Use of mean spot urine sodium concentrations to estimate daily sodium intake in patients with chronic kidney disease

Kang, Shin Sook; Kang, Eun Hee; Kim, Seon‐Ok; Lee, Moo Song; Hong, Changgi D.; Kim, Soon Bae

doi:10.1016/j.nut.2011.06.006

Cited by 21 publications

(33 citation statements)

References 27 publications

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“…Better correlation with 24-hour sodium excretion was observed with the mean spot urine sodium (r = 0.48; p < 0.001) compared to each spot measurement alone or to the mean sample sodium/creatinine ratio (r = 0.31; p < 0.001). According to the results, a mean spot urinary sodium of 83 mEq/l corresponded to a daily sodium intake of 2 g [19]. Contrary to our results, no correlation was found between sodium concentration from the EM UNa and the 24hUNa when the 79 people with CKD stage 3 were analysed separately.…”

Section: Discussioncontrasting

confidence: 91%

“…Obtaining a spot urine specimen is simpler than a 24-hour collection and has as strengths low participant burden and simple specimen handling that make it easy to implement as part of standard clinical practice [14]. Spot urine specimens are commonly used to estimate 24-hour urinary protein excretion, and several investigators have sought to develop methods to estimate 24-hour excretion of sodium (24hUNa) from spot urine values [18,19,20]. Although acceptable accuracy to determine daily sodium intake has been reported in general population studies [21], hypertension [22] and people with CKD [19,23], no single formula is universally applicable, and existing formulae require further validation.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussioncontrasting

confidence: 91%

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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“…28 The differences related to the time of urine specimen collection were tested in a cross-sectional study enrolling patients with pre-dialysis stage CKD, in which three urine samples were collected at different times (morning, afternoon, and evening); the best correlation with 24-hour urinary sodium was obtained when the mean sodium level as calculated for the samples taken at different times (r = 0.48; p < 0.001) versus when the isolated samples were analyzed separately. 22 The limitations of this study include the relatively small population enrolled in the study, the use of one single urine specimen collected the day after the collection of the 24-hour urine specimen, and the lack of validation of the formula for other populations.…”

Section: Discussionmentioning

confidence: 99%

“…21 Little research has been carried out on this matter to date, but recent studies have supported the validity of this method as a marker of sodium intake in individuals with CKD. [22][23][24] We were unable to find studies performed with Brazilian patients whose purpose was to develop a formula or validate the methods in place for the estimation of 24-hour sodium excretion from urine specimens. Therefore, two formulae published by foreign authors were tested in this study: a simple formula developed from a British cohort of patients diagnosed with stage-3 CKD in the Renal Risk in Derby (RRID) study, 23 and the formula proposed by Tanaka et al in 2002 24 from a group of Japanese individuals.…”

Section: Introductionmentioning

confidence: 99%

Formula to detect high sodium excretion from spot urine in chronic kidney disease patients

