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Spot Urine-guided Salt Reduction in Chronic Kidney Disease Patients.
J Ren Nutr. 2017 09; 27(5):311-316.JR

Abstract

OBJECTIVE

Dietary salt restriction is important in patients with chronic kidney disease (CKD) to reduce hypertension, cardiovascular events, progression of CKD, and mortality. However, recommending salt reduction for patients is difficult without knowing their actual sodium intake. This study evaluated the effectiveness of spot urine-guided salt reduction in CKD outpatients.

DESIGN

A prospective cohort study was used.

SUBJECTS

This study included a total of 127 adult outpatients (aged 60 ± 18 years, 80 males) with CKD. Their baseline estimated glomerular filtration rate was 51.4 ± 25.1 (mL/minute/1.73 m2), and 64 (50%) of them were with CKD stage 3a or 3b (both 32 [25%]).

INTERVENTION

We informed the patients of their individual spot urine-estimated salt intake every time they visited the outpatient clinic. Based on the data, the nephrologist encouraged the patients to achieve their salt restriction goal.

MAIN OUTCOME MEASURE

The primary outcome was the estimated salt excretion, and the secondary outcome was the urinary protein-to-Cr ratio (UPCR). Multiple regression analyses were performed to clarify the contributing factors of changes in both outcomes.

RESULTS

Over a follow-up of 12 months, the median number of patients' visits was 7 (5-8). The estimated salt intake was significantly reduced from 7.98 ± 2.49 g/day to 6.77 ± 1.77 g/day (P < .0001). The median UPCR was also reduced from 0.20 (0.10-0.80) to 0.10 (0.10-0.48) (P < .0001). On multiple regression analysis, a reduction in UPCR was positively associated with the baseline UPCR and a reduction in systolic blood pressure significantly (P < .0001 and P < .01, respectively) as well as positively correlated with a reduction in the estimated salt intake, with borderline significance (P = .08).

CONCLUSIONS

Providing spot urine-estimated salt intake feedback effectively motivated CKD patients to reduce their salt intake. Spot urine-guided salt reduction may slow CKD progression through decreased urinary protein excretion.

Authors+Show Affiliations

Division of Nephrology, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan. Electronic address: kiyo.0817.piyo@keio.jp.Division of Nephrology, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan.Division of Nephrology, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28579314

Citation

Uchiyama, Kiyotaka, et al. "Spot Urine-guided Salt Reduction in Chronic Kidney Disease Patients." Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, vol. 27, no. 5, 2017, pp. 311-316.
Uchiyama K, Yanai A, Ishibashi Y. Spot Urine-guided Salt Reduction in Chronic Kidney Disease Patients. J Ren Nutr. 2017;27(5):311-316.
Uchiyama, K., Yanai, A., & Ishibashi, Y. (2017). Spot Urine-guided Salt Reduction in Chronic Kidney Disease Patients. Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, 27(5), 311-316. https://doi.org/10.1053/j.jrn.2017.04.005
Uchiyama K, Yanai A, Ishibashi Y. Spot Urine-guided Salt Reduction in Chronic Kidney Disease Patients. J Ren Nutr. 2017;27(5):311-316. PubMed PMID: 28579314.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spot Urine-guided Salt Reduction in Chronic Kidney Disease Patients. AU - Uchiyama,Kiyotaka, AU - Yanai,Akane, AU - Ishibashi,Yoshitaka, Y1 - 2017/05/31/ PY - 2017/02/03/received PY - 2017/03/07/revised PY - 2017/04/04/accepted PY - 2017/6/6/pubmed PY - 2018/5/25/medline PY - 2017/6/6/entrez SP - 311 EP - 316 JF - Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation JO - J Ren Nutr VL - 27 IS - 5 N2 - OBJECTIVE: Dietary salt restriction is important in patients with chronic kidney disease (CKD) to reduce hypertension, cardiovascular events, progression of CKD, and mortality. However, recommending salt reduction for patients is difficult without knowing their actual sodium intake. This study evaluated the effectiveness of spot urine-guided salt reduction in CKD outpatients. DESIGN: A prospective cohort study was used. SUBJECTS: This study included a total of 127 adult outpatients (aged 60 ± 18 years, 80 males) with CKD. Their baseline estimated glomerular filtration rate was 51.4 ± 25.1 (mL/minute/1.73 m2), and 64 (50%) of them were with CKD stage 3a or 3b (both 32 [25%]). INTERVENTION: We informed the patients of their individual spot urine-estimated salt intake every time they visited the outpatient clinic. Based on the data, the nephrologist encouraged the patients to achieve their salt restriction goal. MAIN OUTCOME MEASURE: The primary outcome was the estimated salt excretion, and the secondary outcome was the urinary protein-to-Cr ratio (UPCR). Multiple regression analyses were performed to clarify the contributing factors of changes in both outcomes. RESULTS: Over a follow-up of 12 months, the median number of patients' visits was 7 (5-8). The estimated salt intake was significantly reduced from 7.98 ± 2.49 g/day to 6.77 ± 1.77 g/day (P < .0001). The median UPCR was also reduced from 0.20 (0.10-0.80) to 0.10 (0.10-0.48) (P < .0001). On multiple regression analysis, a reduction in UPCR was positively associated with the baseline UPCR and a reduction in systolic blood pressure significantly (P < .0001 and P < .01, respectively) as well as positively correlated with a reduction in the estimated salt intake, with borderline significance (P = .08). CONCLUSIONS: Providing spot urine-estimated salt intake feedback effectively motivated CKD patients to reduce their salt intake. Spot urine-guided salt reduction may slow CKD progression through decreased urinary protein excretion. SN - 1532-8503 UR - https://www.unboundmedicine.com/medline/citation/28579314/Spot_Urine_guided_Salt_Reduction_in_Chronic_Kidney_Disease_Patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-2276(17)30106-1 DB - PRIME DP - Unbound Medicine ER -