Generic placeholder image

Current Hypertension Reviews

Editor-in-Chief

ISSN (Print): 1573-4021
ISSN (Online): 1875-6506

General Review Article

Potential Novel Benefits of Sodium Restriction in Chronic Kidney Disease

Author(s): Rodolfo Valtuille*

Volume 17, Issue 1, 2021

Published on: 15 June, 2020

Page: [59 - 66] Pages: 8

DOI: 10.2174/1573402116666200615152139

Price: $65

Abstract

Chronic kidney disease is a global public health issue, and it has been considered as the epidemic of the 21st century. Therefore, all initiatives addressed to slow down the evolution and complications of this condition should be well received. While the effects of salt reduction on cardiovascular disease have some controversial issues, in chronic kidney disease, such a policy is beneficial in multiple aspects. In chronic kidney disease patients, dietary sodium restriction is regularly recommended to control extracellular fluid expansion, hypertension and cardiovascular risk. Instead, the effects of sodium reduction on chronic kidney disease progression are still controversial. In the last years, potentially beneficial effects of a low sodium diet on chronic kidney disease evolution have emerged. Firstly, recent magnetic resonance-based findings of increased Na depots in skin and muscle associated with renal function, ageing and sodium intake open a vast body of investigation as a potential tool for monitoring effects of sodium restriction. In this narrative review, we also discussed novel aspects of sodium restriction in chronic kidney disease to manage metabolic acidosis as well as renal effects on fibroblast growth factor 23 or gut microbiota. Beyond current evidence, these approaches showed that common findings of kidney failure environment such as sodium -sensitivity, micro-inflammation, arterial stiffness metabolic acidosis and sarcopenia could be delayed controlling dietary sodium. Additional studies are now needed in populations with chronic kidney disease to confirm these new findings, addressed to slow down the evolution and complications of this condition.

Keywords: Sodium, salt, chronic kidney disease, cardiovascular, blood pressure, fibroblast growth factor 23, metabolic acidosis, gut microbiota.

