Increased dietary sodium is independently associated with greater mortality among prevalent hemodialysis patients.
Increased dietary sodium is independently associated with greater mortality among prevalent hemodialysis patients.
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DOI：
10.1038/ki.2012.42
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发表时间：
2012-07
影响因子：
19.6
通讯作者：
中科院分区：
文献类型：
--
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膳食钠被认为在血液透析患者高血压、高血容量血症和死亡率的发病机制中起主要作用。因此，限制几乎是普遍推荐的。然而，这些假设所依据的证据是有限的。我们利用现有的饮食、临床和实验室信息对血液透析研究进行了事后分析。拟合线性回归模型来估计膳食钠与超滤需求、血压和营养指标的关系。Cox回归模型拟合估计膳食钠摄入量、钠：卡路里摄入量、钠：钾摄入量和规定的钠限制与全因死亡率的关系。完整的数据来自1770名受试者，其中44%为男性，63%为黑人，44%为糖尿病患者。平均年龄58（±14）岁；中位膳食钠摄入量为2080毫克/天（IQR: 1490-2850）。在病例混合调整后，高报告的膳食钠与更高的超滤需求、热量和蛋白质摄入量相关；钠：热量摄入比例与UF需求相关；钠钾比与高血清钠有关。没有一个与透析前收缩压相关。较高的基线报告饮食钠、钠：热量比和钠：钾比与更高的全因死亡率独立相关。没有观察到规定的饮食钠限制与死亡率之间的关联。在流行的血液透析患者中，较高的饮食钠摄入量与较高的死亡率独立相关。有必要进行随机试验，以确定饮食钠限制是否能提高生存率。
Dietary sodium is thought to play a major role in the pathogenesis of hypertension, hypervolemia and mortality in hemodialysis patients. Thus, restriction is almost universally recommended. However, the evidence on which these assumptions are based is limited. We undertook a post-hoc analysis of the Hemodialysis Study with available dietary, clinical and laboratory information. Linear regression models were fit to estimate associations of dietary sodium with ultrafiltration requirement, blood pressure and nutritional indices. Cox regression models were fit to estimate the association of dietary sodium intake, sodium:calorie intake, sodium:potassium intake and prescribed sodium restriction with all-cause mortality. Complete data were available in 1770 subjects, of whom 44% were male, 63% were black and 44% were diabetic. Mean age was 58 (±14) years; median dietary sodium intake was 2080 (IQR: 1490-2850) mg/day. After case-mix adjustment, higher reported dietary sodium was associated with greater ultrafiltration requirement, caloric and protein intake; sodium:calorie intake ratio associated with greater UF requirement; sodium:potassium ratio associated with higher serum sodium. None were associated with pre-dialysis systolic blood pressure. Higher baseline reported dietary sodium, sodium:calorie ratio and sodium:potassium ratio were independently associated with greater all-cause mortality. No associations between prescribed dietary sodium restriction and mortality were observed. Higher reported dietary sodium intake is independently associated with greater mortality among prevalent hemodialysis subjects. Randomized trials are warranted to determine whether dietary sodium restriction improves survival.
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影响因子：
19.6
作者：
Miskulin, DC;Athienites, NV;Levey, AS
通讯作者：
Levey, AS
DOI：
10.2215/cjn.05410709
发表时间：
2010-02-01
影响因子：
9.8
作者：
Dong, Jie;Li, Yanjun;Luo, Jianfeng
通讯作者：
Luo, Jianfeng
影响因子：
5
作者：
Cole, Stephen R.;Hernan, Miguel A.
通讯作者：
Hernan, Miguel A.
影响因子：
3.9
作者：
PIETINEN, P
通讯作者：
PIETINEN, P
影响因子：
158.5
作者：
Eknoyan, G;Beck, GJ;Toto, R
通讯作者：
Toto, R