Estimating the urinary sodium excretion in patients with chronic kidney disease is not useful in monitoring the effects of a low-salt diet
김세연, 이유호, 김양균, 문주영, 진호준, 김세중, 김동기, 김성권, 박중환, 신성준, 최범순, 임춘수, 이민중, 이상호,
소속 상세정보
김세연 ( Kim Se-Yun )
Kyung Hee University Medical Center Department of Internal Medicine
이유호 ( Lee Yu-Ho )
Kyung Hee University Medical Center Department of Internal Medicine
김양균 ( Kim Yang-Gyun )
Kyung Hee University Medical Center Department of Internal Medicine
문주영 ( Moon Ju-Young )
Kyung Hee University Medical Center Department of Internal Medicine
진호준 ( Chin Ho-Jun )
Seoul National University Bundang Hospital Department of Internal Medicine
김세중 ( Kim Se-Joong )
Seoul National University Bundang Hospital Department of Internal Medicine
김동기 ( Kim Dong-Kie )
Seoul National University Hospital Department of Internal Medicine
김성권 ( Kim Suhng-Gwon )
Seoul National University Hospital Department of Internal Medicine
박중환 ( Park Jung-Hwan )
Konkuk University School of Medicine Department of Internal Medicine
신성준 ( Shin Sung-Joon )
Dongguk University Ilsan Hospital Department of Internal Medicine
최범순 ( Choi Bum-Soon )
Catholic University Seoul St. Mary’s Hospital Department of Internal Medicine
임춘수 ( Lim Chun-Soo )
SMG-SNU Boramae Medical Center Department of Internal Medicine
이민중 ( Lee Min-Jung )
Kyung Hee University School of Medicine Department of Clinical Pharmacology
이상호 ( Lee Sang-Ho )
Kyung Hee University Medical Center Department of Internal Medicine
Abstract
Background: Several epidemiologic studies have suggested that the urine sodium excretion (USE) can be estimated in lieu of performing 24-hour urine collection. However, this method has not been verified in patients with chronic kidney disease (CKD) or in an interventional study. The purpose of this study was to evaluate the usefulness of estimating USE in a prospective low-salt diet education cohort (ESPECIAL).
Methods: A new formula was developed on the basis of morning fasting urine samples from 228 CKD patients in the ESPECIAL cohort. This formula was compared to the previous four formulas in the prediction of 24-hour USE after treatment with olmesartan and low-salt diet education.
Results: Most previously reported formulas had low predictability of the measured USE based on the ESPECIAL cohort. Only the Tanaka formula showed a small but significant bias (9.8 mEq/day, P < 0.05) with a low correlation (r = 0.34). In contrast, a new formula showed improved bias (-0.1 mEq/day) and correlation (r = 0.569) at baseline. This formula demonstrated no significant bias (-1.2 mEq/day) with the same correlation (r = 0.571) after 8 weeks of treatment with olmesartan. Intensive low-salt diet education elicited a significant decrease in the measured USE. However, none of the formulas predicted this change in the measured urine sodium after diet adjustment.
Conclusion: We developed a more reliable formula for estimating the USE in CKD patients. Although estimating USE is applicable in an interventional study, it may be unsuitable for estimating the change of individual sodium intake in a low-salt intervention study.
키워드
Chronic kidney disease; Low-salt diet; Sodium excretion
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