Positive and Negative Aspects of Sodium Intake in Dialysis and Non-Dialysis CKD Patients

Abstract

Sodium intake theoretically has dual effects on both non-dialysis chronic kidney disease (CKD) patients and dialysis patients. One negatively affects mortality by increasing proteinuria and blood pressure. The other positively affects mortality by ameliorating nutritional status through appetite induced by salt intake and the amount of food itself, which is proportional to the amount of salt under the same salty taste. Sodium restriction with enough water intake easily causes hyponatremia in CKD and dialysis patients. Moreover, the balance of these dual effects in dialysis patients is likely different from their balance in non-dialysis CKD patients because dialysis patients lose kidney function. Sodium intake is strongly related to water intake via the thirst center. Therefore, sodium intake is strongly related to extracellular fluid volume, blood pressure, appetite, nutritional status, and mortality. To decrease mortality in both non-dialysis and dialysis CKD patients, sodium restriction is an essential and important factor that can be changed by the patients themselves. However, under sodium restriction, it is important to maintain the balance of negative and positive effects from sodium intake not only in dialysis and non-dialysis CKD patients but also in the general population.

Association between salt intake and long-term mortality in hemodialysis patients: A retrospective cohort study

“…In dialysis patients with anuria, sodium intake is completely balanced with water intake because the kidneys are not functioning properly. For example, 9 grams of sodium chloride intake requires subsequent intake of 1000 mL water, resulting in physiological saline [ 14 ]. Therefore, salt intake can be calculated from body weight and serum sodium concentration, pre- and post-dialysis.…”

Factors Affecting Diet-Related Quality of Life Among Hemodialysis Patients According to Age-group

“…In addition, they are required to conduct self-care, including disease management, prevention and management of acute and chronic complications, management of dialysis vessels, taking of medications, and adherence to water intake and dietary restrictions (National Institute of Diabetes and Digestive and Kidney Diseases, 2018). Fluid intake restrictions, sodium restriction, and diet are key aspects to decrease the cardiovascular mortality and improve self-care for hemodialysis patients (Engelbrecht et al, 2021; Nagasawa, 2021). However, patients report experiencing difficulty with respect to fluid intake restrictions and diet management (Lee et al, 2021).…”

“…Specifically, dry mouth is experienced by 33% to 78% of hemodialysis patients, and its prevalence increases with age (Bossola et al, 2013). Dry mouth in hemodialysis patients increases fluid intake and inter-dialytic weight gain (López-Pintor et al, 2017; Nagasawa, 2021). Inter-dialytic weight gain should be maintained at 4.0% to 4.5% or less of the normal dry weight (Bossola et al, 2020).…”

Calcium carbonate-enriched cheese to improve nutrition, compliance and phosphorus control in patients on kidney replacement therapy

“…They must also reduce their intake of fruits and vegetables to prevent hyperkalemia. Finally, the amount of meat, fish, milk and cheese consumed has to be limited to avoid hyperphosphatemia, one of the main determinants of secondary hyperparathyroidism [ 4 , 5 ].…”