Graphical Abstract

[1]
Oh YS, Appel LJ, Galis ZS, et al. National heart, lung, and blood institute working Group report on salt in human health and sickness: Building on the current scientific evidence. Hypertension 2016; 68(2): 281-8.
[http://dx.doi.org/10.1161/HYPERTENSIONAHA.116.07415] [PMID: 27324228]
[2]
Mozaffarian D, Fahimi S, Singh GM, et al. Global Burden of Diseases Nutrition and Chronic Diseases Expert Group. Global sodium consumption and death from cardiovascular causes. N Engl J Med 2014; 371(7): 624-34.
[http://dx.doi.org/10.1056/NEJMoa1304127] [PMID: 25119608]
[3]
Kong YW, Baqar S, Jerums G, Ekinci EI. Sodium and its role in cardiovascular disease - the debate continues. Front Endocrinol (Lausanne) 2016; 7: 164.
[http://dx.doi.org/10.3389/fendo.2016.00164] [PMID: 28066329]
[4]
WHO. Sodium intake for adults and children Geneva, World Health Organization (WHO) 2012. Available from: 2012.https://www.who.int/publications-detail/sodium-intake-for-adults-and-children
[5]
Kalantar-Zadeh K, Fouque D. Nutritional management of chronic kidney disease. N Engl J Med 2018; 378(6): 584-5.
[PMID: 29414270]
[6]
Koppe L, Fouque D. The role for protein restriction in addition to renin-angiotensin-aldosterone system inhibitors in the management of CKD. Am J Kidney Dis 2019; 73(2): 248-57.
[http://dx.doi.org/10.1053/j.ajkd.2018.06.016] [PMID: 30149957]
[7]
Humalda JK, Navis G. Dietary sodium restriction: A neglected therapeutic opportunity in chronic kidney disease. Curr Opin Nephrol Hypertens 2014; 23(6): 533-40.
[http://dx.doi.org/10.1097/MNH.0000000000000073] [PMID: 25222815]
[8]
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group: KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013; 3: 1-150.
[9]
Ellison DH. Treatment of disorders of sodium balance in chronic kidney disease. Adv Chronic Kidney Dis 2017; 24(5): 332-41.
[http://dx.doi.org/10.1053/j.ackd.2017.07.003] [PMID: 29031361]
[10]
Mallamaci F, Tripepi G. Salt restriction in chronic kidney disease: A simple need or a must? Kidney Blood Press Res 2014; 39(2-3): 124-8.
[http://dx.doi.org/10.1159/000355786] [PMID: 25117718]
[11]
Titze J. Sodium balance is not just a renal affair. Curr Opin Nephrol Hypertens 2014; 23(2): 101-5.
[http://dx.doi.org/10.1097/01.mnh.0000441151.55320.c3] [PMID: 24401786]
[12]
Titze J, Rakova N, Kopp C, Dahlmann A, Jantsch J, Luft FC. Balancing wobbles in the body sodium. Nephrol Dial Transplant 2016; 31(7): 1078-81.
[http://dx.doi.org/10.1093/ndt/gfv343] [PMID: 26410883]
[13]
Johnson RS, Titze J, Weller R. Cutaneous control of blood pressure. Curr Opin Nephrol Hypertens 2016; 25(1): 11-5.
[http://dx.doi.org/10.1097/MNH.0000000000000188] [PMID: 26625865]
[14]
Canaud B, Kooman J, Selby NM, et al. Sodium and water handling during hemodialysis: New pathophysiologic insights and management approaches for improving outcomes in end-stage kidney disease. Kidney Int 2019; 95(2): 296-309.
[http://dx.doi.org/10.1016/j.kint.2018.09.024] [PMID: 30665570]
[15]
Qian Q. Metabolic acidosis in a patient with CKD. Clin J Am Soc Nephrol 2019; 14(8): 1245-7.
[http://dx.doi.org/10.2215/CJN.00600119] [PMID: 31018936]
[16]
Bushinsky DA. Tolerance to sodium in patients with CKD-induced metabolic acidosis: Does the accompanying anion matter? Am J Kidney Dis 2019; 73(6): 858-65.
[http://dx.doi.org/10.1053/j.ajkd.2018.09.004] [PMID: 30518477]
[17]
Leifheit-Nestler M, Haffner D. Paracrine Effects of FGF23 on the heart. Front Endocrinol (Lausanne) 2018; 9: 278.
[http://dx.doi.org/10.3389/fendo.2018.00278] [PMID: 29892269]
[18]
