Effects of sodium restriction and hydrochlorothiazide on RAAS blockade efficacy in diabetic nephropathy: a randomised clinical trial

Kwakernaak, Arjan J.; Krikken, Jan A.; Binnenmars, S Heleen; Visser, Folkert W.; Hemmelder, Marc H; Woittiez, Arend-Jan; Groen, Henk; Laverman, Gozewijn D.; Navis, Gerjan

doi:10.1016/s2213-8587(14)70030-0

Cited by 100 publications

(76 citation statements)

References 26 publications

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“…These corresponded to 12 studies, of which, in the studies by Houlihan et al (12,28) and McMahon and colleagues (30,31), the effects of sodium restriction on UAE and ACR were reported in separate articles, and both were considered for the meta-analysis. Because one of 12 studies reported the outcomes in a way not suitable to our analytic approach (22), only 11 studies (corresponding to 13 articles) were included in this report (12)(13)(14)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). As shown in Table 1, the meta-analysis involved 516 men and women overall from four countries.…”

Section: Characteristics Of the Studies Included In The Meta-analysismentioning

confidence: 99%

“…The participants were healthy individuals, patients with hypertension, patients with type 1 or 2 diabetes, and/or patients with normo-or microalbuminuria, established proteinuria, or a combination thereof. Most studies provided multiple cohorts (for a total of 20), including different categories of patients (25)(26)(27) or patients on different pharmacologic treatments according to a parallel arm or cross-over design (12)(13)(14)28,29,32).…”

Section: Characteristics Of the Studies Included In The Meta-analysismentioning

confidence: 99%

“…The length of intervention ranged from 1 to 6 weeks. The evaluation of the risk of bias level indicated that seven studies were at low risk of bias (14,23,24,27,(29)(30)(31)(32) and that four studies were at high risk of bias (12,13,25,26) (Table 2). External funding sources were declared in all but two studies (Supplemental Table 3).…”

Section: Characteristics Of the Studies Included In The Meta-analysismentioning

confidence: 99%

“…Detailed features of 11 studies included in this analysis are given in Tables 1 and 2 (13,14,(22)(23)(24)(25)(27)(28)(29)(30)32). In the pooled analysis of 23 cohorts, lower sodium intake (average weighted difference in 24-hour urinary sodium excretion =92 mmol or 5.4 g salt) was associated with lower average UAE (232.1%; 95% CI, 244.3 to 218.8; P,0.01) compared with the higher sodium regimen.…”

Section: Effect Of Sodium Intake Reduction On Uaementioning

confidence: 99%

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Meta-Analysis of the Effect of Dietary Sodium Restriction with or without Concomitant Renin-Angiotensin-Aldosterone System–Inhibiting Treatment on Albuminuria

D’Elia¹,

Rossi²,

Cola³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Urinary albumin excretion and/or albumin to creatinine ratio are associated with CKD and higher risk of cardiovascular events. Several studies investigated the effect of reduced dietary sodium intake on urinary albumin excretion and/or albumin to creatinine ratio in adult patient populations, but the majority was inconclusive because of insufficient statistical power. A meta-analysis of the randomized, controlled trials available could overcome this problem and lead to more definitive conclusions.Design, setting, participants, & measurements A systematic search of the online databases available (from 1996 to October of 2014) was conducted of randomized, controlled trials that expressed urinary albumin excretion or albumin to creatinine ratio as the difference between the effects of two different sodium intake regimens. For each study, the mean difference and 95% confidence intervals were pooled using a random effect model. Heterogeneity, publication bias, subgroup, and meta-regression analyses were performed.Results Eleven studies met the predefined inclusion criteria and provided 23 cohorts with 516 participants and 1-6 weeks of follow-up time. In the pooled analysis, an average reduction in sodium intake of 92 mmol/d was associated with a 32.1% (95% confidence interval, 244.3 to 218.8) reduction in urinary albumin excretion. The effect of sodium restriction was higher in the cohorts including patients on concomitant renin-angiotensin-aldosterone system-blocking therapy, in the studies with intervention lasting at least 2 weeks, and among participants with evidence of kidney damage. A greater reduction of urinary albumin excretion was associated with a higher decrease in BP during the intervention. The analysis of changes in albumin to creatinine ratio provided similar results.Conclusions This meta-analysis indicates that sodium intake reduction markedly reduces albumin excretion, more so during concomitant renin-angiotensin-aldosterone system-blocking therapy and among patients with kidney damage.

