Nerbass F B, Pecoits-Filho R, McIntyre N J, McIntyre C W, Taal M W
1] School of Medicine, Pontificia Universidade Católica do Paraná, Curitiba, Brazil [2] Nephrology Division, Nutrition Department, Pro-rim Foundation, Joinville, Brazil.
School of Medicine, Pontificia Universidade Católica do Paraná, Curitiba, Brazil.
Eur J Clin Nutr. 2015 Jul;69(7):786-90. doi: 10.1038/ejcn.2014.215. Epub 2014 Oct 8.
BACKGROUND/OBJECTIVES: An increased risk of mortality and cardiovascular disease (CVD) is observed in people with chronic kidney disease (CKD) even in early stages. Dietary sodium intake has been associated with important CVD and CKD progression risk factors such as hypertension and proteinuria in this population. We aimed to investigate the relationship between sodium intake and CVD or CKD progression risk factors in a large cohort of patients with CKD stage 3 recruited from primary care.
SUBJECTS/METHODS: A total of 1733 patients with previous estimated glomerular filtration rate (eGFR) of 30-59 ml/min/1.73m(2), with a mean age 72.9±9.0 years, were recruited from 32 general practices in primary care in England. Medical history was obtained and participants underwent clinical assessment, urine and serum biochemistry testing. Sodium intake was estimated from three early-morning urine specimens using an equation validated for this study population.
Sixty percent of participants who had estimated sodium intake above recommendation (>100 mmol/day or 6 g salt/day) also had higher diastolic blood pressure, mean arterial pressure (MAP), urinary albumin-to-creatinine ratio, high-sensitive C-reactive protein and uric acid and used a greater number of anti-hypertensive drugs. In multivariable regression analysis, excessive sodium intake was an independent predictor of MAP (B=1.57, 95% confidence interval (CI) 0.41-2.72; P=0.008) and albuminuria (B=1.35, 95% CI 1.02-1.79; P=0.03).
High sodium intake was associated with CVD and CKD progression risk factors in patients with predominantly early stages of CKD followed up in primary care. This suggests that dietary sodium intake could afffect CVD risk even in early or mild CKD. Intervention studies are warranted to investigate the potential benefit of dietary advice to reduce sodium intake in this population.
背景/目的：即使在慢性肾脏病（CKD）的早期阶段，也观察到该人群的死亡率和心血管疾病（CVD）风险增加。饮食中钠的摄入量与该人群中重要的心血管疾病和慢性肾脏病进展风险因素相关，如高血压和蛋白尿。我们旨在调查从初级保健机构招募的一大群3期慢性肾脏病患者中钠摄入量与心血管疾病或慢性肾脏病进展风险因素之间的关系。
受试者/方法：从英国初级保健机构的32家全科诊所招募了总共1733例既往估计肾小球滤过率（eGFR）为30 - 59 ml/min/1.73m²、平均年龄72.9±9.0岁的患者。获取病史并让参与者接受临床评估、尿液和血清生化检测。使用针对该研究人群验证的公式，根据三个清晨尿液标本估算钠摄入量。
估计钠摄入量高于推荐值（>100 mmol/天或6克盐/天）的参与者中，60%还具有更高的舒张压、平均动脉压（MAP）、尿白蛋白与肌酐比值、高敏C反应蛋白和尿酸，并且使用了更多种类的抗高血压药物。在多变量回归分析中，钠摄入过多是平均动脉压（B = 1.57，95%置信区间（CI）0.41 - 2.72；P = 0.008）和蛋白尿（B = 1.35，95% CI 1.02 - 1.79；P = 0.03）的独立预测因素。
在初级保健机构随访的主要处于早期阶段的慢性肾脏病患者中，高钠摄入与心血管疾病和慢性肾脏病进展风险因素相关。这表明即使在慢性肾脏病的早期或轻度阶段，饮食中钠的摄入量也可能影响心血管疾病风险。有必要进行干预研究，以调查饮食建议减少该人群钠摄入量的潜在益处。
