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J Am Soc Nephrol. 2016 Apr;27(4):1202-12. doi: 10.1681/ASN.2015010022. Epub 2015 Sep 17.

Urinary Sodium and Potassium Excretion and CKD Progression.

Author information

1
Departments of Epidemiology and Medicine, Tulane University, New Orleans, Louisiana; jhe@tulane.edu.
2
Departments of Epidemiology and.
3
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Medicine, Baltimore, Maryland;
4
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania;
5
Departments of Epidemiology and Medicine, Tulane University, New Orleans, Louisiana;
6
Medicine, Tulane University, New Orleans, Louisiana;
7
Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois;
8
Division of Nephrology, St. John Hospital and Medical Center, Detroit, Michigan;
9
Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland; and.
10
Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.

Abstract

CKD is a major risk factor for ESRD, cardiovascular disease, and premature death. Whether dietary sodium and potassium intake affect CKD progression remains unclear. We prospectively studied the association of urinary sodium and potassium excretion with CKD progression and all-cause mortality among 3939 patients with CKD in the Chronic Renal Insufficiency Cohort Study. Urinary sodium and potassium excretion were measured using three 24-hour urine specimens, and CKD progression was defined as incident ESRD or halving of eGFR. During follow-up, 939 CKD progression events and 540 deaths occurred. Compared with the lowest quartile of urinary sodium excretion (<116.8 mmol/24 h), hazard ratios (95% confidence intervals) for the highest quartile of urinary sodium excretion (≥194.6 mmol/24 h) were 1.54 (1.23 to 1.92) for CKD progression, 1.45 (1.08 to 1.95) for all-cause mortality, and 1.43 (1.18 to 1.73) for the composite outcome of CKD progression and all-cause mortality after adjusting for multiple covariates, including baseline eGFR. Additionally, compared with the lowest quartile of urinary potassium excretion (<39.4 mmol/24 h), hazard ratios for the highest quartile of urinary potassium excretion (≥67.1 mmol/24 h) were 1.59 (1.25 to 2.03) for CKD progression, 0.98 (0.71 to 1.35) for all-cause mortality, and 1.42 (1.15 to 1.74) for the composite outcome. These data indicate that high urinary sodium and potassium excretion are associated with increased risk of CKD progression. Clinical trials are warranted to test the effect of sodium and potassium reduction on CKD progression.

KEYWORDS:

CKD; ESRD; epidemiology and outcomes; nutrition

PMID:
26382905
PMCID:
PMC4814179
DOI:
10.1681/ASN.2015010022
[Indexed for MEDLINE]
Free PMC Article

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