Assessment and validation of spot urine in estimating the 24-h urinary sodium, potassium, and sodium/potassium ratio in Chinese adults

Xu, Jianwei; Du, Xiaofu; Bai, Yun; Fang, Le; Liu, Min; Ji, Ning; Zhong, Jieming; Yu, Min; Wu, Jing

doi:10.1038/s41371-019-0274-z

Cited by 18 publications

(29 citation statements)

References 37 publications

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“…Two previous studies reported that Tanaka performed well to predict mean population 24-hUNa excretion in both Chinese adults [16] and young adolescents [17], which was in conformance with our study. Nevertheless, other previous studies in Chinese adults found that the Kawasaki formula showed the lowest bias compared to Tanaka and INTERSALT formulas in both general [18][19][20][21] and hypertensive populations [22]. However, the Kawasaki formula performed worst among the six equations in our study.…”

Section: Discussioncontrasting

confidence: 79%

Estimating 24-Hour Sodium Excretion from Spot Urine Samples in Chinese Adults: Can Spot Urine Substitute 24-Hour Urine Samples?

Zhang

Liu

et al. 2020

Nutrients

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Several estimating equations for predicting 24-h urinary sodium (24-hUNa) excretion using spot urine (SU) samples have been developed, but have not been readily available to Chinese populations. We aimed to compare and validate the six existing methods at population level and individual level. We extracted 1671 adults eligible for both 24-h urine and SU sample collection. Mean biases (95% CI) of predicting 24-hUNa excretion using six formulas were 58.6 (54.7, 62.5) mmol for Kawasaki, −2.7 (−6.2, 0.9) mmol for Tanaka, −24.5 (−28.0, −21.0) mmol for the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) with potassium, -26.8 (−30.1, −23.3) mmol for INTERSALT without potassium, 5.9 (2.3, 9.6) mmol for Toft, and −24.2 (−27.7, −20.6) mmol for Whitton. The proportions of relative difference >40% with the six methods were nearly a third, and the proportions of absolute difference >51.3 mmol/24-h (3 g/day salt) were more than 40%. The misclassification rate were all >55% for the six methods at the individual level. Although the Tanaka method could offer a plausible estimation for surveillance of the population sodium excretion in Shandong province, caution remains when using the Tanaka formula for other provincial populations in China. However, these predictive methods were inadequate to evaluate individual sodium excretion.

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Section: Discussioncontrasting

confidence: 79%

Estimating 24-Hour Sodium Excretion from Spot Urine Samples in Chinese Adults: Can Spot Urine Substitute 24-Hour Urine Samples?

Zhang

Liu

et al. 2020

Nutrients

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“…and ICCs of 0.31 and 0.27 (all P < 0.01), respectively, while the mean bias for the Kawasaki method in estimating 24UKV was the least among these methods (16) . In the subgroup analysis regarding different gender and timing of spot urine, all other mean absolute difference between estimated and measured values were all significant different, except for those from Tanaka formula using morning, afternoon, and evening spot urine.…”

Section: Discussionmentioning

confidence: 83%

Accuracy of equations for predicting 24-h urinary potassium excretion from spot urine samples in Chinese children

et al. 2021

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Accurate assessments of potassium intake in children are important for the early prevention of cardiovascular disease. Currently, there is no simple approach for accurate estimation of potassium intake in children. We aim to evaluate the accuracy of 24-hour urinary potassium excretion (24UKV) estimation in children using three common equations: the Kawasaki, Tanaka, and Mage formulas, in a hospital-based setting. A total of 151 participants aged 5˜18 years were initially enrolled, and spot urine samples were collected in the whole 24-hour duration to measure the concentrations of potassium and creatinine. We calculated the mean difference, absolute and relative difference, and misclassification rate between measured 24UKV and the predicted ones using Kawasaki, Tanaka, and Mage formulas in 129 participants. The mean measured 24UKV was 1193.3 mg/d in our study. Mean differences between estimated and measured 24UKV were 1215.6, −14.9, and 230.3 mg/d by the Kawasaki, Tanaka, and Mage formulas, respectively. All estimated 24UKV were significantly different from the measured values in all the timepoint (all P<0.05), except for the predicted values from Tanaka formula using morning, afternoon, and evening spot urine. The proportions with relative differences over 40% were 87.2%, 32.5%, and 47.3% for Kawasaki, Tanaka, and Mage formulas, respectively. Misclassification rates were 91.5% for Kawasaki, 44.4% for Tanaka, and 58.9% for Mage formula at the individual level. Our findings showed that misclassification could occur on the individual level when using Kawasaki, Tanaka, and Mage formulas to estimate 24UKV from spot urine in the child population.

