Dietary sodium restriction

Humalda, Jelmer K.; Navis, Gerjan

doi:10.1097/mnh.0000000000000073

Cited by 65 publications

(21 citation statements)

References 44 publications

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“…While the beneficial effects of a moderate reduction of intake of salt on blood pressure and cardiovascular and renal events in the general population are well documented, 12 the optimal level of salt intake in patients with CKD is controversial 6,7 with some, 13-15 but not all, 16 studies suggesting a U-shaped relationship between salt intake and cardiovascular and renal events risk. While dietary sodium restriction seems to potentiate the renoprotective effect of ACE inhibitors and ARBs in proteinuric renal diseases, 9,10 it is uncertain whether sodium restriction modifies the effect of these drugs on the progression of diseases such as ADPKD where proteinuria is typically low grade.…”

Section: Discussionmentioning

confidence: 99%

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Dietary salt restriction is beneficial to the management of autosomal dominant polycystic kidney disease

Torres

Abebe

Schrier

et al. 2017

Kidney International

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The CRISP study of polycystic kidney disease (PKD) found that urinary sodium excretion associated with the rate of total kidney volume increase. Whether sodium restriction slows the progression of Autosomal Dominant PKD (ADPKD) is not known. To evaluate this we conducted a post-hoc analysis of the HALT-PKD clinical trials of renin-angiotensin blockade in patients with ADPKD. Linear mixed models examined whether dietary sodium affected rates of total kidney volume or change in estimated glomerular filtration rate (eGFR) in patients with an eGFR over 60 ml/min/1.73 m2 (Study A) or the risk for a composite endpoint of 50% reduction in eGFR, end-stage renal disease or death or the rate of eGFR decline in patients with an eGFR 25-60 ml/min/1.73 m2 (Study B) all in patients initiated on an under100 mEq sodium diet. During the trial urinary sodium excretion significantly declined by an average of 0.25 and 0.41 mEq/24 hour per month in studies A and B, respectively. In Study A, averaged and time varying urinary sodium excretions were significantly associated with kidney growth (0.43%/year and 0.09%/year, respectively, for each 18 mEq urinary sodium excretion). Averaged urinary sodium excretion was not significantly associated with faster eGFR decline (−0.07 ml/min/1.73m2/year for each 18 mEq urinary sodium excretion). In Study B, the averaged but not time-varying urinary sodium excretion significantly associated with increased risk for the composite endpoint (hazard ratio 1.08 for each 18 mEq urinary sodium excretion) and a significantly faster eGFR decline (−0.09 ml/min/1.73m2/year for each mEq 18 mEq urinary sodium excretion). Thus, sodium restriction is beneficial in the management of ADPKD.

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Section: Discussionmentioning

confidence: 99%

“…1-5 Sodium restriction may be particularly important as ADPKD patients usually have sodium-sensitive hypertension and moderation of dietary sodium has been shown to potentiate the renal and cardiovascular protective effects of RAAS blockade in other renal diseases. 6,7 …”

Section: Introductionmentioning

confidence: 99%

Dietary salt restriction is beneficial to the management of autosomal dominant polycystic kidney disease

Torres

Abebe

Schrier

et al. 2017

Kidney International

View full text Add to dashboard Cite

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“…An explanation may be that in the present study there were more patients with lower proteinuria levels (13 of 45 had proteinuria <0.5 g/d, whereas in our previous study only 5 of 47 had proteinuria <0.5 g/d). Patients with higher proteinuria reabsorb sodium more avidly, [29] which makes sodium restriction a particular helpful strategy in these patients (as reviewed elsewhere [30] ). In addition, in the present study, the lower proteinuria levels before therapy intensification may have precluded the identification of determinants of proteinuria after therapy intensification in our regression analyses.…”

