Skip to main content
SpringerLink
Log in

Importance and benefits of dietary sodium restriction in the management of chronic kidney disease patients: experience from a single Chinese center

  • Nephrology – Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Aim

Several studies have suggested that sodium intake may affect blood pressure (BP), proteinuria, and intrarenal transforming growth factor-β1 (TGF-β1) production in patients and animal models with chronic kidney disease (CKD). The Chinese population has a high prevalence of CKD and is well known for consuming salty foods. This study will investigate the role of dietary sodium intake on BP control among non-dialysis Chinese CKD patients.

Methods

A cross-sectional study was carried out in a cohort of 176 non-dialysis hypertensive CKD patients to investigate their sodium intake and its effect on BP control by measuring 24-h urine sodium excretion (24-h UNa). A total of 20 patients with immunoglobulin A nephropathy (IgAN) participated in a 7-day sodium restriction study (100 mmol/day). Their changes in BP, proteinuria, and urinary TGF-β1 excretion were subsequently analyzed. Another 23 IgAN patients without salt restriction were included as controls.

Results

The average 24-h UNa of the study cohort was 149.0 ± 66.4 mmol/day. Only 31.8% patients had a 24-h UNa less than 100 mmol/day. The OR for each 17 mmol increment in 24-h UNa (salt 1 g/day) for BP > 130/80 mmHg was 1.26 (95% CI 1.10–1.44, P = 0.001). The sodium restriction group achieved significantly more reduction in SBP (−11.1 mmHg vs. −5.0 mmHg, P = 0.022), DBP (−9.4 mmHg vs. −2.1 mmHg, P = 0.009), and urine protein excretion [−465 (−855 to −340) mg/day vs. −150 (−570 to 40) mg/day, P = 0.024]. A positive correlation was observed between the change of 24-h UNa and the change of SBP (r = 0.450, P = 0.047) in the sodium restriction group. The change of 24-h UNa was also correlated with the 24-h TGF-β1 excretion (r = 0.558, P = 0.011) in these patients.

Conclusion

Dietary sodium intake restriction should be monitored and intensified in the treatment of Chinese CKD patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Elliott P, Stamler J, Nichols R et al (1996) For the INTERSALT Cooperative Research Group: INTERSALT revisited: further analyses of 24 h urinary sodium excretion and blood pressure within and across populations. Br Med J 312:1249–1253

    Article  CAS  Google Scholar 

  2. Sacks FM, Svetkey LP, Vollmer WM et al (2001) DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. N Engl J Med 344:3–10

    Article  PubMed  CAS  Google Scholar 

  3. Koomans HA, Roos JC, Boer P, Geyskes GG, Mees EJ (1982) Salt sensitivity of blood pressure in chronic renal failure. Hypertension 4:190–197

    PubMed  CAS  Google Scholar 

  4. Koomans HA, Roos JC, Boer P, Geyskes GG, Mees EJ (1982) Salt handling in patients with chronic renal insufficiency. Miner Electrolyte Metab 7:134–145

    PubMed  CAS  Google Scholar 

  5. Weir MR, Dengel DR, Behrens MT, Goldberg AP (1995) Salt-induced increases in systolic blood pressure affect renal hemodynamics and proteinuria. Hypertension 25:1339–1344

    PubMed  CAS  Google Scholar 

  6. Vogt L, Waanders F, Boomsma F et al (2008) Effects of dietary sodium and hydrochlorothiazide on the antiproteinuric efficacy of losartan. J Am Soc Nephrol 19:999–1007

    Article  PubMed  CAS  Google Scholar 

  7. De Nicola L, Minutolo R, Chiodini P et al (2006) TArget Blood Pressure LEvels in Chronic Kidney Disease (TABLE in CKD) Study Group. Global approach to cardiovascular risk in chronic kidney disease: reality and opportunities for intervention. Kidney Int 69:538–545

    Article  PubMed  Google Scholar 

  8. Van Zuilen AD, Wetzels JF, Bots ML, Van Blankestijn PJ (2008) MASTERPLAN: study of the role of nurse practitioners in a multifactorial intervention to reduce cardiovascular risk in chronic kidney disease patients. J Nephrol 21:261–267

    PubMed  Google Scholar 

  9. Ruggenenti P, Perna A, Gherardi G, Benini R, Remuzzi G (2000) Chronic proteinuric nephropathies: outcomes and response to treatment in a prospective cohort of 352 patients with different patterns of renal injury. Am J Kidney Dis 35:1155–1165

