six. Sodium Consumption during the Prevent-Stage Kidney Problem

One of users regarding the studies, 804 compound Curriculum vitae occurrences (575 heart incapacity, 305 myocardial infarctions, and you will 148 strokes) occurred through the a median out of six.8 years of realize-up, drawing an excellent linear family anywhere between higher salt consumption and better Curriculum vitae exposure . Similarly, a post-hoc study of your own Reduction of Endpoints into the NIDDM toward Angiotensin II Antagonist Losartan (RENAAL) and you may Irbesartan Diabetic Nephropathy Trial (IDNT) samples in good subgroup regarding 1177 clients with readily available twenty-four h urinary sodium specifications, revealed that the latest helpful effects of RAAS blockers into renal and you will cardio outcomes was deeper inside the customers that have lower salt intake . Furthermore, for the Autosomal Dominating Polycystic Kidney Condition (ADPKD) people, fast progressors irrespective of extreme CKD government [69,70], a current post-hoc analysis of the Halt-PKD trial has revealed one an average salt limitation decrease CKD evolution .

Off notice, the brand new bad studies are blog post hoc analyses regarding systematic products tailored to test the power of RAAS inhibitors instead of of lower-salt intervention, confounding ergo a potential association [fifteen,sixteen,17,18]

While doing so, most other studies have perhaps not confirmed such overall performance, finding no relationship ranging from low salt consumption and upgrade of kidney medical diagnosis, into the CKD patients [15,sixteen,17]. Specifically, supplementary studies of the very first and you can next Ramipril Efficacy in the Nephropathy (REIN) products showed that low-salt intake was associated with a lesser chance of ESKD, but it connection disappeared shortly after variations to have basal proteinuria . About longitudinal follow through of one’s Amendment away from Diet during the Renal Problem (MDRD) Analysis, no organization out-of solitary standard twenty four h urinary salt excretion having kidney inability and you may a chemical result of kidney inability or all the-end up in death are discover . Furthermore, post-hoc studies of the constant telmisartan by yourself along with combination with ramipril international endpoint trial (ONTARGET) and you will telmisartan randomized assessment studies in the Expert intolerant subjects having cardiovascular situation (TRANSCEND) education trials exhibited zero organization between UNaV (even though estimated because of the day location urine) and you can kidney endpoints (30% decline of eGFR or ESKD) inside the clients which have or instead of CKD at the standard . Surprisingly, inside diabetic low-CKD people, UNaV try inversely regarding the a cumulative incidence out-of ESKD, and in reality, people with the reduced salt excretion encountered the large collective frequency out-of ESKD .

On the CRIC investigation, a big observational studies carried out in 3757 CKD people observed for almost eight years, the group regarding clients with a beneficial UnaV out-of >195 mmol/time try from the a top danger of CKD progression

In addition, in a few ones studies, UNaV is actually counted because of the an individual twenty-four h urine or room pee try . Concurrently, we simply cannot exclude you to definitely other variables might play a role: a kidney hemodynamic reaction to a severe reduced total of salt intake try impaired by the aging, especially when atherosclerotic damage coexists . This could present customers to severe renal injury and hypotension . Also, patients which have CKD have a top frequency out-of light coating impact [73,74], presenting CKD clients to help you “inappropriate” antihypertensive medication, that may probably end up in renal hypoperfusion . Therefore, version of attract should be paid-in the management of CKD patients, customizing sodium consumption on the basis of “true” hypertensive condition counted because of the ABPM and you will volemic updates, and you can keeping track of the newest adherence and you can anti-hypertensive feeling LSD over time.

In ESKD patients, similarly to early CKD stages ( Figure 1 ), the deleterious effects of high salt intake are mainly related to the fluid overload, resulting in high BP levels, left ventricular hypertrophy, and increased CV mortality [76,77,78,79,80]. Therefore, sodium restriction is a major therapeutic goal in these patients. Indeed, it has been estimated that, in ESKD patients with no residual diuresis, a salt intake of <6 g should cause patients to gain no more than 0.8 kg/day in interdialytic weight.