Dolansky Mary A, Schaefer Julie T, Hawkins Misty Aw, Gunstad John, Basuray Anup, Redle Joseph D, Fang James C, Josephson Richard A, Moore Shirley M, Hughes Joel W
School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
Department of Psychology, Kent State University, Kent, OH, USA.
Patient Prefer Adherence. 2016 Mar 2;10:233-41. doi: 10.2147/PPA.S95528. eCollection 2016.
Although cognitive impairment is common in heart failure (HF) patients, its effects on sodium adherence recommendations are unknown.
Our aim is to examine if cognitive function is associated with patient sodium adherence.
Sodium collection/excretion and cognitive function were assessed for 339 HF patients over a 5-8-week period. Neuropsychological testing was performed at baseline (Visit 1), whereas two 24-hour urine samples were collected within 7 weeks postbaseline. The ability to collect two 24-hour urine samples and the estimation of sodium excretion levels from these samples were used to estimate sodium adherence recommendations.
Nearly half (47%) of the study participants (n=159) were unable to give two valid 24-hour urine samples. Participants who were unable to adhere to two valid 24-hour urine samples had significantly poorer attention and global cognition tests (P<0.044), with a trend for poorer executive function (P=0.064). Among those with valid samples, urine sodium level was not associated with global cognitive function, attention, executive function, or memory after adjusting for covariates. Female sex was associated with lower sodium excretion (all P<0.01); individuals with knowledge of sodium guidelines had less intake of sodium, resulting in excretion of less sodium (all P≤0.03). Conversely, higher socioeconomic status (SES) and body mass index (BMI) were associated with greater sodium (all P≤0.02 and P≤0.01).
Adherence to urine sodium collection was poor, especially among those with poorer cognitive function. Sodium consumption exceeded recommended amounts and was unrelated to cognitive function. Interventions for improving sodium adherence should focus on at-risk groups (high SES and BMI) and at improving knowledge of recommended salt intake.
尽管认知障碍在心力衰竭（HF）患者中很常见，但其对钠摄入建议依从性的影响尚不清楚。
我们的目的是研究认知功能是否与患者的钠摄入依从性相关。
在5至8周的时间内，对339例HF患者进行了钠收集/排泄和认知功能评估。在基线（访视1）时进行神经心理学测试，而在基线后7周内收集两份24小时尿液样本。收集两份24小时尿液样本的能力以及根据这些样本估算钠排泄水平，用于评估钠摄入建议的依从性。
近一半（47%）的研究参与者（n = 159）无法提供两份有效的24小时尿液样本。无法坚持提供两份有效24小时尿液样本的参与者，其注意力和整体认知测试结果明显较差（P < 0.044），执行功能也有较差的趋势（P = 0.064）。在有有效样本的参与者中，调整协变量后，尿钠水平与整体认知功能、注意力、执行功能或记忆力无关。女性的钠排泄量较低（所有P < 0.01）；了解钠指南的个体钠摄入量较少，导致钠排泄量较少（所有P≤0.03）。相反，较高的社会经济地位（SES）和体重指数（BMI）与更多的钠摄入相关（所有P≤0.02和P≤0.01）。
尿钠收集的依从性较差，尤其是认知功能较差的患者。钠摄入量超过推荐量，且与认知功能无关。改善钠摄入依从性的干预措施应侧重于高危人群（高SES和BMI），并提高对推荐盐摄入量的认识。
