med 2013; 173:1682-1692.
Lin J, Hu FB, Curhan GC. Associations of diet with albuminuria and kidney function decline. Clin J Am Soc Nephrol 2010; 5:836-843.
Sharma S, McFann K, Chonchol M, de Boer IH, Kendrick J. Association between dietary sodium and potassium intake with chronic kidney disease in US adults: A cross-sectional study. Am J Nephrol 2013; 37:526-533.
Sanders PW. Effect of salt intake on progression of chronic kidney disease. Curr Opin Nephrol Hypertens 2006; 15:54-60.
Fukui M, Tanaka M, Toda H, Asano M, Yamazaki M, Hasegawa G, et al. Low serum potassium concentration is a predictor of chronic kidney disease. Int J Clin Pract 2014; 68:700-704.
Araki S, Haneda M, Koya D, Kondo K, Tanaka S, Arima H, et al. Urinary potassium excretion and renal and cardiovascular complications in patients with type 2 diabetes and normal renal function. Clin J Am Soc Nephrol 2015; 10:2152-2158.
Ko BJ, Chang Y, Ryu S, Kim EM, Lee MY, Hyun YY, et al. Dietary acid load and chronic kidney disease in elderly adults: Protein and potassium intake. PLoS One 2017; 12:e0185069.
Oberleithner H, Callies C, Kusche-Vihrog K, Schillers H, Shahin V, Riethmüller C, et al. Potassium softens vascular endothelium and increases nitric oxide release. Proc Natl Acad Sci U S A 2009; 106: 2829-2834.
Fang Y, Mu JJ, He LC, Wang SC, Liu ZQ. Salt loading on plasma asymmetrical dimethylarginine and the protective role of potassium supplement in normotensive salt-sensitive asians. Hypertension 2006; 48:724-729.
Iwahori T, Miura K, Ueshima H. Time to consider use of the sodium-topotassium ratio for practical sodium reduction and potassium increase. Nutrients 2017; 700:1-11; doi:10.3390/nu9070700.
Yatabe MS, Iwahori T, Watanabe A, Takano K, Sanada H, Watanabe T, et al. Urinary sodium-to-potassium ratio tracks the changes in salt intake during an experimental feeding study using standardized lowsalt and high-salt meals among healthy Japanese volunteers. Nutrients 2017; 951:1-13; doi:10.3390/nu9090951.
Iwahori T, Miura K, Ueshima H, Chan Q, Dyer AR, Elliott P, et al. Estimating 24-h urinary sodium/potassium ratio from casual ('spot') urinary sodium/potassium ratio: The INTERSALT Study. Int J Epidemiol 2017; 46:1564-1572.
Adrogué HJ, Madias NE. Sodium surfeit and potassium deficit: Keys to the pathogenesis of hypertension. J Am Soc Hypertens 2014; 8:203-213.
Firmann M, Mayor V, Vidal PM, Bochud M, Pécoud A, Hayoz D, et al. The CoLaus study: A population-based study to investigate the epidemiology and genetic determinants of cardiovascular risk factors and metabolic syndrome. BMC Cardiovasc Disord 2008; 8:6.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150:604-612.
Kawasaki T, Itoh K, Uezono K, Sasaki H. A simple method for estimating 24 h urinary sodium and potassium excretion from second morning voiding urine specimen in adults. Clin Exp Pharmacol Physiol 1993; 20:7-14.
Mills KT, Chen J, Yang W, Appel LJ, Kusek JW, Alper A, et al. Sodium excretion and the risk of cardiovascular disease in patients with chronic kidney disease. JAMA 2016; 315:2200.
O'Donnell M, Mente A, Yusuf S. Sodium intake and cardiovascular health. Circ Res 2015; 116:1046-1057.
Kwakernaak AJ, Krikken JA, Binnenmars SH, Visser FW, Hemmelder MH, Woittiez AJ, et al. Effects of sodium restriction and hydrochlorothiazide on RAAS blockade efficacy in diabetic nephropathy: A randomised clinical trial. Lancet Diabetes Endocrinol 2014; 2:385-395.
