South West Thames Renal Unit, Epsom and St Helier University Hospitals NHS Trust, Surrey, London, SM5 1AA, UK.
Wolfson Institute of Preventative Medicine, Queen Mary University of London, London, UK.
J Nephrol. 2019 Apr;32(2):259-264. doi: 10.1007/s40620-018-0541-z. Epub 2018 Oct 16.
Higher serum sodium concentration has been reported to be a risk factor for the development of incident chronic kidney disease (CKD), but its relationship with the progression of established CKD has not been investigated. We hypothesised that increased serum sodium concentration is a risk factor for estimated glomerular filtration rate (eGFR) decline in CKD.
This was a retrospective cohort study using data collected over a 6-year period, with baseline data obtained during the first 2 years. We included patients known to our renal service who had had a minimum of three blood tests every 2 years and an eGFR of < 60 mL/min/1.73 m at baseline. Exclusion criteria were renal replacement therapy, diabetes mellitus, heart failure and decompensated liver disease. A multiple linear regression model investigated the relationship between baseline serum sodium and eGFR decline after adjustment for confounding factors.
7418 blood results from 326 patients were included. There was no relationship between serum sodium concentration and estimated glomerular filtration rate at baseline. After multivariable adjustment, a 1 mmol/L increase in baseline serum sodium was associated with a 1.5 mL/min/1.73 m decline in eGFR during the study period (95% CI 0.9, 2.0). A reduction in eGFR was not associated with significant changes in serum sodium concentration over 6 years.
Higher serum sodium concentration is associated with the progression of CKD, independently of other established risk factors. Conversely, significant alterations in serum sodium concentration do not occur with declining kidney function.
已有研究报告血清钠浓度升高是新发慢性肾脏病（CKD）的危险因素，但尚未对其与已确诊 CKD 的进展之间的关系进行研究。我们假设血清钠浓度升高是 CKD 估算肾小球滤过率（eGFR）下降的危险因素。
这是一项回顾性队列研究，使用了 6 年内收集的数据，基线数据来自前 2 年。我们纳入了我们肾脏科服务的已知患者，这些患者每 2 年至少进行了 3 次血液检查，基线时 eGFR <60 mL/min/1.73 m。排除标准为肾脏替代治疗、糖尿病、心力衰竭和肝功能失代偿。多线性回归模型用于研究基线血清钠与 eGFR 下降之间的关系，并进行了混杂因素调整。
共纳入了 326 名患者的 7418 次血液结果。基线时血清钠浓度与估算肾小球滤过率之间没有关系。经多变量调整后，基线时血清钠升高 1 mmol/L，研究期间 eGFR 下降 1.5 mL/min/1.73 m（95%CI 0.9, 2.0）。6 年内 eGFR 下降与血清钠浓度无明显变化相关。
较高的血清钠浓度与 CKD 的进展有关，与其他已确定的危险因素无关。相反，随着肾功能下降，血清钠浓度不会发生显著变化。
