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Altered dietary salt intake for preventing and treating diabetic kidney disease.
Cochrane Database Syst Rev 2010; (12):CD006763CD

Abstract

BACKGROUND

There is strong evidence that our current consumption of salt is a major factor for increased blood pressure (BP) and a modest reduction in salt intake lowers BP whether BP levels are normal or raised. Tight control of BP in diabetics lowers the risk of strokes, heart attacks and heart failure and slows the progression of diabetic kidney disease (DKD). Currently there is no consensus in restricting salt intake in diabetic patients.

OBJECTIVES

To evaluate the effect of altered salt intake on BP and markers of cardiovascular disease and DKD.

SEARCH STRATEGY

In January 2010, we searched the Cochrane Renal Group's Specialised Register, CENTRAL (in The Cochrane Library), MEDLINE (from 1966) and EMBASE (from 1980) to identify appropriate articles.

SELECTION CRITERIA

We included all randomised controlled trials of salt reduction in individuals with type 1 and type 2 diabetes.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed studies and resolved differences by discussion with a third independent author. We calculated mean effect sizes using both the fixed-effect and random-effects models.

MAIN RESULTS

Thirteen studies (254 individuals) met our inclusion criteria. These included 75 individuals with type 1 diabetes and 158 individuals with type 2 diabetes. The median reduction in urinary sodium was 203 mmol/24 h (11.9 g/day) in type 1 diabetes and 125 mmol/24 h (7.3 g/day) in type 2 diabetes. The median duration of salt restriction was one week in both type 1 and type 2 diabetes. BP was reduced in both type 1 and type 2 diabetes. In type 1 diabetes (56 individuals), salt restriction reduced BP by -7.11/-3.13 mm Hg (systolic/diastolic); 95% CI: systolic BP (SBP) -9.13 to -5.10; diastolic BP (DBP) -4.28 to -1.98). In type 2 diabetes (56 individuals), salt restriction reduced BP by -6.90/-2.87 mm Hg (95% CI: SBP -9.84 to -3.95; DBP -4.39 to -1.35). There was a greater reduction in BP in normotensive patients, possibly due to a larger decrease in salt intake in this group.

AUTHORS' CONCLUSIONS

Although the studies are not extensive, this meta-analysis shows a large fall in BP with salt restriction, similar to that of single drug therapy. All diabetics should consider reducing salt intake at least to less than 5-6 g/day in keeping with current recommendations for the general population and may consider lowering salt intake to lower levels, although further studies are needed.

Authors+Show Affiliations

Blood Pressure Unit, St. George's Hospital Medical School, Crammer Terrace, London, UK, SW17 0RE.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

21154374

Citation

Suckling, Rebecca J., et al. "Altered Dietary Salt Intake for Preventing and Treating Diabetic Kidney Disease." The Cochrane Database of Systematic Reviews, 2010, p. CD006763.
Suckling RJ, He FJ, Macgregor GA. Altered dietary salt intake for preventing and treating diabetic kidney disease. Cochrane Database Syst Rev. 2010.
Suckling, R. J., He, F. J., & Macgregor, G. A. (2010). Altered dietary salt intake for preventing and treating diabetic kidney disease. The Cochrane Database of Systematic Reviews, (12), p. CD006763. doi:10.1002/14651858.CD006763.pub2.
Suckling RJ, He FJ, Macgregor GA. Altered Dietary Salt Intake for Preventing and Treating Diabetic Kidney Disease. Cochrane Database Syst Rev. 2010 Dec 8;(12)CD006763. PubMed PMID: 21154374.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Altered dietary salt intake for preventing and treating diabetic kidney disease. AU - Suckling,Rebecca J, AU - He,Feng J, AU - Macgregor,Graham A, Y1 - 2010/12/08/ PY - 2010/12/15/entrez PY - 2010/12/15/pubmed PY - 2011/2/11/medline SP - CD006763 EP - CD006763 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 12 N2 - BACKGROUND: There is strong evidence that our current consumption of salt is a major factor for increased blood pressure (BP) and a modest reduction in salt intake lowers BP whether BP levels are normal or raised. Tight control of BP in diabetics lowers the risk of strokes, heart attacks and heart failure and slows the progression of diabetic kidney disease (DKD). Currently there is no consensus in restricting salt intake in diabetic patients. OBJECTIVES: To evaluate the effect of altered salt intake on BP and markers of cardiovascular disease and DKD. SEARCH STRATEGY: In January 2010, we searched the Cochrane Renal Group's Specialised Register, CENTRAL (in The Cochrane Library), MEDLINE (from 1966) and EMBASE (from 1980) to identify appropriate articles. SELECTION CRITERIA: We included all randomised controlled trials of salt reduction in individuals with type 1 and type 2 diabetes. DATA COLLECTION AND ANALYSIS: Two authors independently assessed studies and resolved differences by discussion with a third independent author. We calculated mean effect sizes using both the fixed-effect and random-effects models. MAIN RESULTS: Thirteen studies (254 individuals) met our inclusion criteria. These included 75 individuals with type 1 diabetes and 158 individuals with type 2 diabetes. The median reduction in urinary sodium was 203 mmol/24 h (11.9 g/day) in type 1 diabetes and 125 mmol/24 h (7.3 g/day) in type 2 diabetes. The median duration of salt restriction was one week in both type 1 and type 2 diabetes. BP was reduced in both type 1 and type 2 diabetes. In type 1 diabetes (56 individuals), salt restriction reduced BP by -7.11/-3.13 mm Hg (systolic/diastolic); 95% CI: systolic BP (SBP) -9.13 to -5.10; diastolic BP (DBP) -4.28 to -1.98). In type 2 diabetes (56 individuals), salt restriction reduced BP by -6.90/-2.87 mm Hg (95% CI: SBP -9.84 to -3.95; DBP -4.39 to -1.35). There was a greater reduction in BP in normotensive patients, possibly due to a larger decrease in salt intake in this group. AUTHORS' CONCLUSIONS: Although the studies are not extensive, this meta-analysis shows a large fall in BP with salt restriction, similar to that of single drug therapy. All diabetics should consider reducing salt intake at least to less than 5-6 g/day in keeping with current recommendations for the general population and may consider lowering salt intake to lower levels, although further studies are needed. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/21154374/Altered_dietary_salt_intake_for_preventing_and_treating_diabetic_kidney_disease_ L2 - https://doi.org/10.1002/14651858.CD006763.pub2 DB - PRIME DP - Unbound Medicine ER -