Section: Discussionmentioning

confidence: 99%

Response of fibroblast growth factor 23 to volume interventions in arterial hypertension and diabetic nephropathy

et al. 2016

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Fibroblast growth factor 23 (FGF-23) rises progressively in chronic kidney disease and is associated with adverse cardiovascular outcomes. FGF-23 putatively induces volume retention by upregulating the sodium-chloride cotransporter (NCC). We studied whether, conversely, interventions in volume status affect FGF-23 concentrations.We performed a post hoc analysis of 1) a prospective saline infusion study with 12 patients with arterial hypertension who received 2 L of isotonic saline over 4 hours, and 2) a randomized controlled trial with 45 diabetic nephropathy (DN) patients on background angiotensin-converting enzyme -inhibition (ACEi), who underwent 4 6-week treatment periods with add-on hydrochlorothiazide (HCT) or placebo, combined with regular sodium (RS) or low sodium (LS) diet in a cross-over design. Plasma C-terminal FGF-23 was measured by ELISA (Immutopics) after each treatment period in DN and before and after saline infusion in hypertensives.The patients with arterial hypertension were 45 ± 13 (mean ± SD) years old with an estimated glomerular filtration rate (eGFR) of 101 ± 18 mL/min/1.73 m2. Isotonic saline infusion did not affect FGF-23 (before infusion: 68 median [first to third quartile: 58–97] relative unit (RU)/mL, after infusion: 67 [57–77] RU/mL, P = 0.37). DN patients were 65 ± 9 years old. During ACEi + RS treatment, eGFR was 65 ± 25 mL/min/1.73 m2 and albuminuria 649 mg/d (230–2008 mg/d). FGF23 level was 94 (73–141) RU/mL during ACEi therapy. FGF-23 did not change significantly by add-on HCT (99 [74–148] RU/mL), LS diet (99 [75–135] RU/mL), or their combination (111 [81–160] RU/mL, P = 0.15).Acute and chronic changes in volume status did not materially change FGF-23 in hypertensive patients and DN, respectively. Our data do not support a direct feedback loop between volume status and FGF-23 in hypertension or DN.

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“…Clinical trials currently assess adverse effects only, nutritional background is not specified. There is no search for the best nutritional background that fits the study purpose, even for conditions where evidence for interaction of nutritional factors with pharmacological efficacy, or adverse drug effects, was available early in the course of drug development, as was the case for interaction of renin–angiotensin–aldosterone-blockade and sodium intake [ 120 ]. Accordingly, investigator brochures focus on toxicity, without assessment of favorable or adverse nutritional conditions that blunt or potentiate drug effect.…”

Section: Clinical Assessment Of Interactions Of Drugs With Nutrients:mentioning

confidence: 99%

Public health relevance of drug–nutrition interactions

et al. 2017

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The public health relevance of drug–nutrition interactions is currently highly undervalued and overlooked. This is particularly the case for elderly persons where multi-morbidity and consequently polypharmacy is very common. Vitamins and other micronutrients have central functions in metabolism, and their interactions with drugs may result in clinically relevant physiological impairments but possibly also in positive effects. On 12 April 2016, the University Medical Center Groningen (The Netherlands), as part of its Healthy Ageing program, organized a workshop on the public health relevance of drug–nutrient interactions. In this meeting, experts in the field presented results from recent studies on interactions between pharmaceuticals and nutrients, and discussed the role of nutrition for elderly, focusing on those persons receiving pharmaceutical treatment. This paper summarizes the proceedings of the symposium and provides an outlook for future research needs and public health measures. Since food, pharma and health are closely interconnected domains, awareness is needed in the medical community about the potential relevance of drug–nutrition interactions. Experts and stakeholders should advocate for the integration of drug–nutrition evaluations in the drug development process. Strategies for the individual patients should be developed, by installing drug review protocols, screening for malnutrition and integrating this topic into the general medical advice.

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Dietary sodium restriction

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Cited by 65 publications

References 44 publications

Dietary salt restriction is beneficial to the management of autosomal dominant polycystic kidney disease

Dietary salt restriction is beneficial to the management of autosomal dominant polycystic kidney disease

Response of fibroblast growth factor 23 to volume interventions in arterial hypertension and diabetic nephropathy

Public health relevance of drug–nutrition interactions

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