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Kidney Blood Press Res. 2019;44(5):1101-1114. doi: 10.1159/000502354. Epub 2019 Sep 18.

Long-Term Effects of Intensive Low-Salt Diet Education on Deterioration of Glomerular Filtration Rate among Non-Diabetic Hypertensive Patients with Chronic Kidney Disease.

Ahn SY1,2, Kim DK3,4, Park JH5, Shin SJ6, Lee SH7, Choi BS8, Lim CS9, Lee A10, Jung H10, Chin HJ11,12,13.

Author information

1
Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea.
2
Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
3
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
4
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
5
Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea.
6
Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
7
Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea.
8
Department of Internal Medicine, Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea.
9
Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
10
Department of Internal Medicine, Seoul National University Bundang Hospital, Seong-Nam, Republic of Korea.
11
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea, mednep@snubh.org.
12
Department of Internal Medicine, Seoul National University Bundang Hospital, Seong-Nam, Republic of Korea, mednep@snubh.org.
13
Research Institute of Salt and Health, Seoul, Republic of Korea, mednep@snubh.org.

Abstract

BACKGROUND:

Diet modification, especially a decrease in salt intake, might be an important non-pharmacological strategy to improve chronic kidney disease (CKD) prognosis.

OBJECTIVES:

We conducted a prospective cohort study to investigate whether an intensive low-salt diet education program effectively attenuated the rate of renal function decline in hypertensive patients with CKD.

METHODS:

This cohort study recruited 171 participants from a previous open-labelled, case-controlled, randomized clinical trial that originally consisted of 245 hypertensive CKD patients who were assigned to two groups, intensive low-salt diet or conventional education. We evaluated the renal outcomes, which included the rate of change in estimated glomerular filtration rate (eGFR) per year, the increase in serum creatinine ≥50%, the decrease in eGFR ≥30%, and the percent change in albuminuria throughout the entire study period.

RESULTS:

The baseline characteristics of the cohort participants between the two groups were similar at the time of trial phase randomization. During the whole study period, the rate of renal function decline was significantly faster in the conventional group (0.11 ± 4.63 vs. -1.53 ± 3.04 mL/min/1.73 m2/year, p = 0.01). The percent of incremental change in serum creatinine ≥50% was 1.1% in the intensive group and 8.2% in the conventional group (p = 0.025), and the percent of decremental change in eGFR ≥30% was 3.3% in the intensive group and 11.1% in the conventional group (p= 0.048). With logistic regression analysis adjusted for related factors, we found that the conventional group showed a higher risk for deterioration in serum creatinine and eGFR during the entire study period. Especially, we found that the intensive education program preserved eGFR in participants with one, several, or all of the following characteristics at the time of randomization: older age, female, obese, had higher protein intake, higher amounts of albuminuria, higher salt intake.

CONCLUSION:

This cohort study demonstrated that an intensive low-salt diet education program attenuated the rate of renal function decline in hypertensive CKD patients independent of its effect on lowering salt intake or albuminuria during the 36 months of follow-up.

KEYWORDS:

Chronic kidney disease; Education; Hypertension; Low-salt diet; Renal function decline

PMID:
31533093
DOI:
10.1159/000502354
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