Sodium Intake and Renal Outcomes: A Systematic Review (original) (raw)

Journal Article

,

1

Department of Nephrology, Galway University Hospitals

,

Galway

,

Ireland

;

2

Health Research Board Clinical Research Facility, National University of Ireland

,

Galway

,

Ireland

;

3

Population Health Research Institute

,

Hamilton, Ontario

,

Canada

;

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2

Health Research Board Clinical Research Facility, National University of Ireland

,

Galway

,

Ireland

;

3

Population Health Research Institute

,

Hamilton, Ontario

,

Canada

;

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,

3

Population Health Research Institute

,

Hamilton, Ontario

,

Canada

;

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4

Department of Nephrology, McMaster University

,

Hamilton, Ontario

,

Canada

;

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,

3

Population Health Research Institute

,

Hamilton, Ontario

,

Canada

;

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,

2

Health Research Board Clinical Research Facility, National University of Ireland

,

Galway

,

Ireland

;

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,

1

Department of Nephrology, Galway University Hospitals

,

Galway

,

Ireland

;

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3

Population Health Research Institute

,

Hamilton, Ontario

,

Canada

;

5

Friedrich Alexander University of Erlangen

,

Germany

;

6

Department of Nephrology, Hypertension & Rheumatology, Munich General Hospitals

,

Munich

,

Germany

.

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Received:

18 October 2013

Revision received:

23 November 2013

Accepted:

18 December 2013

Published:

07 February 2014

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Andrew Smyth, Martin J. O’Donnell, Salim Yusuf, Catherine M. Clase, Koon K. Teo, Michelle Canavan, Donal N. Reddan, Johannes F. E. Mann, Sodium Intake and Renal Outcomes: A Systematic Review, American Journal of Hypertension, Volume 27, Issue 10, October 2014, Pages 1277–1284, https://doi.org/10.1093/ajh/hpt294
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BACKGROUND

Sodium intake is an important determinant of blood pressure; therefore, reduction of intake may be an attractive population-based target for chronic kidney disease (CKD) prevention. Most guidelines recommend sodium intake of <2.3g/day, based on limited evidence. We reviewed the association between sodium intake and renal outcomes.

METHODS

We reviewed cohort studies and clinical trials, which were retrieved by searching electronic databases, that evaluated the association between sodium intake/excretion and measures of renal function, proteinuria, or new need for dialysis.

RESULTS

Of 4,337 reviewed citations, seven (n = 8,129) were eligible, including six cohort studies (n = 7,942) and one clinical trial (n = 187). Four studies (n = 1,787) included patients with CKD. All four cohort studies reported that high intake (>4.6g/day) was associated with adverse outcomes (vs. moderate/low), while none reported an increased risk with moderate intake (vs. low). Three studies (n = 6,342) included patients without CKD. Two cohort studies (n = 6,155) reported opposing directions of association between low (vs. moderate) sodium intake and renal outcomes, and one clinical trial (n = 187) reported a benefit from low intake (vs. moderate) on proteinuria but an adverse effect on serum creatinine.

CONCLUSIONS

Available, but limited, evidence supports an association between high sodium intake (>4.6g/day) and adverse outcomes. However, the association with low intake (vs. moderate) is uncertain, with inconsistent findings from cohort studies. There is urgent need to clarify the long-term efficacy and safety of currently recommended low sodium intake in patients with CKD.

© American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Topic:

• proteinuria
• hypertension
• excretory function
• renal function
• hyponatremia
• kidney failure, chronic
• blood pressure
• hypernatremia
• guidelines
• kidney
• sodium intake
• creatinine tests, serum

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• Companion Article

  • What Level of Sodium Intake Worsens Renal Outcomes?

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