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Am J Hypertens. 2014 Oct;27(10):1277-84. doi: 10.1093/ajh/hpt294. Epub 2014 Feb 7.

Sodium intake and renal outcomes: a systematic review.

Author information

1
andrewsmyth@physicians.ie.
2
Health Research Board Clinical Research Facility, National University of Ireland, Galway, Ireland; Population Health Research Institute, Hamilton, Ontario, Canada;
3
Population Health Research Institute, Hamilton, Ontario, Canada;
4
Department of Nephrology, McMaster University, Hamilton, Ontario, Canada;
5
Health Research Board Clinical Research Facility, National University of Ireland, Galway, Ireland;
6
Department of Nephrology, Galway University Hospitals, Galway, Ireland;
7
Population Health Research Institute, Hamilton, Ontario, Canada; Friedrich Alexander University of Erlangen, Germany; Department of Nephrology, Hypertension & Rheumatology, Munich General Hospitals, Munich, Germany.

Abstract

BACKGROUND:

Sodium intake is an important determinant of blood pressure; therefore, reduction of intake may be an attractive population-based target for chronic kidney disease (CKD) prevention. Most guidelines recommend sodium intake of < 2.3 g/day, based on limited evidence. We reviewed the association between sodium intake and renal outcomes.

METHODS:

We reviewed cohort studies and clinical trials, which were retrieved by searching electronic databases, that evaluated the association between sodium intake/excretion and measures of renal function, proteinuria, or new need for dialysis.

RESULTS:

Of 4,337 reviewed citations, seven (n = 8,129) were eligible, including six cohort studies (n = 7,942) and one clinical trial (n = 187). Four studies (n = 1,787) included patients with CKD. All four cohort studies reported that high intake (> 4.6 g/day) was associated with adverse outcomes (vs. moderate/low), while none reported an increased risk with moderate intake (vs. low). Three studies (n = 6,342) included patients without CKD. Two cohort studies (n = 6,155) reported opposing directions of association between low (vs. moderate) sodium intake and renal outcomes, and one clinical trial (n = 187) reported a benefit from low intake (vs. moderate) on proteinuria but an adverse effect on serum creatinine.

CONCLUSIONS:

Available, but limited, evidence supports an association between high sodium intake (> 4.6g/day) and adverse outcomes. However, the association with low intake (vs. moderate) is uncertain, with inconsistent findings from cohort studies. There is urgent need to clarify the long-term efficacy and safety of currently recommended low sodium intake in patients with CKD.

KEYWORDS:

blood pressure; chronic kidney disease; clinical epidemiology; hypertension; nutrition.

PMID:
24510182
DOI:
10.1093/ajh/hpt294
[Indexed for MEDLINE]

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