Daily Sodium Intake in Chronic Kidney Disease Patients during Nephrology Clinic Follow-Up: An Observational Study with 24-Hour Urine Sodium Measurement

Kutlugun, Aysun Aybal; Arıcı, Mustafa; Yıldırım, Tolga; Turgut, Didem; Yılmaz, Rahmi; Altındal, Mahmut; Altun, Bülent; Erdem, Yunus; Yasavul, Ünal; Turgan, Çetin

doi:10.1159/000323392

Cited by 28 publications

(12 citation statements)

References 67 publications

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“…Salt intake with the modern Western-type diet has been estimated up to 12 g/day (4.6 g or 200 mmol of sodium) [ 10 ]. Clinical guideline groups such as the National Kidney Foundation Kidney Dialysis Outcome Quality Initiative and European Best Practice Clinical Guidelines have recommended that kidney dialysis patients should limit their dietary salt intake to 5 g/day (2.0 g or 85 mmol of sodium) [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Estimated dietary sodium intake in haemodialysis patients using food frequency questionnaires

Gkza

Davenport

2017

Clinical Kidney Journal

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BackgroundIn clinical practice, dietary sodium assessment requires reliable and rapid screening tools. We wished to evaluate the usefulness of food frequency questionnaires (FFQ) in estimating dietary sodium intakes in haemodialysis patients.MethodsWe used the Derby Salt Questionnaire (DSQ), and Scored Sodium Questionnaire (SSQ) to estimate sodium intake. Body composition was determined by bioimpedance.ResultsIn total, 139 haemodialysis patients (95 men) completed the FFQs, with mean ± standard deviation age 67 ± 15 years. The mean FFQ scores were DSQ 3.5 ± 2.0 and SSQ 68.4 ± 24.5. Men had higher estimated dietary sodium intakes [DSQ median (range) 3.6 (0.6–10.1) versus female 2.2 (0.5–9.1), P = 0.007)]. Younger patients and those aged >75 years had the higher SSQ dietary sodium scores; 70.7 ± 27.8 and 76.8 ± 24.6 versus those aged 55–75 years, 61.8 ± 22.3, P = 0.04. Patients with greater estimated sodium intake had higher extracellular water (ECW) to intracellular water (ICW) ratios pre-dialysis [75.1 ±12.5 versus 67.7 ± 4.8, P < 0.001] and ECW excess pre-dialysis [1.8 (1.5–2.6) versus 1.3 (0.8–2.0) L, P < 0.05]. Mean arterial pressure (MAP) and inter-dialytic weight gains did not differ; however, the fall in MAP during dialysis was lower in the higher estimated dietary sodium group (0.9 ± 13.7% versus 6.5 ± 14.1%, P = 0.04).ConclusionsBoth questionnaires were acceptable to patients and identified higher estimated dietary sodium intake for men, those with greater ECW and, somewhat surprisingly, we found that older patients had a greater dietary sodium intake than expected.

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Section: Introductionmentioning

confidence: 99%

Estimated dietary sodium intake in haemodialysis patients using food frequency questionnaires

Gkza

Davenport

2017

Clinical Kidney Journal

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“…Thus, programs that achieve sodium reduction have potential to benefit a significant portion of the population [ 8 , 9 ]. Despite guidelines to limit daily sodium intake [ 10 - 13 ], consumption of dietary sodium in patients with CKD remains high [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Results of a novel screening tool measuring dietary sodium knowledge in patients with chronic kidney disease

