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Sodium Intake and Chronic Kidney Disease.
Int J Mol Sci. 2020 Jul 03; 21(13)IJ

Abstract

In Chronic Kidney Disease (CKD) patients, elevated blood pressure (BP) is a frequent finding and is traditionally considered a direct consequence of their sodium sensitivity. Indeed, sodium and fluid retention, causing hypervolemia, leads to the development of hypertension in CKD. On the other hand, in non-dialysis CKD patients, salt restriction reduces BP levels and enhances anti-proteinuric effect of renin-angiotensin-aldosterone system inhibitors in non-dialysis CKD patients. However, studies on the long-term effect of low salt diet (LSD) on cardio-renal prognosis showed controversial findings. The negative results might be the consequence of measurement bias (spot urine and/or single measurement), reverse epidemiology, as well as poor adherence to diet. In end-stage kidney disease (ESKD), dialysis remains the only effective means to remove dietary sodium intake. The mismatch between intake and removal of sodium leads to fluid overload, hypertension and left ventricular hypertrophy, therefore worsening the prognosis of ESKD patients. This imposes the implementation of a LSD in these patients, irrespective of the lack of trials proving the efficacy of this measure in these patients. LSD is, therefore, a rational and basic tool to correct fluid overload and hypertension in all CKD stages. The implementation of LSD should be personalized, similarly to diuretic treatment, keeping into account the volume status and true burden of hypertension evaluated by ambulatory BP monitoring.

Authors+Show Affiliations

Nephrology Unit, Advanced Surgical and Medical Sciences Department of University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80137 Naples, Italy.Nephrology Unit, Department of Health Sciences, "Magna Grecia" University, 88100 Catanzaro, Italy.Nephrology Unit, Department of Health Sciences, "Magna Grecia" University, 88100 Catanzaro, Italy.Nephrology Unit, Department of Health Sciences, "Magna Grecia" University, 88100 Catanzaro, Italy.Nephrology Unit, Advanced Surgical and Medical Sciences Department of University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80137 Naples, Italy.Nephrology Unit, Advanced Surgical and Medical Sciences Department of University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80137 Naples, Italy.Nephrology Unit, Advanced Surgical and Medical Sciences Department of University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80137 Naples, Italy.Nephrology Unit, Advanced Surgical and Medical Sciences Department of University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80137 Naples, Italy.Nephrology Unit, Department of Health Sciences, "Magna Grecia" University, 88100 Catanzaro, Italy.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32635265

Citation

Borrelli, Silvio, et al. "Sodium Intake and Chronic Kidney Disease." International Journal of Molecular Sciences, vol. 21, no. 13, 2020.
Borrelli S, Provenzano M, Gagliardi I, et al. Sodium Intake and Chronic Kidney Disease. Int J Mol Sci. 2020;21(13).
Borrelli, S., Provenzano, M., Gagliardi, I., Ashour, M., Liberti, M. E., De Nicola, L., Conte, G., Garofalo, C., & Andreucci, M. (2020). Sodium Intake and Chronic Kidney Disease. International Journal of Molecular Sciences, 21(13). https://doi.org/10.3390/ijms21134744
Borrelli S, et al. Sodium Intake and Chronic Kidney Disease. Int J Mol Sci. 2020 Jul 3;21(13) PubMed PMID: 32635265.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sodium Intake and Chronic Kidney Disease. AU - Borrelli,Silvio, AU - Provenzano,Michele, AU - Gagliardi,Ida, AU - Ashour,Michael, AU - Liberti,Maria Elena, AU - De Nicola,Luca, AU - Conte,Giuseppe, AU - Garofalo,Carlo, AU - Andreucci,Michele, Y1 - 2020/07/03/ PY - 2020/05/30/received PY - 2020/06/27/revised PY - 2020/07/01/accepted PY - 2020/7/9/entrez PY - 2020/7/9/pubmed PY - 2020/7/9/medline KW - cardiovascular risk KW - hypertension KW - mortality KW - prognosis KW - salt intake KW - sodium JF - International journal of molecular sciences JO - Int J Mol Sci VL - 21 IS - 13 N2 - In Chronic Kidney Disease (CKD) patients, elevated blood pressure (BP) is a frequent finding and is traditionally considered a direct consequence of their sodium sensitivity. Indeed, sodium and fluid retention, causing hypervolemia, leads to the development of hypertension in CKD. On the other hand, in non-dialysis CKD patients, salt restriction reduces BP levels and enhances anti-proteinuric effect of renin-angiotensin-aldosterone system inhibitors in non-dialysis CKD patients. However, studies on the long-term effect of low salt diet (LSD) on cardio-renal prognosis showed controversial findings. The negative results might be the consequence of measurement bias (spot urine and/or single measurement), reverse epidemiology, as well as poor adherence to diet. In end-stage kidney disease (ESKD), dialysis remains the only effective means to remove dietary sodium intake. The mismatch between intake and removal of sodium leads to fluid overload, hypertension and left ventricular hypertrophy, therefore worsening the prognosis of ESKD patients. This imposes the implementation of a LSD in these patients, irrespective of the lack of trials proving the efficacy of this measure in these patients. LSD is, therefore, a rational and basic tool to correct fluid overload and hypertension in all CKD stages. The implementation of LSD should be personalized, similarly to diuretic treatment, keeping into account the volume status and true burden of hypertension evaluated by ambulatory BP monitoring. SN - 1422-0067 UR - https://www.unboundmedicine.com/medline/citation/32635265/Sodium_Intake_and_Chronic_Kidney_Disease L2 - https://www.mdpi.com/resolver?pii=ijms21134744 DB - PRIME DP - Unbound Medicine ER -
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