Spot urine sodium measurements do not accurately estimate dietary sodium intake in chronic kidney disease 1,2

Dougher, Carly E.; Rifkin, Dena E.; Anderson, Cheryl A.M.; Smits, Gerard; Persky, Martha S.; Block, Geoffrey A.; Ix, Joachim H.

doi:10.3945/ajcn.115.127423

Cited by 49 publications

(45 citation statements)

References 37 publications

(46 reference statements)

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“…Although the Tanaka formula showed the best performance in predicting 24-hUNa excretion at population level, the misclassification rates at individual level were more than 60%. These results were consistent with previous studies conducted in Chinese [17,20] and in US adults with chronic kidney disease [25]. It indicated that these six formulas might be inappropriate to estimate 24-hUNa excretion at individual level.…”

Section: Discussionsupporting

confidence: 91%

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: Discussionsupporting

confidence: 91%

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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“…In addition, when participants were further classified into different salt intake groups on the basis of their estimated urinary sodium by the 3 estimation methods, .60% individuals were misclassified. This finding was consistent with a current validation study conducted in US adults with chronic kidney disease, which reported that only 18-50% of individuals were appropriately classified into their quartiles (25). Our work presented here suggests that existing methods for estimating 24-h sodium excretion commonly used in clinical and epidemiologic studies produce a high degree of variability and thus may lead to salt intake misclassification, which could contribute to null findings for the relation between salt intake and health outcomes.…”

Section: Discussionsupporting

confidence: 80%

Validation of spot urine in predicting 24-h sodium excretion at the individual level ,

Zhou

Tian

et al. 2017

The American Journal of Clinical Nutrition

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Background: Evidence for the effect of dietary sodium intake on the risk of cardiovascular disease has been controversial. One of the main explanations for the conflicting results lies in the great variability associated with measurement methods for sodium intake. Spot urine collection is a convenient method commonly used for sodium estimation, but its validity for predicting 24-h urinary sodium excretion at the individual level has not been well evaluated among the general population. Objective: The aim of this study was to evaluate the validity of the Kawasaki, the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT), and the Tanaka formulas in predicting 24-h urinary sodium excretion by using spot urine samples in Chinese adults. Design: We analyzed the relative and absolute differences and misclassification at the individual level from 3 commonly used methods for estimating sodium intake among 141 Chinese community residents. Results: The mean measured 24-h sodium excretion was 220.8 mmol/d. The median (95% CIs) differences between measured sodium and those estimated from the Kawasaki, INTERSALT, and Tanaka methods were 6.4 mmol/d (217.5, 36.8 mmol/d), 267.3 mmol/d (296.5, 246.9 mmol/d), and 242.9 mmol/d (259.1, 224.8 mmol/d), respectively. The proportions of relative differences .40% with the Kawasaki, INTERSALT, and Tanaka methods were 31.2%, 41.1%, and 22.0%, respectively; and the absolute difference for the 3 methods was .51.3 mmol/d (3 g salt) in approximately half of the participants. The misclassification rate was 63.1% for the Kawasaki method, 78.7% for the INTERSALT method, and 66.0% for the Tanaka method at the individual level. Conclusion:The results from our study do not support the use of spot urine to estimate 24-h urinary sodium excretion at the individual level because of its poor performance with respect to misclassification. This trial was registered at www.chictr.org.cn as ChiCTR-IOR-16010278.

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“…Estimation of 24-h urine sodium excretion from spot urine in patients with stage 3-4 chronic renal failure is not accurate. (9) Patients with a serum creatinine level ³2.0 mg/dl and those taking diuretics were excluded from the study.…”

Section: Methodsmentioning

confidence: 99%

Estimation of salt intake from spot urine may assist the risk assessment of gastric cancer

Goto

Nishikawa

Ito

et al. 2020

J. Clin. Biochem. Nutr.

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Daily salt intake can be estimated by measuring sodium and creatinine concentrations in spot urine. Excessive salt intake is risk factor for gastric cancer. We examined the correlation between estimated salt intake from spot urine and risk of gastric cancer. This study included gastric cancer patients who underwent treatment at our hospital and patients in whom esophagogastro duodenoscopy was performed but gastric cancer was not observed. The history of H. pylori infection was known in these patients. Spot urine was collected, and daily salt intake was estimated from urine sodium and urine creatinine. Mean estimated salt intake was significantly higher in 120 gastric cancer patients (9.18 g/day) than in 80 non gastric cancer patients (8.22 g/day). Multivariate analysis revealed estimated salt intake and H. pylori infection to be independent risk factors for gastric cancer. Among H. pylori infected patients, salt intake was significantly higher in gastric cancer patients (9.25 g/day) than in non gastric cancer patients (8.01 g/day). In conclusion, salt intake estimated from spot urine was high in patients with gastric cancer, especially in H. pylori infected patients. Spot urine is a simple examination and it may be applied as a new risk assessment of gastric cancer.

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Spot urine sodium measurements do not accurately estimate dietary sodium intake in chronic kidney disease 1,2

Cited by 49 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?

Validation of spot urine in predicting 24-h sodium excretion at the individual level ,

Estimation of salt intake from spot urine may assist the risk assessment of gastric cancer

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