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Section: Characteristics Of the Studies Included In The Meta-analysismentioning

confidence: 99%

Section: Characteristics Of the Studies Included In The Meta-analysismentioning

confidence: 99%

Section: Characteristics Of the Studies Included In The Meta-analysismentioning

confidence: 99%

Section: Effect Of Sodium Intake Reduction On Uaementioning

confidence: 99%

See 2 more Smart Citations

Meta-Analysis of the Effect of Dietary Sodium Restriction with or without Concomitant Renin-Angiotensin-Aldosterone System–Inhibiting Treatment on Albuminuria

D’Elia¹,

Rossi²,

Cola³

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Previous studies have shown that sodium retention and subsequent volume overload are the main determinants of poor response to RAAS therapy 4, 5. Accordingly, volume restriction by means of co‐diuretic treatment or a low sodium diet enhances the blood pressure‐lowering and albuminuria‐reducing effects of RAAS inhibition 6. Diuretic treatment is therefore recommended, although not always implemented in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) predicts the cardio‐renal response to aliskiren in patients with type 2 diabetes at high renal and cardiovascular risk

Idzerda

Persson

Pena

et al. 2018

Diabetes Obesity Metabolism

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Sodium retention and volume overload are the main determinants of poor response to renin‐angiotensin‐aldosterone system (RAAS) inhibition in patients with diabetes. As volume excess can exist without symptoms, biomarkers are needed to identify a priori which patients are volume overloaded and may experience less benefit from RAAS inhibition. N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) is released in the setting of increased cardiac wall stress and volume overload. We conducted a post hoc analysis among 5081 patients with type 2 diabetes mellitus participating in the ALTITUDE trial to investigate whether NTproBNP can predict the effects of additional therapy with aliskiren on cardio‐renal endpoints. Aliskiren compared to placebo reduced the risk of the primary cardio‐renal endpoint events by 20% (95% confidence interval [CI] 16 to 61) and 2% (95% CI –42 to 30) in the two lowest NT‐proBNP tertiles, and it increased the risk by 25% (95% CI –4 to 96) in the highest NT‐proBNP tertile (P value for trend = 0.009). Similar trends were observed for the cardiovascular and end‐stage renal disease endpoints. Effects of aliskiren compared to placebo on safety outcomes (hyperkalaemia and hospitalization for acute kidney injury) were independent of NT‐proBNP. In conclusion, baseline NT‐proBNP may be used as a marker to predict the response to aliskiren with regard to cardio‐renal outcomes when added to standard therapy with RAAS inhibition.

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Altered dietary salt intake for preventing diabetic kidney disease and its progression

Hodson

Cooper

2023

Cochrane Database of Systematic Reviews

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Effects of sodium restriction and hydrochlorothiazide on RAAS blockade efficacy in diabetic nephropathy: a randomised clinical trial

Cited by 100 publications

References 26 publications

Meta-Analysis of the Effect of Dietary Sodium Restriction with or without Concomitant Renin-Angiotensin-Aldosterone System–Inhibiting Treatment on Albuminuria

Meta-Analysis of the Effect of Dietary Sodium Restriction with or without Concomitant Renin-Angiotensin-Aldosterone System–Inhibiting Treatment on Albuminuria

N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) predicts the cardio‐renal response to aliskiren in patients with type 2 diabetes at high renal and cardiovascular risk

Altered dietary salt intake for preventing diabetic kidney disease and its progression

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