Anyfanti Panagiota, Antza Christina, Ainatzoglou Alexandra, Angeloudi Elena, Palaska Smaro, Poulis Dimitrios, Chaida Evangelia, Dimitroulas Theodoros, Kotsis Vasilios, Gkaliagkousi Eugenia
3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Fourth Department of Internal Medicine, Hippokration Hospital, Thessaloniki, Greece.
Clin Rheumatol. 2025 Sep;44(9):3515-3523. doi: 10.1007/s10067-025-07608-4. Epub 2025 Aug 1.
INTRODUCTION/OBJECTIVES: Patients with rheumatoid arthritis (RA) are at increased cardiovascular risk. Rather than either sodium or potassium intake alone, the ratio of urinary sodium-to-potassium excretion has been introduced as a simple and useful indicator of diet quality and a more reliable index of cardiovascular risk assessment. We assessed the clinical impact of sodium-to-potassium ratio as a marker of cardiovascular health in patients with RA.
Sodium and potassium intake were assessed from 24-h urine samples, and urinary sodium-to-potassium ratio was calculated in patients with RA. Myocardial perfusion was assessed by measurement of subendocardial viability ratio (SEVR) using applanation tonometry. Pulse wave velocity and augmentation index were assessed as markers of arterial stiffness with the same device.
Among 61 patients with RA, only two presented an optimal sodium-to-potassium ratio of ≤ 1. In univariate analysis, urinary sodium excretion was significantly associated with high-density lipoprotein cholesterol (HDL-c) and uric acid. Potassium excretion positively correlated with estimated glomerular filtration rate (eGFR) and negatively with disease activity and inflammatory load. No associations were observed between markers of arterial stiffness and either urinary sodium excretion, potassium excretion, or their ratio. By contrast, both urinary sodium and urinary sodium-to-potassium ratio inversely correlated with SEVR, and these associations remained significant even after adjustment for other variables (beta = - 0.247, p = 0.034, and beta = - 0.247, p = 0.026, respectively).
Findings from the present study suggest that in concordance with population-based studies, urinary sodium-to-potassium ratio might serve as an indicator of myocardial health in patients with autoimmune inflammatory diseases such as RA. Key Points • Increased dietary sodium intake, decreased dietary potassium intake, and increased sodium-to-potassium ratio have been associated with adverse cardiovascular outcomes in longitudinal population-based cohorts. • In a population of high cardiovascular risk patients with RA, increased dietary sodium intake and increased urinary sodium-to-potassium ratio were both associated with impaired coronary microvascular perfusion. • Dietary potassium intake inversely correlated with disease activity and inflammatory load. • In patients with chronic inflammatory arthritis, interventions aiming at dietary modifications of sodium and potassium intake might positively affect both cardiovascular outcomes and disease-related parameters.
引言/目的：类风湿关节炎（RA）患者心血管疾病风险增加。尿钠排泄与钾排泄的比值已被引入，作为饮食质量的一个简单且有用的指标以及心血管疾病风险评估的一个更可靠指标，而不是单独的钠或钾摄入量。我们评估了钠钾比值作为RA患者心血管健康标志物的临床影响。
通过24小时尿液样本评估钠和钾的摄入量，并计算RA患者的尿钠钾比值。使用压平眼压计测量心内膜下存活比值（SEVR）来评估心肌灌注。用同一设备评估脉搏波速度和增强指数作为动脉僵硬度的标志物。
在61例RA患者中，只有2例的钠钾比值最佳，≤1。单因素分析中，尿钠排泄与高密度脂蛋白胆固醇（HDL-c）和尿酸显著相关。钾排泄与估计肾小球滤过率（eGFR）呈正相关，与疾病活动度和炎症负荷呈负相关。未观察到动脉僵硬度标志物与尿钠排泄、钾排泄或其比值之间存在关联。相比之下，尿钠和尿钠钾比值均与SEVR呈负相关，即使在调整其他变量后，这些关联仍具有显著性（β分别为-0.247，p = 0.034和β = -0.247，p = 0.026）。
本研究结果表明，与基于人群的研究一致，尿钠钾比值可能作为RA等自身免疫性炎症疾病患者心肌健康的一个指标。要点 • 在基于人群的纵向队列研究中，饮食中钠摄入量增加、钾摄入量减少以及钠钾比值增加与不良心血管结局相关。 • 在心血管疾病高风险的RA患者群体中，饮食中钠摄入量增加和尿钠钾比值增加均与冠状动脉微血管灌注受损相关。 • 饮食中钾摄入量与疾病活动度和炎症负荷呈负相关。 • 在慢性炎症性关节炎患者中，旨在调整钠和钾摄入量的饮食干预可能对心血管结局和疾病相关参数产生积极影响。
