Eastern Virginia Medical School, Norfolk, Virginia, USA.
Cohen Children's Medical Center, New Hyde Park, New York, USA.
Nephron. 2019;142(3):216-226. doi: 10.1159/000497780. Epub 2019 Mar 19.
Experimental evidence suggests that hyperosmolality may be a causative factor in the development of both salt-sensitive hypertension and chronic kidney disease (CKD). There are no population-wide studies in young persons to assess the relationships among these factors.
To determine the association of serum osmolality and serum sodium with high systolic blood pressure (SBP) and decreased estimated glomerular filtration rate (eGFR) among a nationally representative population of adolescents.
Relevant data among participants ages 12-14 were obtained from the National Health and Nutrition Examination Survey cycles 1999-2012. Serum osmolality was calculated using the Worthley equation. eGFR was calculated using the Counahan-Barratt equation, and values < 90 mL/min/1.73 m2 were considered decreased. High SBP was defined as SBP ≥95th percentile for age, height, and sex.
A total of 4,168 adolescents were analyzed (representative population: 10,464,592). Adolescents with serum osmolality ≥290 mOsm/kg and/or serum sodium ≥143 mmol/L had increased odds for both high SBP (serum osmolality ≥290 mOsm/kg: OR 2.04; 95% CI 1.03-4.02; sodium ≥143 mmol/L: OR 4.36; 95% CI 1.58-12.04) and decreased eGFR (serum osmolality ≥290 mOsm/kg: OR 1.61; 95% CI 1.18-2.21; sodium ≥143 mmol/L: OR 3.27; 95% CI 1.77-6.03) when compared to participants with values below these thresholds. These thresholds remained significant even after multivariable adjustment.
Among adolescents in a nationally representative survey, hypernatremia and hyperosmolality were associated with high SBP and decreased eGFR. These findings may support the hypothesis that an imbalance of salt and water contribute to hypertension and CKD.
实验证据表明，高渗透压可能是导致盐敏感型高血压和慢性肾病（CKD）发展的一个致病因素。目前还没有在年轻人中进行的人群范围研究来评估这些因素之间的关系。
评估血清渗透压和血清钠与全国代表性青少年人群中收缩压升高和估算肾小球滤过率（eGFR）降低的相关性。
从 1999 年至 2012 年全国健康和营养调查周期中获取了年龄在 12-14 岁的参与者的相关数据。使用沃利方程计算血清渗透压。使用库纳汉-巴雷特方程计算 eGFR，<90 mL/min/1.73 m2 被认为是降低的。高收缩压定义为收缩压≥年龄、身高和性别第 95 百分位的收缩压。
共分析了 4168 名青少年（代表性人群：10464592 人）。血清渗透压≥290 mOsm/kg 和/或血清钠≥143 mmol/L 的青少年发生高收缩压（血清渗透压≥290 mOsm/kg：OR 2.04；95%CI 1.03-4.02；血清钠≥143 mmol/L：OR 4.36；95%CI 1.58-12.04）和 eGFR 降低（血清渗透压≥290 mOsm/kg：OR 1.61；95%CI 1.18-2.21；血清钠≥143 mmol/L：OR 3.27；95%CI 1.77-6.03）的可能性均高于这些阈值以下的参与者。即使在多变量调整后，这些阈值仍然具有统计学意义。
在全国代表性调查中，青少年高钠血症和高渗透压与收缩压升高和 eGFR 降低有关。这些发现可能支持盐和水失衡导致高血压和 CKD 的假说。
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