Urinary sodium is a potent correlate of proteinuria: Lessons from the chronic renal insufficiency cohort study

Matthew R. Weir, Raymond R. Townsend, Jeffrey C. Fink, Valerie Teal, Stephen M Sozio, Cheryl A. Anderson, Lawrence Appel, Sharon I Turban, Jing Chen, Jiang He, Natasha Litbarg, Akinlolu Ojo, Mahboob Rahman, Leigh Rosen, Susan Steigerwalt, Louise Strauss, Marshall M. Joffe

Research output: Contribution to journalArticle

Abstract

Background: While higher blood pressure is known to increase proteinuria, whether increased dietary sodium as estimated from 24-hour urinary excretion correlates with increased proteinuria in patients with chronic kidney disease (CKD) is not well studied. Methods: We measured 24-hour urinary sodium, potassium and protein excretion in 3,680 participants in the Chronic Renal Insufficiency Cohort study, to determine the relationship between urinary sodium and potassium and urinary protein excretion in patients with CKD. We stratified our data based on the presence or absence of diabetes given the absence of any data on this relationship and evidence that diabetics had greater urinary protein excretion at nearly every level of urinary sodium excretion. Multiple linear regressions were used with a stepwise inclusion of covariates such as systolic blood pressure, demographics, hemoglobin A1c and type of antihypertensive medications to evaluate the relationship between urinary electrolyte excretion and proteinuria. Results: Our data demonstrated that urinary sodium (+1 SD above the mean), as a univariate variable, explained 12% of the variation in proteinuria (β = 0.29, p <0.0001), with rising urinary sodium excretion associated with increasing proteinuria. The significance of that relationship was only partially attenuated with adjustment for demographic and clinical factors and the addition of 24-hour urinary potassium to the model (β = 0.13, R2 = 0.35, p <0.0001). Conclusions: An understanding of the relationship between these clinical factors and dietary sodium may allow a more tailored approach for dietary salt restriction in patients with CKD.

Original languageEnglish (US)
Pages (from-to)397-404
Number of pages8
JournalAmerican Journal of Nephrology
Volume36
Issue number5
DOIs
StatePublished - Nov 2012

Fingerprint

Chronic Renal Insufficiency
Proteinuria
Cohort Studies
Sodium
Dietary Sodium
Potassium
Demography
Blood Pressure
Proteins
Antihypertensive Agents
Electrolytes
Linear Models
Hemoglobins
Salts
Hypertension

Keywords

  • Blood pressure
  • Potassium
  • Proteinuria
  • Sodium

ASJC Scopus subject areas

  • Nephrology

Cite this

Urinary sodium is a potent correlate of proteinuria : Lessons from the chronic renal insufficiency cohort study. / Weir, Matthew R.; Townsend, Raymond R.; Fink, Jeffrey C.; Teal, Valerie; Sozio, Stephen M; Anderson, Cheryl A.; Appel, Lawrence; Turban, Sharon I; Chen, Jing; He, Jiang; Litbarg, Natasha; Ojo, Akinlolu; Rahman, Mahboob; Rosen, Leigh; Steigerwalt, Susan; Strauss, Louise; Joffe, Marshall M.

In: American Journal of Nephrology, Vol. 36, No. 5, 11.2012, p. 397-404.

Research output: Contribution to journalArticle

Weir, MR, Townsend, RR, Fink, JC, Teal, V, Sozio, SM, Anderson, CA, Appel, L, Turban, SI, Chen, J, He, J, Litbarg, N, Ojo, A, Rahman, M, Rosen, L, Steigerwalt, S, Strauss, L & Joffe, MM 2012, 'Urinary sodium is a potent correlate of proteinuria: Lessons from the chronic renal insufficiency cohort study', American Journal of Nephrology, vol. 36, no. 5, pp. 397-404. https://doi.org/10.1159/000342966
Weir, Matthew R. ; Townsend, Raymond R. ; Fink, Jeffrey C. ; Teal, Valerie ; Sozio, Stephen M ; Anderson, Cheryl A. ; Appel, Lawrence ; Turban, Sharon I ; Chen, Jing ; He, Jiang ; Litbarg, Natasha ; Ojo, Akinlolu ; Rahman, Mahboob ; Rosen, Leigh ; Steigerwalt, Susan ; Strauss, Louise ; Joffe, Marshall M. / Urinary sodium is a potent correlate of proteinuria : Lessons from the chronic renal insufficiency cohort study. In: American Journal of Nephrology. 2012 ; Vol. 36, No. 5. pp. 397-404.
@article{bff4177ed71a441c80de555f5ecb2eef,
title = "Urinary sodium is a potent correlate of proteinuria: Lessons from the chronic renal insufficiency cohort study",
abstract = "Background: While higher blood pressure is known to increase proteinuria, whether increased dietary sodium as estimated from 24-hour urinary excretion correlates with increased proteinuria in patients with chronic kidney disease (CKD) is not well studied. Methods: We measured 24-hour urinary sodium, potassium and protein excretion in 3,680 participants in the Chronic Renal Insufficiency Cohort study, to determine the relationship between urinary sodium and potassium and urinary protein excretion in patients with CKD. We stratified our data based on the presence or absence of diabetes given the absence of any data on this relationship and evidence that diabetics had greater urinary protein excretion at nearly every level of urinary sodium excretion. Multiple linear regressions were used with a stepwise inclusion of covariates such as systolic blood pressure, demographics, hemoglobin A1c and type of antihypertensive medications to evaluate the relationship between urinary electrolyte excretion and proteinuria. Results: Our data demonstrated that urinary sodium (+1 SD above the mean), as a univariate variable, explained 12{\%} of the variation in proteinuria (β = 0.29, p <0.0001), with rising urinary sodium excretion associated with increasing proteinuria. The significance of that relationship was only partially attenuated with adjustment for demographic and clinical factors and the addition of 24-hour urinary potassium to the model (β = 0.13, R2 = 0.35, p <0.0001). Conclusions: An understanding of the relationship between these clinical factors and dietary sodium may allow a more tailored approach for dietary salt restriction in patients with CKD.",
keywords = "Blood pressure, Potassium, Proteinuria, Sodium",
author = "Weir, {Matthew R.} and Townsend, {Raymond R.} and Fink, {Jeffrey C.} and Valerie Teal and Sozio, {Stephen M} and Anderson, {Cheryl A.} and Lawrence Appel and Turban, {Sharon I} and Jing Chen and Jiang He and Natasha Litbarg and Akinlolu Ojo and Mahboob Rahman and Leigh Rosen and Susan Steigerwalt and Louise Strauss and Joffe, {Marshall M.}",
year = "2012",
month = "11",
doi = "10.1159/000342966",
language = "English (US)",
volume = "36",
pages = "397--404",
journal = "American Journal of Nephrology",
issn = "0250-8095",
publisher = "S. Karger AG",
number = "5",

