Suleyman Demirel University, School of Medicine, Department of Nephrology, 32260, Cunur, Isparta, Türkiye; Saint Louis University, School of Medicine, Division of Nephrology, St. Louis, MO, USA.
Suleyman Demirel University, School of Medicine, Department of Nephrology, 32260, Cunur, Isparta, Türkiye; Saint Louis University, School of Medicine, Division of Nephrology, St. Louis, MO, USA.
Transplant Rev (Orlando). 2024 Jul;38(3):100859. doi: 10.1016/j.trre.2024.100859. Epub 2024 May 12.
Kidney transplantation (KT) is the best treatment option for end-stage kidney disease (ESKD). Acute rejection rates have decreased drastically in recent years but chronic kidney allograft disease (CKAD) is still an important cause of allograft failure and return to dialysis. Thus, there is unmet need to identify and reverse the cause of CKAD. Additionally, cardiovascular events after KT are still leading causes of morbidity and mortality. One overlooked potential contributor to CKAD and adverse cardiovascular events is increased sodium/salt intake in kidney transplant recipients (KTRs). In general population, the adverse effects of high sodium intake are well known but in KTRs, there is a paucity of evidence despite decades of experience with KT. Limited research showed that sodium intake is high in most KTRs. Moreover, excess sodium intake is associated with elevated blood pressure and albuminuria in some studies involving KTRs. There is also experimental evidence suggesting that increased sodium intake is associated with histologic graft damage. Critical knowledge gaps still remain, including the exact amount of sodium restriction needed in KTRs to optimize outcomes and allograft survival. Additionally, best methods to measure sodium intake and practices to follow-up are not clarified in KTRs. To meet these deficits, prospective long term studies are warranted in KTRs. Moreover, preventive measures must be determined and implemented both at individual and societal levels to achieve sodium restriction in KTRs.
肾移植（KT）是治疗终末期肾病（ESKD）的最佳选择。近年来，急性排斥反应率大幅下降，但慢性肾移植肾病（CKAD）仍然是移植失败和返回透析的重要原因。因此，需要确定并逆转 CKAD 的病因。此外，KT 后的心血管事件仍然是发病率和死亡率的主要原因。一个被忽视的潜在导致 CKAD 和不良心血管事件的原因是肾移植受者（KTR）中钠/盐摄入量的增加。在一般人群中，高钠摄入的不良影响是众所周知的，但在 KTR 中，尽管有几十年的 KT 经验，但证据很少。有限的研究表明，大多数 KTR 中的钠摄入量较高。此外，一些涉及 KTR 的研究表明，过量的钠摄入与血压升高和蛋白尿有关。也有实验证据表明，钠摄入量的增加与组织学移植损伤有关。仍存在关键的知识空白，包括 KTR 中需要限制多少钠才能优化结果和移植器官的存活率。此外，KTR 中未明确测量钠摄入量的最佳方法和随访实践。为了弥补这些不足，需要在 KTR 中进行前瞻性长期研究。此外，必须在个人和社会层面确定和实施预防措施，以实现 KTR 中的钠限制。