McMahon EJ, Bauer JD, Hawley CM, Isbel NM, Stowasser M, Johnson DW, et al. A randomized trial of dietary sodium restriction in CKD. J Am Soc Nephrol 2013; 24:2096-2103.
Swift PA, Markandu ND, Sagnella GA, He FJ, MacGregor GA. Modest salt reduction reduces blood pressure and urine protein excretion in black hypertensives: A randomized control trial. Hypertension 2005; 46:308-312.
Kalantar-Zadeh K, Fouque D. Nutritional management of chronic kidney disease. N Engl J Med 2017; 377:1765-1776.
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.
Heerspink HJL, Holtkamp FA, Parving HH, Navis GJ, Lewis JB, Ritz E, et al. Moderation of dietary sodium potentiates the renal and cardiovascular protective effects of angiotensin receptor blockers. Kidney Int 2012; 82:330-337.
Weir MR, Fink JC. Salt intake and progression of chronic kidney disease: An overlooked modifiable exposure? A commentary. Am J Kidney Dis 2005; 45:176-188.
Kitiyakara C, Chabrashvili T, Chen Y, Blau J, Karber A, Aslam S, et al. Salt intake, oxidative stress, and renal expression of NADPH oxidase and superoxide dismutase. J Am Soc Nephrol 2003; 14:2775-2782.
Ying WZ, Sanders PW. Dietary salt increases endothelial nitric oxide synthase and TGF-beta1 in rat aortic endothelium. Am J Physiol 1999; 277:H1293-H1298.
Morrison AC, Ness RB. Sodium intake and cardiovascular disease. Annu Rev Public Health 2011; 32:71-90.
Sanders PW. Vascular consequences of dietary salt intake. Am J Physiol Renal Physiol 2009; 297:F237-F243.
World Health Organization. Guideline: Potassium intake for adults and children. Geneva: World Health Organization; 2012; http://www.ncbi.nlm.nih.gov/books/NBK132470/. [Accessed 23 November 2017].
McDonough AA, Veiras LC, Guevara CA, Ralph DL. Cardiovascular benefits associated with higher dietary K vs. lower dietary Na : Evidence from population and mechanistic studies. Am J Physiol Endocrinol Metab 2017; 312:E348-E356.
Tabara Y, Takahashi Y, Setoh K, Kawaguchi T, Kosugi S, Nakayama T, et al. Prognostic significance of spot urine Na/K for longitudinal changes in blood pressure and renal function: The Nagahama study. Am J Hypertens 2017; 30:899-906.
[No authors listed]. Intersalt: An international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. Intersalt Cooperative Research Group. BMJ 1988; 297:319-328.
Stamler J, Rose G, Stamler R, Elliott P, Dyer A, Marmot M. INTERSALT study findings. Public health and medical care implications. Hypertension 1989; 14:570-577.
Okayama A, Okuda N, Miura K, Okamura T, Hayakawa T, Akasaka H, et al. Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: The NIPPON DATA80 cohort study. BMJ Open 2016; 6:e011632.
Willey J, Gardener H, Cespedes S, Cheung YK, Sacco RL, Elkind MSV. Dietary sodium to potassium ratio and risk of stroke in a multiethnic urban population: The Northern Manhattan Study. Stroke 2017; 48:2979-2983.
Rebholz CM, Crews DC, Grams ME, Steffen LM, Levey AS, Miller ER, et al. DASH (Dietary Approaches to Stop Hypertension) diet and risk of subsequent kidney disease. Am J Kidney Dis 2016; 68:853-861.
Polonia J, Lobo MF, Martins L, Pinto F, Nazare J. Estimation of populational 24-h urinary sodium and potassium excretion from spot urine samples: Evaluation of four formulas in a large national representative population. J Hypertens 2017; 35:477-486.
Weldegiorgis M, de Zeeuw D, Li L, Parving HH, Hou FF, Remuzzi G, et al. Longitudinal estimated GFR trajectories in patients with and without type 2 diabetes and nephropathy. Am J Kidney Dis 2018; 71:91-101.