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Association Between Urinary Sodium, Creatinine, Albumin, and Long-Term Survival in Chronic Kidney Disease

Dietary sodium intake is associated with hypertension and cardiovascular risk in the general population. In patients with chronic kidney disease, sodium intake has been associated with progressive renal disease, but not independently of proteinuria. We studied the relationship between urinary sodium... Full description

Journal Title: Hypertension (Dallas Tex. 1979), 2014-07, Vol.64 (1), p.111-117
Main Author: McQuarrie, Emily P
Other Authors: Traynor, Jamie P , Taylor, Alison H , Freel, E Marie , Fox, Jonathan G , Jardine, Alan G , Mark, Patrick B
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: Hagerstown, MD: American Heart Association, Inc
ID: ISSN: 0194-911X
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recordid: cdi_proquest_miscellaneous_1535628278
title: Association Between Urinary Sodium, Creatinine, Albumin, and Long-Term Survival in Chronic Kidney Disease
format: Article
creator:
  • McQuarrie, Emily P
  • Traynor, Jamie P
  • Taylor, Alison H
  • Freel, E Marie
  • Fox, Jonathan G
  • Jardine, Alan G
  • Mark, Patrick B
subjects:
  • Adult
  • Aged
  • Aged, 80 and over
  • Albuminuria - complications
  • Albuminuria - mortality
  • Albuminuria - urine
  • Arterial hypertension. Arterial hypotension
  • Biological and medical sciences
  • Blood and lymphatic vessels
  • Cardiology. Vascular system
  • Creatinine - urine
  • Disease Progression
  • Female
  • Humans
  • Kidney - physiopathology
  • Kidneys
  • Male
  • Medical sciences
  • Middle Aged
  • Nephrology. Urinary tract diseases
  • Nephropathies. Renovascular diseases. Renal failure
  • Renal failure
  • Renal Insufficiency, Chronic - complications
  • Renal Insufficiency, Chronic - mortality
  • Renal Insufficiency, Chronic - urine
  • Sodium - urine
  • Urinary system involvement in other diseases. Miscellaneous
  • Urinary tract. Prostate gland
ispartof: Hypertension (Dallas, Tex. 1979), 2014-07, Vol.64 (1), p.111-117
description: Dietary sodium intake is associated with hypertension and cardiovascular risk in the general population. In patients with chronic kidney disease, sodium intake has been associated with progressive renal disease, but not independently of proteinuria. We studied the relationship between urinary sodium (UNa) excretion and UNa to creatinine ratio and mortality or requirement for renal replacement therapy in chronic kidney disease. Adult patients attending a renal clinic who had ≥1 24-hour UNa measurement were identified. Twenty-four-hour UNa measures were collected and UNa to creatinine ratio calculated. Time to renal replacement therapy or death was recorded. Four hundred twenty-three patients were identified with mean estimated glomerular filtration rate of 48 mL/min per 1.73 m. Ninety patients required renal replacement therapy and 102 patients died. Mean slope decline in estimated glomerular filtration rate was −2.8 mL/min per 1.73 m per year. Median follow-up was 8.5 years. Patients who died or required renal replacement therapy had significantly higher UNa excretion and UNa to creatinine ratio, but the association with these parameters and poor outcome was not independent of renal function, age, and albuminuria. When stratified by albuminuria, UNa to creatinine ratio was a significant cumulative additional risk for mortality, even in patients with low-level albuminuria. There was no association between low UNa and risk, as observed in some studies. This study demonstrates an association between UNa excretion and mortality in chronic kidney disease, with a cumulative relationship between sodium excretion, albuminuria, and reduced survival. These data support reducing dietary sodium intake in chronic kidney disease, but additional study is required to determine the target sodium intake.
language: eng
source:
identifier: ISSN: 0194-911X
fulltext: no_fulltext
issn:
  • 0194-911X
  • 1524-4563
url: Link


