Urinary sodium excretion and kidney disease progression events in patients with chronic kidney disease stage 3-4 – a single center cohort study

 

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https://storage.unitedwebnetwork.com/files/1099/eb3009beb3dfee86d52fb00de8cc390c.pdf
Urinary sodium excretion and kidney disease progression events in patients with chronic kidney disease stage 3-4 – a single center cohort study

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Jinwei
Wang
Jinwei Wang gslzwjw@163.com Peking University First Hospital Renal division, department of medicine Beijing China *
Yu Wang ddwangyu@sina.com Peking University First Hospital Renal division, department of medicine Beijing China -
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Inconsistency exists about whether dietary sodium intake is associated with increased risk of chronic kidney disease (CKD) progression. Drawbacks regarding ways to measure sodium intake and to handle time-dependent confounding from proteinuria may be attributed to the inconsistency. Here, we prospectively investigated kidney failure events in relation to baseline or time-updated 24-hour urinary sodium excretion (UNaV) among patients with CKD stage 3 and 4.

Study participants came from a prospective CKD cohort recruited in out-patients at a single tertiary hospital. UNaV was split into tertiles (<120, 120- <180.5, and ≥180.5 mmol/24h) or according to whether ≥120 mmol/24h. Outcomes included incidence of kidney failure with replacement therapy, estimated glomerular filtration rate (eGFR) declining for ≥50 % or composite of the two. Cox regression model was used to estimate the association between baseline UNaV and outcomes, while marginal structural model to assess the effect of time-updated UNaV and address time-dependent confounding of proteinuria (Figure 1).

Totally, 307 patients were included, with mean age of 55±15 years, 51.14% of male and average UNaV of 157.30±68.60 mmol/24h. During a median follow-up of 3.31 years, 15 events of kidney failure with replacement therapy, 58 eGFR halving and 61 composite events occurred. Baseline UNaV was not associated with study outcomes after adjusting for 24-hour urinary protein, while maintaining UNaV in ≥180.5 mmol/24h throughout follow-up was associated with a significantly higher risk of eGFR halving or composite events with hazard ratios of 6.29 (95% confidence interval: 1.47, 26.86) and 6.12 (1.46, 25.74), respectively, comparing to <120 mmol/24h.

High dietary sodium intake is associated with increased risk of CKD progression among patients with CKD stage 3 and 4.

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