Han X, Quarles LD. Multiple faces of fibroblast growth factor-23. Curr Opin Nephrol Hypertens 2016; 25(4): 333-42.
[http://dx.doi.org/10.1097/MNH.0000000000000240] [PMID: 27219044]
[19]
Humalda JK, Heerspink HJL, Kwakernaak AJ, et al. NIGRAM Consortium. Fibroblast growth factor 23 and the antiproteinuric response to dietary sodium restriction during renin-angiotensin-aldosterone system blockade. Am J Kidney Dis 2015; 65(2): 259-66.
[http://dx.doi.org/10.1053/j.ajkd.2014.07.022] [PMID: 25278093]
[20]
Hu JW, Wang Y, Chu C, Mu JJ. Effect of salt intervention on serum levels of fibroblast growth factor 23 (FGF23) in Chinese adults: An intervention study. Med Sci Monit 2018; 24: 1948-54.
[http://dx.doi.org/10.12659/MSM.906489] [PMID: 29608553]
[21]
Polychronopoulou E, Braconnier P, Burnier M. New Insights on the role of sodium in the physiological regulation of blood pressure and development of hypertension. Front Cardiovasc Med 2019; 6: 136.
[http://dx.doi.org/10.3389/fcvm.2019.00136] [PMID: 31608291]
[22]
Jose PA, Raj D. Gut microbiota in hypertension. Curr Opin Nephrol Hypertens 2015; 24(5): 403-9.
[http://dx.doi.org/10.1097/MNH.0000000000000149] [PMID: 26125644]
[23]
Ramezani A, Raj DS. The gut microbiome, kidney disease, and targeted interventions. J Am Soc Nephrol 2014; 25(4): 657-70.
[http://dx.doi.org/10.1681/ASN.2013080905] [PMID: 24231662]
[24]
Nerbass FB, Calice-Silva V, Pecoits-Filho R. Sodium intake and blood pressure in patients with chronic kidney disease: A salty relationship. Blood Purif 2018; 45(1-3): 166-72.
[http://dx.doi.org/10.1159/000485154] [PMID: 29478050]
[25]
Felder RA, White MJ, Williams SM, Jose PA. Diagnostic tools for hypertension and salt sensitivity testing. Curr Opin Nephrol Hypertens 2013; 22(1): 65-76.
[http://dx.doi.org/10.1097/MNH.0b013e32835b3693] [PMID: 23197156]
[26]
Nishiyama A. Pathophysiological mechanisms of mineralocorticoid receptor-dependent cardiovascular and chronic kidney disease. Hypertens Res 2019; 42(3): 293-300.
[http://dx.doi.org/10.1038/s41440-018-0158-6] [PMID: 30523293]
[27]
Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO Clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppl 2012; 2: 337-414.
[28]
Taler SJ, Agarwal R, Bakris GL, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for management of blood pressure in CKD. Am J Kidney Dis 2013; 62(2): 201-13.
[http://dx.doi.org/10.1053/j.ajkd.2013.03.018] [PMID: 23684145]
[29]
Verbeke F, Lindley E, Van Bortel L, et al. A European Renal Best Practice (ERBP) position statement on the Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline for the management of blood pressure in non-dialysis-dependent chronic kidney disease: An endorsement with some caveats for real-life application. Nephrol Dial Transplant 2014; 29(3): 490-6.
[http://dx.doi.org/10.1093/ndt/gft321] [PMID: 24071661]
[30]
Ruzicka M, Quinn RR, McFarlane P, et al. Canadian Society of Nephrology commentary on the 2012 KDIGO clinical practice guideline for the management of blood pressure in CKD. Am J Kidney Dis 2014; 63(6): 869-87.
[http://dx.doi.org/10.1053/j.ajkd.2014.03.003] [PMID: 24725980]
[31]
Cheung AK, Chang TI, Cushman WC, et al. Conference Participants. Blood pressure in chronic kidney disease: Conclusions from a kidney disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2019; 95(5): 1027-36.
[http://dx.doi.org/10.1016/j.kint.2018.12.025] [PMID: 31010478]
[32]
Oparil S. Low sodium intake--cardiovascular health benefit or risk? N Engl J Med 2014; 371(7): 677-9.
[http://dx.doi.org/10.1056/NEJMe1407695] [PMID: 25119614]
[33]