    Article  PubMed  CAS  Google Scholar 

  10. Sanders PW (2004) Salt intake, endothelial cell signaling, and progression of kidney disease. Hypertension 43:142–146

    Article  PubMed  CAS  Google Scholar 

  11. Yu HCM, Burrell LM, Black MJ et al (1998) Salt induces myocardial and renal fibrosis in normotensive and hypertensive rats. Circulation 98:2621–2628

    PubMed  CAS  Google Scholar 

  12. Cianciaruso B, Bellizzi V, Minutolo R et al (1998) Salt intake and renal outcome in patients with progressive renal disease. Miner Electrolyte Metab 24:296–301

    Article  PubMed  CAS  Google Scholar 

  13. Sanders PW (2006) Effect of salt intake on progression of chronic kidney disease. Curr Opin Nephrol Hypertens 15:54–60

    Article  PubMed  CAS  Google Scholar 

  14. Ying WZ, Sanders PW (1998) Dietary salt modulates renal production of transforming growth factor-β1 in rats. Am J Physiol 274:F635–F641

    PubMed  CAS  Google Scholar 

  15. The Ministry of Health, Science and Technology and the Bureau of Statistics of Peoples Republic of China (2004) The current nutrition and health status in Chinese residents. 12 Oct 2004. http://www.news.xinhuanet.com/video/2004-10/12/content 2080855.htm

  16. Zhang L, Zhang P, Wang F et al (2008) Prevalence and factors associated with CKD: a population study from Beijing. Am J Kidney Dis 51:373–384

    Article  PubMed  Google Scholar 

  17. Chen W, Chen W, Wang H et al (2009) Prevalence and risk factors associated with chronic kidney disease in an adult population from southern China. Nephrol Dial Transplant 24:1205–1212

    Article  PubMed  Google Scholar 

  18. Chen N, Wang W, Huang Y et al (2009) Community-based study on CKD subjects and the associated risk factors. Nephrol Dial Transplant 24:2117–2123

    Article  PubMed  Google Scholar 

  19. Wang Y, Zhang L, Li X et al (2009) Improvement of awareness, treatment and control of hypertension among chronic kidney disease patients in China from 1999 to 2005. Hypertens Res 32:444–449

    Article  PubMed  Google Scholar 

  20. WHO Collaborating Center for Drug Statistics Methodology. ATC/DDD Index 2010. www.whocc.no/atcddd/

  21. Chobanian AV, Bakris GL, Black HR et al. (2003) Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. J Am Med Assoc 289:2560–2572

  22. Mancia G, De Backer G, Dominiczak A et al. (2007) Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 25:1105-1187

    Google Scholar 

  23. Kidney Disease Outcome Quality Initiative (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation classification stratification. Am J Kidney Dis 39(suppl 2):S1–S246

    Google Scholar 

  24. Ma YC, Zuo L, Chen JH et al (2006) Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol 17:2937–2944

    Article  PubMed  Google Scholar 

  25. Boudville N, Ward S, Benaroia M, House A (2004) Increased sodium intake correlates with greater use of antihypertensive agents by subjects with chronic kidney disease. Am J Hypertens 18:1300–1305

    Article  Google Scholar 

  26. Konishi Y, Okada N, Okamura M et al (2001) Sodium sensitivity of blood pressure appearing before hypertension and related to histological damage in immunoglobulin a nephropathy. Hypertension 38:81–85

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Joe Xie for editing this manuscript.

Author information

Authors and Affiliations

  1. Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, No. 8, Xishiku Street, 100034, Beijing, China

    Wang Yu, Sun Luying, Wang Haiyan & Li Xiaomei

  2. Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China

    Wang Yu, Sun Luying, Wang Haiyan & Li Xiaomei

Authors
  1. Wang Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sun Luying
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wang Haiyan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Li Xiaomei
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Li Xiaomei.

Additional information

Wang Yu and Sun Luying contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yu, W., Luying, S., Haiyan, W. et al. Importance and benefits of dietary sodium restriction in the management of chronic kidney disease patients: experience from a single Chinese center. Int Urol Nephrol 44, 549–556 (2012). https://doi.org/10.1007/s11255-011-9986-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-011-9986-x

Keywords

Search

Navigation