From Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (E.P.M., A.H.T., E.M.F., A.G.J., P.B.M.); The Glasgow Renal and Transplant Unit, Western Infirmary, Glasgow, United Kingdom (E.P.M., A.H.T., J.G.F., A.G.J., P.B.M.); and Renal Unit, Monklands Hospital, Airdrie, United Kingdom (J.P.T.).
Hypertension. 2014 Jul;64(1):111-7. doi: 10.1161/HYPERTENSIONAHA.113.03093. Epub 2014 Apr 14.
Dietary sodium intake is associated with hypertension and cardiovascular risk in the general population. In patients with chronic kidney disease, sodium intake has been associated with progressive renal disease, but not independently of proteinuria. We studied the relationship between urinary sodium (UNa) excretion and UNa to creatinine ratio and mortality or requirement for renal replacement therapy in chronic kidney disease. Adult patients attending a renal clinic who had ≥1 24-hour UNa measurement were identified. Twenty-four-hour UNa measures were collected and UNa to creatinine ratio calculated. Time to renal replacement therapy or death was recorded. Four hundred twenty-three patients were identified with mean estimated glomerular filtration rate of 48 mL/min per 1.73 m(2). Ninety patients required renal replacement therapy and 102 patients died. Mean slope decline in estimated glomerular filtration rate was -2.8 mL/min per 1.73 m(2) per year. Median follow-up was 8.5 years. Patients who died or required renal replacement therapy had significantly higher UNa excretion and UNa to creatinine ratio, but the association with these parameters and poor outcome was not independent of renal function, age, and albuminuria. When stratified by albuminuria, UNa to creatinine ratio was a significant cumulative additional risk for mortality, even in patients with low-level albuminuria. There was no association between low UNa and risk, as observed in some studies. This study demonstrates an association between UNa excretion and mortality in chronic kidney disease, with a cumulative relationship between sodium excretion, albuminuria, and reduced survival. These data support reducing dietary sodium intake in chronic kidney disease, but additional study is required to determine the target sodium intake.
饮食钠摄入量与普通人群中的高血压和心血管风险相关。在慢性肾脏病患者中，钠摄入量与进行性肾病相关，但与蛋白尿无关。我们研究了尿钠（UNa）排泄量和 UNa 与肌酐比值与慢性肾脏病患者的死亡率或需要肾脏替代治疗之间的关系。确定了在肾脏诊所就诊且至少有 1 次 24 小时 UNa 测量值的成年患者。收集 24 小时 UNa 测量值并计算 UNa 与肌酐比值。记录肾脏替代治疗或死亡的时间。确定了 423 名平均估计肾小球滤过率为 48 ml/min per 1.73 m²的患者。90 名患者需要肾脏替代治疗，102 名患者死亡。估计肾小球滤过率的平均斜率下降为 -2.8 ml/min per 1.73 m² per year。中位随访时间为 8.5 年。死亡或需要肾脏替代治疗的患者的 UNa 排泄量和 UNa 与肌酐比值明显更高，但与这些参数和不良预后的相关性并不能独立于肾功能、年龄和白蛋白尿。按白蛋白尿分层时，即使在低水平白蛋白尿患者中，UNa 与肌酐比值也是死亡率的显著累积附加风险。与一些研究观察到的情况相反，低 UNa 与风险之间没有关联。这项研究表明，在慢性肾脏病中，UNa 排泄与死亡率之间存在关联，且钠排泄、白蛋白尿和生存率降低之间存在累积关系。这些数据支持减少慢性肾脏病患者的饮食钠摄入量，但需要进一步研究来确定目标钠摄入量。
