Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Nephrology, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey.
Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Division of Nephrology and Hypertension, Vanderbilt O'Brien Center for Kidney Disease, Nashville, TN; Department of Veteran Affairs, Tennessee Valley Healthcare System, Nashville, TN.
Semin Nephrol. 2023 Mar;43(2):151407. doi: 10.1016/j.semnephrol.2023.151407. Epub 2023 Aug 26.
Excessive dietary sodium intake is associated with an increased risk of hypertension, especially in the setting of chronic kidney disease (CKD). Although implementation of a low-sodium diet in patients with CKD generally is recommended, data supporting the efficacy of this practice is mostly opinion-based. Few controlled studies have investigated the specific association of dietary sodium intake and cardiovascular events and mortality in CKD. Furthermore, in epidemiologic studies, the association of sodium intake with CKD progression, cardiovascular risk, and mortality is not homogeneous, and both low- and high-sodium intake has been associated with adverse health outcomes in different studies. In general, the adverse effects of high dietary sodium intake are more apparent in the setting of advanced CKD. However, there is no established definitive target level of dietary sodium intake in different CKD stages based on glomerular filtration rate and albuminuria/proteinuria. This review discusses the current challenges regarding the rationale of sodium restriction, target levels and assessment of sodium intake, and interventions for sodium restrictions in CKD in relation to clinical outcomes.
过量的钠摄入与高血压风险增加有关，尤其是在慢性肾脏病（CKD）患者中。尽管建议 CKD 患者通常采用低钠饮食，但支持这一做法的疗效数据主要基于意见。很少有对照研究调查了 CKD 患者饮食中钠摄入量与心血管事件和死亡率的具体关联。此外，在流行病学研究中，钠摄入量与 CKD 进展、心血管风险和死亡率的关联并不一致，并且在不同的研究中，低钠和高钠摄入都与不良健康结果相关。一般来说，高膳食钠摄入的不良影响在 CKD 晚期更为明显。然而，基于肾小球滤过率和白蛋白尿/蛋白尿，不同 CKD 阶段的膳食钠摄入量的明确目标水平尚未确定。这篇综述讨论了关于钠限制的合理性、目标水平和钠摄入量评估以及 CKD 中钠限制干预与临床结局相关的当前挑战。