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“… 23 , 24 , 25 , 26 For example, Peng and colleagues studied rural and urban residents from Shanxi Province who were participating in the Prospective Urban Rural Epidemiology (PURE)‐China study, and found that the mean differences between the measured values and values estimated using the Kawasaki, Tanaka, and INTERSALT methods were −740.49, −2305.05, and −2797.39 mg/day. 24 Other studies 23 , 25 , 26 that were performed in the Chinese populations also demonstrated that the differences between the measured values and values estimated using the Kawasaki method were smaller than that those obtained when using the Tanaka or INTERSALT methods. In addition, a sub‐study of the PURE study, which was of 1083 participants aged 35–70 years who were recruited worldwide, obtained similar results.…”

Section: Discussionmentioning

confidence: 99%

Assessment and validation of three spot urine assay methods for the estimation of 24‐hour urinary sodium excretion in Chinese Tibetan adults living in the mountains

Zhang

Liao

et al. 2021

J of Clinical Hypertension

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Twenty‐four‐hour urine collection is the gold standard method for the evaluation of salt intake, but it is often impractical in large‐scale investigations, especially in resource‐poor areas. Methods for the estimation of 24‐hour urinary sodium excretion (USE) using a spot urine sample have been established, but have not been validated in Chinese Tibetans. Therefore, the authors aimed to evaluate the Kawasaki, Tanaka, and the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) formulas for the prediction of 24‐hour USE in Chinese Tibetan adults. The authors analyzed the bias, correlation, agreements between estimated values and measured values, and the relative and absolute differences and misclassification at the individual level for the three methods in 323 Tibetan participants from the Ganzi Tibetan Autonomous Prefecture of Sichuan Province, China. The mean biases between the measured values and the estimated 24‐hour USE using the Kawasaki, Tanaka, and INTERSALT methods were 5.4 mmol/day (95% confidence interval [CI]: 0.8–10.1 mmol/day), −40.8 mmol/day (95% CI: −44.6 to −36.9 mmol/day), and −57.1 mmol/day (95% CI: −61.9 to −52.4 mmol/day), respectively. The Pearson correlation coefficients for the relationships between the measured values and the estimated 24‐hour USE were 0.43 (Kawasaki), 0.38 (Tanaka), and 0.27 (INTERSALT), respectively (all p < .01). The intraclass correlation coefficients showed similar patterns to the correlation data: 0.47 for Kawasaki, 0.40 for Tanaka, and 0.27 for INTERSALT (all p < .01). The upper and lower limits of agreement between the measured values and the estimated 24‐hour USE were −92.6 and 81.8 mmol/day for the Kawasaki method, −28.5 and 110.0 mmol/day for the Tanaka method, and −28.4 and 142.7 mmol/day for the INTERSALT method. Compared with the other two methods, the percentage of individuals that were misclassified by using the Kawasaki method was 48.2%, while those for the Tanaka and INTERSAL methods was 72.1% and 75.5%, respectively. However, when an individual's salt intake was higher than 12.8 g/day, the misclassification rates of the Kawasaki, Tanaka, and INTERSALT methods were 20%, 90%, and 97.5%, respectively. Thus, the authors found that the Kawasaki equation may have performed better than the other equations at Chinese Tibetan population level assessment, but none of these equations are suitable for use or perform well at the individual level. A more accurate method of using a spot urine sample to evaluate individual 24‐hour USE for Tibetans is needed.

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Assessment and validation of spot urine in estimating the 24-h urinary sodium, potassium, and sodium/potassium ratio in Chinese adults

Cited by 18 publications

References 37 publications

Estimating 24-Hour Sodium Excretion from Spot Urine Samples in Chinese Adults: Can Spot Urine Substitute 24-Hour Urine Samples?

Estimating 24-Hour Sodium Excretion from Spot Urine Samples in Chinese Adults: Can Spot Urine Substitute 24-Hour Urine Samples?

Accuracy of equations for predicting 24-h urinary potassium excretion from spot urine samples in Chinese children

Assessment and validation of three spot urine assay methods for the estimation of 24‐hour urinary sodium excretion in Chinese Tibetan adults living in the mountains

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