Clinical Rheumatology

, Volume 37, Issue 4, pp 895–900 | Cite as

Association between urinary sodium and potassium excretion and blood pressure and inflammation in patients with rheumatoid arthritis

  • Daniel Carranza-Leon
  • Rany Octaria
  • Michelle J. Ormseth
  • Annette Oeser
  • Joseph F. Solus
  • Yahua Zhang
  • Chimalum R. Okafor
  • Jens Titze
  • C. Michael Stein
  • Cecilia P. Chung
Original Article


Hypertension is highly prevalent in patients with rheumatoid arthritis (RA). In other populations, high sodium (Na+) and low potassium (K+) intake are associated with an increased risk of hypertension, and in animal models, a high salt intake exacerbated arthritis. Patients with RA have many comorbidities associated with salt sensitivity, but their salt intake and its relationship to blood pressure and inflammation is unknown. Using the Kawasaki formula, Na+ and K+ urinary excretion (reflecting intake) was estimated in 166 patients with RA and 92 controls, frequency matched for age, sex, and race. Inflammatory markers and disease activity were measured in RA patients. We tested the associations between blood pressure and Na+ and K+ excretion. Estimated 24-h Na+ excretion was similarly high in both RA (median [IQR] 5.1 g, [3.9–6.6 g]) and controls (4.9 g, [4.0–6.5 g]), p = 0.9, despite higher rates of hypertension in RA (54 vs. 39%, p = 0.03). The Na+:K+ excretion ratio was significantly higher in RA (2.0 [1.6–2.4]) vs. 1.7 [1.5–2.1]), p = 0.02] compared to controls. In RA, a lower K+ excretion was inversely correlated with diastolic blood pressure (adjusted β = − 1.79, p = 0.04). There was no significant association between Na+ or K+ excretion and inflammatory markers. Despite a similar Na+ excretion, patients with RA had higher rates of hypertension than controls, a finding compatible with increased salt sensitivity. Patients with RA had a lower Na+:K+ excretion ratio than controls, and lower K+ excretion was associated with higher diastolic blood pressure in RA.


Hypertension Potassium Rheumatoid arthritis Sodium 


Financial support

Supported by grants from: Alpha Omicron Pi (Stein), Arthritis Foundation Clinical to Research Transition Award (Stein), P60-AR-056116 (Stein), K23AR064768 (Chung), Rheumatology Research Foundation K-supplement (Chung), T32 GM07569 (Stein), and CTSA awards No. UL1TR000445 and UL1RR024975 from the National Center for Advancing Translational Sciences.

Compliance with ethical standards

Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Institutes of Health. Informed consent was given by all patients and controls prior to data and sample collection. The study protocol was approved by the Vanderbilt University Medical Center’s institutional review board.




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Copyright information

© International League of Associations for Rheumatology (ILAR) 2017

Authors and Affiliations

  • Daniel Carranza-Leon
    • 1
  • Rany Octaria
    • 1
  • Michelle J. Ormseth
    • 1
  • Annette Oeser
    • 1
  • Joseph F. Solus
    • 1
  • Yahua Zhang
    • 1
  • Chimalum R. Okafor
    • 1
  • Jens Titze
    • 1
  • C. Michael Stein
    • 1
  • Cecilia P. Chung
    • 1
  1. 1.Department of MedicineVanderbilt UniversityNashvilleUSA

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