Nagasawa Yasuyuki
Department of Internal Medicine, Division of Kidney and Dialysis, Hyogo College of Medicine, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo 663-8501, Japan.
Nutrients. 2021 Mar 16;13(3):951. doi: 10.3390/nu13030951.
Sodium intake theoretically has dual effects on both non-dialysis chronic kidney disease (CKD) patients and dialysis patients. One negatively affects mortality by increasing proteinuria and blood pressure. The other positively affects mortality by ameliorating nutritional status through appetite induced by salt intake and the amount of food itself, which is proportional to the amount of salt under the same salty taste. Sodium restriction with enough water intake easily causes hyponatremia in CKD and dialysis patients. Moreover, the balance of these dual effects in dialysis patients is likely different from their balance in non-dialysis CKD patients because dialysis patients lose kidney function. Sodium intake is strongly related to water intake via the thirst center. Therefore, sodium intake is strongly related to extracellular fluid volume, blood pressure, appetite, nutritional status, and mortality. To decrease mortality in both non-dialysis and dialysis CKD patients, sodium restriction is an essential and important factor that can be changed by the patients themselves. However, under sodium restriction, it is important to maintain the balance of negative and positive effects from sodium intake not only in dialysis and non-dialysis CKD patients but also in the general population.
理论上，钠摄入对非透析慢性肾脏病（CKD）患者和透析患者都有双重影响。一方面，钠摄入通过增加蛋白尿和血压对死亡率产生负面影响。另一方面，钠摄入通过盐诱导的食欲和食物本身的量（在相同咸度下与盐量成正比）改善营养状况，从而对死亡率产生正面影响。在CKD和透析患者中，在摄入足够水分的情况下限制钠摄入很容易导致低钠血症。此外，透析患者中这些双重影响的平衡可能与非透析CKD患者不同，因为透析患者失去了肾功能。钠摄入通过口渴中枢与水摄入密切相关。因此，钠摄入与细胞外液量、血压、食欲、营养状况和死亡率密切相关。为降低非透析和透析CKD患者的死亡率，限制钠摄入是一个重要且患者自身可以改变的因素。然而，在限制钠摄入的情况下，不仅在透析和非透析CKD患者中，而且在普通人群中，维持钠摄入正负效应的平衡都很重要。