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creatorMcQuarrie, Emily P ; Traynor, Jamie P ; Taylor, Alison H ; Freel, E Marie ; Fox, Jonathan G ; Jardine, Alan G ; Mark, Patrick B
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descriptionDietary sodium intake is associated with hypertension and cardiovascular risk in the general population. In patients with chronic kidney disease, sodium intake has been associated with progressive renal disease, but not independently of proteinuria. We studied the relationship between urinary sodium (UNa) excretion and UNa to creatinine ratio and mortality or requirement for renal replacement therapy in chronic kidney disease. Adult patients attending a renal clinic who had ≥1 24-hour UNa measurement were identified. Twenty-four-hour UNa measures were collected and UNa to creatinine ratio calculated. Time to renal replacement therapy or death was recorded. Four hundred twenty-three patients were identified with mean estimated glomerular filtration rate of 48 mL/min per 1.73 m. Ninety patients required renal replacement therapy and 102 patients died. Mean slope decline in estimated glomerular filtration rate was −2.8 mL/min per 1.73 m per year. Median follow-up was 8.5 years. Patients who died or required renal replacement therapy had significantly higher UNa excretion and UNa to creatinine ratio, but the association with these parameters and poor outcome was not independent of renal function, age, and albuminuria. When stratified by albuminuria, UNa to creatinine ratio was a significant cumulative additional risk for mortality, even in patients with low-level albuminuria. There was no association between low UNa and risk, as observed in some studies. This study demonstrates an association between UNa excretion and mortality in chronic kidney disease, with a cumulative relationship between sodium excretion, albuminuria, and reduced survival. These data support reducing dietary sodium intake in chronic kidney disease, but additional study is required to determine the target sodium intake.
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subjectAdult ; Aged ; Aged, 80 and over ; Albuminuria - complications ; Albuminuria - mortality ; Albuminuria - urine ; Arterial hypertension. Arterial hypotension ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Creatinine - urine ; Disease Progression ; Female ; Humans ; Kidney - physiopathology ; Kidneys ; Male ; Medical sciences ; Middle Aged ; Nephrology. Urinary tract diseases ; Nephropathies. Renovascular diseases. Renal failure ; Renal failure ; Renal Insufficiency, Chronic - complications ; Renal Insufficiency, Chronic - mortality ; Renal Insufficiency, Chronic - urine ; Sodium - urine ; Urinary system involvement in other diseases. Miscellaneous ; Urinary tract. Prostate gland
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descriptionDietary sodium intake is associated with hypertension and cardiovascular risk in the general population. In patients with chronic kidney disease, sodium intake has been associated with progressive renal disease, but not independently of proteinuria. We studied the relationship between urinary sodium (UNa) excretion and UNa to creatinine ratio and mortality or requirement for renal replacement therapy in chronic kidney disease. Adult patients attending a renal clinic who had ≥1 24-hour UNa measurement were identified. Twenty-four-hour UNa measures were collected and UNa to creatinine ratio calculated. Time to renal replacement therapy or death was recorded. Four hundred twenty-three patients were identified with mean estimated glomerular filtration rate of 48 mL/min per 1.73 m. Ninety patients required renal replacement therapy and 102 patients died. Mean slope decline in estimated glomerular filtration rate was −2.8 mL/min per 1.73 m per year. Median follow-up was 8.5 years. Patients who died or required renal replacement therapy had significantly higher UNa excretion and UNa to creatinine ratio, but the association with these parameters and poor outcome was not independent of renal function, age, and albuminuria. When stratified by albuminuria, UNa to creatinine ratio was a significant cumulative additional risk for mortality, even in patients with low-level albuminuria. There was no association between low UNa and risk, as observed in some studies. This study demonstrates an association between UNa excretion and mortality in chronic kidney disease, with a cumulative relationship between sodium excretion, albuminuria, and reduced survival. These data support reducing dietary sodium intake in chronic kidney disease, but additional study is required to determine the target sodium intake.
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0Adult
1Aged
2Aged, 80 and over
3Albuminuria - complications
4Albuminuria - mortality
5Albuminuria - urine
6Arterial hypertension. Arterial hypotension
7Biological and medical sciences
8Blood and lymphatic vessels
9Cardiology. Vascular system
10Creatinine - urine
11Disease Progression
12Female
13Humans
14Kidney - physiopathology
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16Male
17Medical sciences
18Middle Aged
19Nephrology. Urinary tract diseases
20Nephropathies. Renovascular diseases. Renal failure
21Renal failure
22Renal Insufficiency, Chronic - complications
23Renal Insufficiency, Chronic - mortality
24Renal Insufficiency, Chronic - urine
25Sodium - urine
26Urinary system involvement in other diseases. Miscellaneous
27Urinary tract. Prostate gland
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abstractDietary sodium intake is associated with hypertension and cardiovascular risk in the general population. In patients with chronic kidney disease, sodium intake has been associated with progressive renal disease, but not independently of proteinuria. We studied the relationship between urinary sodium (UNa) excretion and UNa to creatinine ratio and mortality or requirement for renal replacement therapy in chronic kidney disease. Adult patients attending a renal clinic who had ≥1 24-hour UNa measurement were identified. Twenty-four-hour UNa measures were collected and UNa to creatinine ratio calculated. Time to renal replacement therapy or death was recorded. Four hundred twenty-three patients were identified with mean estimated glomerular filtration rate of 48 mL/min per 1.73 m. Ninety patients required renal replacement therapy and 102 patients died. Mean slope decline in estimated glomerular filtration rate was −2.8 mL/min per 1.73 m per year. Median follow-up was 8.5 years. Patients who died or required renal replacement therapy had significantly higher UNa excretion and UNa to creatinine ratio, but the association with these parameters and poor outcome was not independent of renal function, age, and albuminuria. When stratified by albuminuria, UNa to creatinine ratio was a significant cumulative additional risk for mortality, even in patients with low-level albuminuria. There was no association between low UNa and risk, as observed in some studies. This study demonstrates an association between UNa excretion and mortality in chronic kidney disease, with a cumulative relationship between sodium excretion, albuminuria, and reduced survival. These data support reducing dietary sodium intake in chronic kidney disease, but additional study is required to determine the target sodium intake.
copHagerstown, MD
pubAmerican Heart Association, Inc
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doi10.1161/HYPERTENSIONAHA.113.03093
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