}

TY - JOUR

T1 - Urinary sodium is a potent correlate of proteinuria

T2 - Lessons from the chronic renal insufficiency cohort study

AU - Weir, Matthew R.

AU - Townsend, Raymond R.

AU - Fink, Jeffrey C.

AU - Teal, Valerie

AU - Sozio, Stephen M

AU - Anderson, Cheryl A.

AU - Appel, Lawrence

AU - Turban, Sharon I

AU - Chen, Jing

AU - He, Jiang

AU - Litbarg, Natasha

AU - Ojo, Akinlolu

AU - Rahman, Mahboob

AU - Rosen, Leigh

AU - Steigerwalt, Susan

AU - Strauss, Louise

AU - Joffe, Marshall M.

PY - 2012/11

Y1 - 2012/11

N2 - Background: While higher blood pressure is known to increase proteinuria, whether increased dietary sodium as estimated from 24-hour urinary excretion correlates with increased proteinuria in patients with chronic kidney disease (CKD) is not well studied. Methods: We measured 24-hour urinary sodium, potassium and protein excretion in 3,680 participants in the Chronic Renal Insufficiency Cohort study, to determine the relationship between urinary sodium and potassium and urinary protein excretion in patients with CKD. We stratified our data based on the presence or absence of diabetes given the absence of any data on this relationship and evidence that diabetics had greater urinary protein excretion at nearly every level of urinary sodium excretion. Multiple linear regressions were used with a stepwise inclusion of covariates such as systolic blood pressure, demographics, hemoglobin A1c and type of antihypertensive medications to evaluate the relationship between urinary electrolyte excretion and proteinuria. Results: Our data demonstrated that urinary sodium (+1 SD above the mean), as a univariate variable, explained 12% of the variation in proteinuria (β = 0.29, p <0.0001), with rising urinary sodium excretion associated with increasing proteinuria. The significance of that relationship was only partially attenuated with adjustment for demographic and clinical factors and the addition of 24-hour urinary potassium to the model (β = 0.13, R2 = 0.35, p <0.0001). Conclusions: An understanding of the relationship between these clinical factors and dietary sodium may allow a more tailored approach for dietary salt restriction in patients with CKD.

AB - Background: While higher blood pressure is known to increase proteinuria, whether increased dietary sodium as estimated from 24-hour urinary excretion correlates with increased proteinuria in patients with chronic kidney disease (CKD) is not well studied. Methods: We measured 24-hour urinary sodium, potassium and protein excretion in 3,680 participants in the Chronic Renal Insufficiency Cohort study, to determine the relationship between urinary sodium and potassium and urinary protein excretion in patients with CKD. We stratified our data based on the presence or absence of diabetes given the absence of any data on this relationship and evidence that diabetics had greater urinary protein excretion at nearly every level of urinary sodium excretion. Multiple linear regressions were used with a stepwise inclusion of covariates such as systolic blood pressure, demographics, hemoglobin A1c and type of antihypertensive medications to evaluate the relationship between urinary electrolyte excretion and proteinuria. Results: Our data demonstrated that urinary sodium (+1 SD above the mean), as a univariate variable, explained 12% of the variation in proteinuria (β = 0.29, p <0.0001), with rising urinary sodium excretion associated with increasing proteinuria. The significance of that relationship was only partially attenuated with adjustment for demographic and clinical factors and the addition of 24-hour urinary potassium to the model (β = 0.13, R2 = 0.35, p <0.0001). Conclusions: An understanding of the relationship between these clinical factors and dietary sodium may allow a more tailored approach for dietary salt restriction in patients with CKD.

KW - Blood pressure

KW - Potassium

KW - Proteinuria

KW - Sodium

UR - http://www.scopus.com/inward/record.url?scp=84867480706&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84867480706&partnerID=8YFLogxK

U2 - 10.1159/000342966

DO - 10.1159/000342966

M3 - Article

C2 - 23076013

AN - SCOPUS:84867480706

VL - 36

SP - 397

EP - 404

JO - American Journal of Nephrology

JF - American Journal of Nephrology

SN - 0250-8095

IS - 5

ER -