Estimating 24-Hour Urinary Sodium Excretion From Spot Urine Samples in Chronic Kidney Disease Patients
Estimating 24-Hour Urinary Sodium Excretion From Spot Urine Samples in Chronic Kidney Disease Patients
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DOI：
10.1053/j.jrn.2019.02.002
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发表时间：
2020-01-01
影响因子：
3.2
通讯作者：
Ding, Xiaoqiang
中科院分区：
文献类型：
--
作者：
Hu, Jiachang;Wang, Yimei;Ding, Xiaoqiang
目的：在许多大规模研究中，点尿钠和相关的估计方程为 24 小时钠排泄提供了合适的替代评估，但不适用于肾功能下降的慢性肾脏病 (CKD) 患者。在此，我们旨在开发一个新的预测方程。 设计和方法：我们回顾性纳入了2014年1月1日至2017年12月31日在我们的单一中心接受现场和24小时尿液分析的所有1-4期CKD患者。多元线性回归分析生成了一个预测方程，用于估计2014年至2015年入院的衍生队列中现场尿液样本的24小时钠排泄量，然后我们在 2016 年至 2017 年入院的验证队列中评估了这一预测方程。 结果：最终对所有 5,235 名患者进行了分析，并根据入院日期分为衍生队列 (n = 2,460) 和验证队列 (n = 2,775)。我们生成了一个预测方程并将其定义为“CKDSALT”方程，因为它用于估计 CKD 患者的盐摄入量。当我们测量钠排泄作为金标准时，我们将这一新颖的验证与其他 3 个方程进行了比较：Kawasaki、INTERSALT 和 Tanaka。Bland-Altman 图表明 CKDSALT 方程显示出最低的偏差，且具有一致性限制（偏差 = -1.25 mmol，95% 置信区间） -121.3 至 123.8），并且在任何亚组分析中表现最佳：男性和女性、老年人和年轻人、不同水平的体重指数、不同水平的估计肾小球滤过率和 24 小时尿量，CKDSALT 方程在所有验证队列和上述队列中也具有最高的 Pearson（0.745）和组内相关系数（0.853，95% 置信区间 0.841-0.863）。结论：采用 CKDSALT 方程的点尿法可能有望用于估算肾功能正常的 CKD 患者和估计肾小球滤过率降低的患者的 24 小时尿钠排泄量 (C) 2019，国家肾脏基金会，Inc. 保留所有权利。
Objective: Spot urine sodium and associated estimating equations provide a suitable alternative assessment of 24-hour sodium excretion in many large-scale studies, but not in chronic kidney disease (CKD) patients with decreased renal function. Herein, we aimed to develop a novel predictive equation.Design and Methods: We retrospectively enrolled all CKD patients at Stage 1-4 who received spot and 24-hour urinary analysis in our single center from January 1, 2014 to December 31, 2017. Multiple linear regression analysis generated a predictive equation for estimating 24-hour sodium excretion from spot urine samples in the derivation cohort admitted from 2014 to 2015, and then we assessed this predictive equation in a validation cohort admitted from 2016 to 2017.Results: All 5,235 patients were finally analyzed and divided into derivation (n = 2,460) and validation (n = 2,775) cohort according to the admission date. We generated a predictive equation and defined it as "CKDSALT'' equation because it was used for the estimation of salt intake in CKD patients. When we measured sodium excretion as the gold standard, we compared this novel validation with other 3 equations: Kawasaki, INTERSALT, and Tanaka. The Bland-Altman plots indicated that the CKDSALT equation showed the lowest bias with limits of agreement (bias = -1.25 mmol, 95% confidence interval -121.3 to 123.8), and the best performance in any subgroup analysis: male and female, old and young, different levels of body mass index, various levels of estimated glomerular filtration rate, and 24-hour urine volume. The CKDSALT equation also had the highest Pearson (0.745) and intraclass correlation coefficient (0.853, 95% confidence interval 0.841-0.863) in all validation cohort and the above subgroups.Conclusion: Spot urine method by CKDSALT equation may be promising for estimating 24-hour urinary sodium excretion in CKD patients with normal renal function and patients with decreased estimated glomerular filtration rate. (C) 2019 by the National Kidney Foundation, Inc. All rights reserved.