High sodium intake is associated with important risk factors in a large cohort of chronic kidney disease patients
High sodium intake is associated with important risk factors in a large cohort of chronic kidney disease patients
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DOI：
10.1038/ejcn.2014.215
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发表时间：
2015-07-01
影响因子：
4.7
通讯作者：
Taal, M. W.
中科院分区：
文献类型：
--
作者：
Nerbass, F. B.;Pecoits-Filho, R.;Taal, M. W.
背景/目的：慢性肾脏疾病（CKD）患者即使在早期阶段，死亡和心血管疾病（CVD）的风险也会增加。膳食钠摄入量与心血管疾病和慢性肾病进展的重要危险因素如高血压和蛋白尿有关。我们的目的是调查钠摄入量与CVD或CKD进展危险因素之间的关系，研究对象是来自初级保健的CKD 3期患者。受试者/方法：共有1733名患者，既往估计肾小球滤过率（eGFR）为30-59 ml/min/1.73m(2)，平均年龄72.9±9.0岁，来自英格兰32家初级保健全科诊所。获得病史，并进行临床评估、尿液和血清生化检测。钠摄入量是根据三个清晨尿液样本估算的，使用的公式在本研究人群中得到了验证。结果：估计钠摄入量高于推荐值（100毫摩尔/天或6克盐/天）的参与者中，60%的参与者也有更高的舒张压、平均动脉压（MAP）、尿白蛋白与肌酐比、高敏c反应蛋白和尿酸，并使用更多的抗高血压药物。在多变量回归分析中，过量钠摄入是MAP的独立预测因子(B = 1.57, 95%可信区间（CI） 0.41-2.72；P = 0.008)和蛋白尿（B = 1.35, 95% CI 1.02-1.79; P = 0.03）。结论：在初级保健随访的主要是早期CKD患者中，高钠摄入与CVD和CKD进展危险因素相关。这表明，即使在早期或轻度CKD中，饮食钠摄入量也可能影响心血管疾病的风险。有必要进行干预研究，以调查在这一人群中减少钠摄入量的饮食建议的潜在益处。
BACKGROUND/OBJECTIVES: An increased risk of mortality and cardiovascular disease (CVD) is observed in people with chronic kidney disease (CKD) even in early stages. Dietary sodium intake has been associated with important CVD and CKD progression risk factors such as hypertension and proteinuria in this population. We aimed to investigate the relationship between sodium intake and CVD or CKD progression risk factors in a large cohort of patients with CKD stage 3 recruited from primary care.SUBJECTS/METHODS: A total of 1733 patients with previous estimated glomerular filtration rate (eGFR) of 30-59 ml/min/1.73m(2), with a mean age 72.9 +/- 9.0 years, were recruited from 32 general practices in primary care in England. Medical history was obtained and participants underwent clinical assessment, urine and serum biochemistry testing. Sodium intake was estimated from three early-morning urine specimens using an equation validated for this study population.RESULTS: Sixty percent of participants who had estimated sodium intake above recommendation (> 100 mmol/day or 6 g salt/day) also had higher diastolic blood pressure, mean arterial pressure (MAP), urinary albumin-to-creatinine ratio, high-sensitive C-reactive protein and uric acid and used a greater number of anti-hypertensive drugs. In multivariable regression analysis, excessive sodium intake was an independent predictor of MAP (B = 1.57, 95% confidence interval (CI) 0.41-2.72; P = 0.008) and albuminuria (B = 1.35, 95% CI 1.02-1.79; P = 0.03).CONCLUSIONS: High sodium intake was associated with CVD and CKD progression risk factors in patients with predominantly early stages of CKD followed up in primary care. This suggests that dietary sodium intake could afffect CVD risk even in early or mild CKD. Intervention studies are warranted to investigate the potential benefit of dietary advice to reduce sodium intake in this population.