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Association between urinary salt excretion and albuminuria in Japanese patients with chronic kidney disease: the Fukuoka kidney disease registry study

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Abstract

Background

Several large population-based studies have demonstrated that urinary salt excretion (USALT) is associated with albuminuria. However, this relationship has not been assessed in a large cohort study of patients with chronic kidney disease (CKD). Thus, the present study aimed to elucidate whether USALT was independently associated with albuminuria in a large cohort of patients with CKD.

Methods

This cross-sectional study was conducted in 4075 patients with CKD not on dialysis. USALT (g/day) was estimated from spot urine. Patients were divided into quartiles (Q1–Q4) according to estimated USALT. Multivariable regression models were used to determine whether USALT was independently related to urinary albumin-to-creatinine ratio (UACR) or the presence of macroalbuminuria.

Results

In multivariable linear regression analyses, 1-g/day increment in USALT was significantly associated with log UACR [coefficient 0.098, 95% confidence interval (CI) 0.075–0.121]. In addition, compared with the first USALT quartile, the third and fourth quartiles exhibited significant associations with log UACR (Q3: coefficient 0.305, 95% CI 0.154–0.456; Q4: coefficient 0.601, 95% CI 0.447–0.756). Furthermore, multivariable logistic regression analyses showed that USALT (1-g/day increment) was significantly associated with the presence of macroalbuminuria [odds ratio (OR) 1.11, 95% CI 1.07–1.14]; the third and fourth USALT quartiles exhibited significantly greater risks of macroalbuminuria, compared with the first quartile (Q3: OR 1.33, 95% CI 1.09–1.62; Q4: OR 1.89, 95% CI 1.54–2.32).

Conclusions

This significant association of USALT with UACR and macroalbuminuria suggests that higher USALT may cause increased albuminuria, thereby contributing to kidney disease progression.

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Acknowledgements

The authors thank the participants in the FKR Study, the members of the FKR Study Group listed below, and all personnel in participating institutions involved in the study. The authors also thank Ryan Chastain-Gross, Ph.D., from Edanz Group (https://en-author-services.edanzgroup.com) for editing a draft of this manuscript. Steering Committee and Principal Collaborators of the FKR Study Group: Satoru Fujimi (Fukuoka Renal Clinic), Hideki Hirakata (Fukuoka Renal Clinic), Tadashi Hirano (Hakujyuji Hospital), Tetsuhiko Yoshida (Hamanomachi Hospital), Takashi Deguchi (Hamanomachi Hospital), Hideki Yotsueda (Harasanshin Hospital), Kiichiro Fujisaki (Iizuka Hospital), Keita Takae (Japanese Red Cross Fukuoka Hospital), Koji Mitsuiki (Japanese Red Cross Fukuoka Hospital), Akinori Nagashima (Japanese Red Cross Karatsu Hospital), Ritsuko Katafuchi (Kano Hospital), Hidetoshi Kanai (Kokura Memorial Hospital), Kenji Harada (Kokura Memorial Hospital), Tohru Mizumasa (Kyushu Central Hospital), Takanari Kitazono (Kyushu University), Toshiaki Nakano (Kyushu University), Toshiharu Ninomiya (Kyushu University), Kumiko Torisu (Kyushu University), Akihiro Tsuchimoto (Kyushu University), Shunsuke Yamada (Kyushu University), Hiroto Hiyamuta (Kyushu University), Shigeru Tanaka (Kyushu University), Dai Matsuo (Munakata Medical Association Hospital), Yusuke Kuroki (National Fukuoka-Higashi Medical Center), Hiroshi Nagae (National Fukuoka-Higashi Medical Center), Masaru Nakayama (National Kyushu Medical Center), Kazuhiko Tsuruya (Nara Medical University), Masaharu Nagata (Shin-eikai Hospital), Taihei Yanagida (Steel Memorial Yawata Hospital), Shotaro Onaka (Tagawa Municipal Hospital).

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Authors and Affiliations

  1. Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan

    Akiko Fukui, Masaru Nakayama, Yuta Matsukuma & Ryota Yoshitomi

  2. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Shigeru Tanaka, Toshiaki Nakano & Takanari Kitazono

  3. Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan

    Kazuhiko Tsuruya

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  1. Akiko Fukui
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Contributions

AF and MN contributed to research idea, study design and the data interpretation, and wrote the manuscript. ST contributed to the data acquisition and data interpretation. YM and RY contributed to the data interpretation. TN, KT, and TK contributed to the data interpretation and reviewed and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kazuhiko Tsuruya.

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Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at the institutes where the studies were conducted and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Clinical Research Ethics Committee of the Institutional Review Board at Kyushu University (approval number 469–04) and the ethics committees at all participating institutions; it was also registered in the UMIN Clinical Trials Registry (UMIN000007988).

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Informed written consent was obtained by all the participants included in this study.

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Fukui, A., Nakayama, M., Tanaka, S. et al. Association between urinary salt excretion and albuminuria in Japanese patients with chronic kidney disease: the Fukuoka kidney disease registry study. Clin Exp Nephrol 25, 9–18 (2021). https://doi.org/10.1007/s10157-020-01950-4

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  • DOI: https://doi.org/10.1007/s10157-020-01950-4

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