Nerbass¹,

Hallvass²,

Pécoits-Filho³

2017

Jornal Brasileiro De Nefrologia

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Fórmula para detectar elevada excreção de sódio a partir de amostra isolada de urina de pacientes com doença renal crônica pré-dialítica Introdução: O consumo excessivo de sódio está relacionado a piores desfechos renais e cardiovasculares em pacientes com doença renal crônica (DRC), mas a avaliação deste consumo é complexa e mensurada com baixa frequência na prática clínica. Objetivo: Desenvolver uma nova fórmula para estimar a excreção de sódio de 24h a partir da concentração de sódio em amostra isolada da segunda urina do dia em pacientes com DRC pré-dialítica. Métodos: 51 participantes com DRC forneceram coleta de urina de 24h e uma amostra da segunda urina do dia para determinação da excreção de sódio. Uma fórmula para estimar a excreção de sódio de 24h foi desenvolvida a partir dos coeficientes da equação de regressão. A acurácia da fórmula foi testada por meio do cálculo do P30. A habilidade da fórmula em discriminar consumo de sódio superior a 3,6 g/dia foi avaliada pela curva ROC. Resultados: O teste de correlação entre sódio mensurado e estimado pela fórmula foi r = 0,57; p < 0,001, porém o resultado do P30 identificou baixa acurácia (61%). Diferentes pontos de corte foram testados por meio de testes de performance e uma curva ROC foi gerada com o ponto de corte de melhor performance (3,6 g/dia). Foi obtida uma área sob a curva de 0,69 com sensibilidade 0,91 e especificidade 0,53. Conclusão: Foi desenvolvida uma fórmula simples com elevada sensibilidade em detectar pacientes com consumo de sódio superior a 3,6 g/dia a partir de amostra de urina isolada. Estudos que testem a fórmula com um maior número de participantes e com outras populações são necessários. ResumoPalavras-chave: coleta de urina; falência renal crônica; sódio na dieta. Introduction:Excessive sodium intake is related to adverse renal and cardiovascular outcomes in patients with chronic kidney disease (CKD) and assessment of sodium intake is complex and not evaluated very often in clinical practice. Objective: To develop a new formula to estimate 24h sodium excretion from urine sample (second void) of patients with CKD. Methods: We included 51 participants with CKD who provided 24-hour urine collection and a sample of the second urine of the day to determine the sodium excretion. A formula to estimate the 24-hour sodium excretion was developed from a multivariate regression equation coefficients. 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 formula to discriminate sodium intake higher than 3.6 g/day was evaluated by ROC curve. Results: Correlation test between measured and estimated sodium was significant (r = 0.57; p < 0.001), but P30 test identified a low accuracy (61%) of the formula. Different cutoff points were tested by performance tests and a ROC curve was generated with the cutoff that showed better performance (3.6 g/ day). An area under the curve of 0.69 with a sensitivity of 0.91 and specificity of 0.53 was obtained. Conclu...

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“…Due to the increased participant burden involved in 24-hour urine collection, 24 hr collections (at baseline and all follow up points) will be supplemented with mid-stream urine collections occurring weekly in Phase 1 and at follow up points in Phase 2 (see Figure 2). Mid-stream urinary sodium has recently been demonstrated to have good agreement with 24-hour urinary sodium in CKD [53,54], and the collection of 24-hour samples concurrently with mid-stream samples will allow for further exploration of the agreement between these measures. Mid-stream urine samples will be analyzed for sodium, creatinine and albumin concentrations (Figure 3).…”

Section: Methodsmentioning

confidence: 99%

The effect of lowering salt intake on ambulatory blood pressure to reduce cardiovascular risk in chronic kidney disease (LowSALT CKD study): protocol of a randomized trial

et al. 2012

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BackgroundDespite evidence implicating dietary sodium in the pathogenesis of cardiovascular disease (CVD) in chronic kidney disease (CKD), quality intervention trials in CKD patients are lacking. This study aims to investigate the effect of reducing sodium intake on blood pressure, risk factors for progression of CKD and other cardiovascular risk factors in CKD.Methods/designThe LowSALT CKD study is a six week randomized-crossover trial assessing the effect of a moderate (180 mmol/day) compared with a low (60 mmol/day) sodium intake on cardiovascular risk factors and risk factors for kidney function decline in mild-moderate CKD (stage III-IV). The primary outcome of interest is 24-hour ambulatory blood pressure, with secondary outcomes including arterial stiffness (pulse wave velocity), proteinuria and fluid status. The randomized crossover trial (Phase 1) is supported by an ancillary trial (Phase 2) of longitudinal-observational design to assess the longer term effectiveness of sodium restriction. Phase 2 will continue measurement of outcomes as per Phase 1, with the addition of patient-centered outcomes, such as dietary adherence to sodium restriction (degree of adherence and barriers/enablers), quality of life and taste assessment.DiscussionThe LowSALT CKD study is an investigator-initiated study specifically designed to assess the proof-of-concept and efficacy of sodium restriction in patients with established CKD. Phase 2 will assess the longer term effectiveness of sodium restriction in the same participants, enhancing the translation of Phase 1 results into practice. This trial will provide much-needed insight into sodium restriction as a treatment option to reduce risk of CVD and CKD progression in CKD patients.Trial registrationUniversal Trial Number: U1111-1125-2149. Australian New Zealand Clinical Trials Registry Number: ACTRN12611001097932

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Use of mean spot urine sodium concentrations to estimate daily sodium intake in patients with chronic kidney disease

Cited by 21 publications

References 27 publications

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

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

Formula to detect high sodium excretion from spot urine in chronic kidney disease patients

The effect of lowering salt intake on ambulatory blood pressure to reduce cardiovascular risk in chronic kidney disease (LowSALT CKD study): protocol of a randomized trial

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