TY - JOUR
T1 - Urinary sodium and potassium excretion and CKD progression
AU - Chronic Renal Insufficiency Cohort Study Investigators
AU - He, Jiang
AU - Mills, Katherine T.
AU - Appel, Lawrence J.
AU - Yang, Wei
AU - Chen, Jing
AU - Lee, Belinda T.
AU - Rosas, Sylvia E.
AU - Porter, Anna
AU - Makos, Gail
AU - Weir, Matthew R.
AU - Hamm, L. Lee
AU - Kusek, John W.
N1 - Funding Information:
This study was funded by National Institute of Diabetes and Digestive and Kidney Diseases Research Grant R01-DK074615. Funding for the Chronic Renal Insufficiency Cohort (CRIC) Study was obtained under a cooperative agreement with National Institute of Diabetes and Digestive and Kidney Diseases Grants U01-DK060990, U01-DK060984, U01-DK061022, U01-DK061021, U01-DK061028, U01-DK060980, U01-DK060963, and U01-DK060902. In addition, this work was supported, in part, by University of Pennsylvania Clinical and Translational Science Award National Institutes of Health (NIH)/National Center for Advancing Translational Sciences Grant UL1-TR000003, Johns Hopkins University Grant UL1-TR000424, University of Maryland Grant GCRC M01-RR16500, Clinical and Translational Science Collaborative of Cleveland Grant UL1-TR000439, Michigan Institute for Clinical and Health Research Grant UL1-TR000433, University of Illinois at Chicago Grant CTSA UL1-RR029879, Tulane University Translational Research in Hypertension and Renal Biology Grant P30-GM103337, and Kaiser NIH/National Center for Research Resources Grant UCSF-CTSI UL1-RR024131.
Publisher Copyright:
Copyright © 2016 by the American Society of Nephrology.
PY - 2016
Y1 - 2016
N2 - CKD is a major risk factor for ESRD, cardiovascular disease, and premature death. Whether dietary sodium and potassium intake affect CKD progression remains unclear. We prospectively studied the association of urinary sodium and potassium excretion with CKD progression and all-cause mortality among 3939 patients with CKD in the Chronic Renal Insufficiency Cohort Study. Urinary sodium and potassium excretion were measured using three 24-hour urine specimens, and CKD progression was defined as incident ESRD or halving of eGFR. During follow-up, 939 CKD progression events and 540 deaths occurred. Compared with the lowest quartile of urinary sodium excretion (,116.8 mmol/24 h), hazard ratios (95% confidence intervals) for the highest quartile of urinary sodium excretion ($194.6 mmol/24 h) were 1.54 (1.23 to 1.92) for CKD progression, 1.45 (1.08 to 1.95) for all-cause mortality, and 1.43 (1.18 to 1.73) for the composite outcome of CKD progression and all-cause mortality after adjusting for multiple covariates, including baseline eGFR. Additionally, compared with the lowest quartile of urinary potassium excretion (,39.4 mmol/24 h), hazard ratios for the highest quartile of urinary potassium excretion ($67.1 mmol/24 h) were 1.59 (1.25 to 2.03) for CKD progression, 0.98 (0.71 to 1.35) for all-cause mortality, and 1.42 (1.15 to 1.74) for the composite outcome. These data indicate that high urinary sodium and potassium excretion are associated with increased risk of CKD progression. Clinical trials are warranted to test the effect of sodium and potassium reduction on CKD progression.
AB - CKD is a major risk factor for ESRD, cardiovascular disease, and premature death. Whether dietary sodium and potassium intake affect CKD progression remains unclear. We prospectively studied the association of urinary sodium and potassium excretion with CKD progression and all-cause mortality among 3939 patients with CKD in the Chronic Renal Insufficiency Cohort Study. Urinary sodium and potassium excretion were measured using three 24-hour urine specimens, and CKD progression was defined as incident ESRD or halving of eGFR. During follow-up, 939 CKD progression events and 540 deaths occurred. Compared with the lowest quartile of urinary sodium excretion (,116.8 mmol/24 h), hazard ratios (95% confidence intervals) for the highest quartile of urinary sodium excretion ($194.6 mmol/24 h) were 1.54 (1.23 to 1.92) for CKD progression, 1.45 (1.08 to 1.95) for all-cause mortality, and 1.43 (1.18 to 1.73) for the composite outcome of CKD progression and all-cause mortality after adjusting for multiple covariates, including baseline eGFR. Additionally, compared with the lowest quartile of urinary potassium excretion (,39.4 mmol/24 h), hazard ratios for the highest quartile of urinary potassium excretion ($67.1 mmol/24 h) were 1.59 (1.25 to 2.03) for CKD progression, 0.98 (0.71 to 1.35) for all-cause mortality, and 1.42 (1.15 to 1.74) for the composite outcome. These data indicate that high urinary sodium and potassium excretion are associated with increased risk of CKD progression. Clinical trials are warranted to test the effect of sodium and potassium reduction on CKD progression.
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U2 - 10.1681/ASN.2015010022
DO - 10.1681/ASN.2015010022
M3 - Article
C2 - 26382905
AN - SCOPUS:85017072679
SN - 1046-6673
VL - 27
SP - 1202
EP - 1212
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 4
ER -