et al. 2015

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BackgroundReducing dietary sodium has potential to benefit patients with chronic kidney disease (CKD). Little research is available defining dietary sodium knowledge gaps in patients with pre-dialysis CKD. We designed a brief screening tool to rapidly identify patient knowledge gaps related to dietary sodium for patients with CKD not yet on dialysis.MethodsA Short Sodium Knowledge Survey (SSKS) was developed and administered to patients with pre-dialysis CKD. We also asked patients if they received counseling on dietary sodium reduction and about recommended intake limits. We performed logistic regression to examine the association between sodium knowledge and patient characteristics. Characteristics of patients who answered all SSKS questions correctly were compared to those who did not.ResultsOne-hundred fifty-five patients were surveyed. The mean (SD) age was 56.6 (15.1) years, 84 (54%) were men, and 119 (77%) were white. Sixty-seven patients (43.2%) correctly identified their daily intake sodium limit. Fifty-eight (37.4%) were unable to answer all survey questions correctly. In analysis adjusted for age, sex, race, education, health literacy, CKD stage, self-reported hypertension and attendance in a kidney education class, women and patients of non-white race had lower odds of correctly answering survey questions (0.36 [0.16,0.81]; p = 0.01 women versus men and 0.33 [0.14,0.76]; p = 0.01 non-white versus white, respectively).ConclusionsOur survey provides a mechanism to quickly identify dietary sodium knowledge gaps in patients with CKD. Women and patients of non-white race may have knowledge barriers impeding adherence to sodium reduction advice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0027-3) contains supplementary material, which is available to authorized users.

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“…Research data indicate approximately 80-90% of people with CKD consume more than 100 mmol of sodium per day [8,11], equivalent to the current recommended maximum intake of 6 g of salt/day in guidelines from the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF/KDOQI) [12]. Despite its importance, sodium intake is often not evaluated in people with CKD in clinical practice or even in cohort studies due to the lack of a simple method [13].…”

Section: Introductionmentioning

confidence: 99%

Development of a Formula for Estimation of Sodium Intake from Spot Urine in People with Chronic Kidney Disease

et al. 2014

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Background/Aims: High sodium intake is associated with adverse cardiovascular and renal outcomes in people with chronic kidney disease (CKD), and simple methods to facilitate assessment of sodium intake are required. The objective of this study was to develop a new formula to estimate 24-hour urinary sodium (24hUNa) excretion from urinary Na concentration measured on an early morning urine specimen (EM UNa). Methods: Seventy participants from a prospective cohort of patients with CKD stage 3 in primary care, the Renal Risk in Derby (RRID) study, agreed to collect an additional EM UNa on the day after completing a 24-hour urine collection. A formula to estimate 24hUNa from EM UNa and body weight was developed using the coefficients from a multivariable linear regression equation. The accuracy of the formula was tested by calculating the P30 (proportion of estimates within 30% of measured sodium exection), and the ability of the estimated 24hUNa to discriminate between measured sodium intake above or below 100 mmol/day was assessed by receiver operating characteristic (ROC) curve. A Bland-Altman plot was used to estimate the bias and limits of agreement between estimated and measured 24hUNa. Seventy-four additional paired 24hUNa and EM UNa from 50 CKD stage 3 patients in the RRID study were used to validate the formula. Results: The mean difference between measured and estimated 24hUNa was 2.08 mmol/day. Measured and estimated 24hUNa were significantly correlated (r = 0.55; p < 0.001) but accuracy of estimated 24hUNa was low (P30 = 60%). Analysis of the ROC curve with a cut-off point >100 mmol/day yielded an area under the curve of 0.668, sensitivity of 0.85 and specificity of 0.52. Conclusions: We have developed a simple formula to identify people with a high sodium intake from EM UNa, suitable for use in large-cohort or population studies.

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Daily Sodium Intake in Chronic Kidney Disease Patients during Nephrology Clinic Follow-Up: An Observational Study with 24-Hour Urine Sodium Measurement

Cited by 28 publications

References 67 publications

Estimated dietary sodium intake in haemodialysis patients using food frequency questionnaires

Estimated dietary sodium intake in haemodialysis patients using food frequency questionnaires

Results of a novel screening tool measuring dietary sodium knowledge in patients with chronic kidney disease

Development of a Formula for Estimation of Sodium Intake from Spot Urine in People with Chronic Kidney Disease

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