Cogswell ME, Mugavero K, Bowman BA, Frieden TR. Dietary sodium and cardiovascular disease risk-measurement matters. N Engl J Med 2016; 375(6): 580-6.
[http://dx.doi.org/10.1056/NEJMsb1607161] [PMID: 27248297]
[34]
Stolarz-Skrzypek K, Kuznetsova T, Thijs L, et al. European Project on Genes in Hypertension (EPOGH) Investigators. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA 2011; 305(17): 1777-85.
[http://dx.doi.org/10.1001/jama.2011.574] [PMID: 21540421]
[35]
Graudal N, Jürgens G, Baslund B, Alderman MH. Compared with usual sodium intake, low- and excessive-sodium diets are associated with increased mortality: A meta-analysis. Am J Hypertens 2014; 27(9): 1129-37.
[http://dx.doi.org/10.1093/ajh/hpu028] [PMID: 24651634]
[36]
Smyth A, O’Donnell MJ, Yusuf S, et al. Sodium intake and renal outcomes: A systematic review. Am J Hypertens 2014; 27(10): 1277-84.
[http://dx.doi.org/10.1093/ajh/hpt294] [PMID: 24510182]
[37]
McLean RM. Measuring population sodium intake: A review of methods. Nutrients 2014; 6(11): 4651-62.
[http://dx.doi.org/10.3390/nu6114651] [PMID: 25353661]
[38]
He J, Mills KT, Appel LJ, et al. Chronic Renal Insufficiency Cohort Study Investigators. Urinary sodium and potassium excretion and CKD progression. J Am Soc Nephrol 2016; 27(4): 1202-12.
[http://dx.doi.org/10.1681/ASN.2015010022] [PMID: 26382905]
[39]
de Brito-Ashurst I, Perry L, Sanders TA, et al. The role of salt intake and salt sensitivity in the management of hypertension in South Asian people with chronic kidney disease: A randomised controlled trial. Heart 2013; 99(17): 1256-60.
[http://dx.doi.org/10.1136/heartjnl-2013-303688] [PMID: 23766446]
[40]
McMahon EJ, Bauer JD, Hawley CM, et al. A randomized trial of dietary sodium restriction in CKD. J Am Soc Nephrol 2013; 24(12): 2096-103.
[http://dx.doi.org/10.1681/ASN.2013030285] [PMID: 24204003]
[41]
Fan L, Tighiouart H, Levey AS, Beck GJ, Sarnak MJ. Urinary sodium excretion and kidney failure in nondiabetic chronic kidney disease. Kidney Int 2014; 86(3): 582-8.
[http://dx.doi.org/10.1038/ki.2014.59] [PMID: 24646858]
[42]
Saran R, Padilla RL, Gillespie BW, et al. A randomized crossover trial of dietary sodium restriction in stage 3-4 CKD. Clin J Am Soc Nephrol 2017; 12(3): 399-407.
[http://dx.doi.org/10.2215/CJN.01120216] [PMID: 28209636]
[43]
Mills KT, Chen J, Yang W, et al. Chronic Renal Insufficiency Cohort (CRIC) Study Investigators. Sodium excretion and the risk of cardiovascular disease in patients with chronic kidney disease. JAMA 2016; 315(20): 2200-10.
[http://dx.doi.org/10.1001/jama.2016.4447] [PMID: 27218629]
[44]
Leonberg-Yoo AK, Sarnak MJ. Don’t pass the salt: Evidence to support avoidance of high salt intake in CKD. Am J Kidney Dis 2017; 69(2): 175-8.
[http://dx.doi.org/10.1053/j.ajkd.2016.09.008] [PMID: 27789126]
[45]
Dahlmann A, Dörfelt K, Eicher F, et al. Magnetic resonance-determined sodium removal from tissue stores in hemodialysis patients. Kidney Int 2015; 87(2): 434-41.
[http://dx.doi.org/10.1038/ki.2014.269] [PMID: 25100048]
[46]
Kopp C, Linz P, Dahlmann A, et al. 23Na magnetic resonance imaging-determined tissue sodium in healthy subjects and hypertensive patients. Hypertension 2013; 61(3): 635-40.
[http://dx.doi.org/10.1161/HYPERTENSIONAHA.111.00566] [PMID: 23339169]
[47]
Schneider MP, Raff U, Kopp C, et al. Skin sodium concentration correlates with left ventricular hypertrophy in CKD. J Am Soc Nephrol 2017; 28(6): 1867-76.
[http://dx.doi.org/10.1681/ASN.2016060662] [PMID: 28154199]
[48]
Karg MV, Bosch A, Kannenkeril D, et al. SGLT-2-inhibition with dapagliflozin reduces tissue sodium content: A randomised controlled trial. Cardiovasc Diabetol 2018; 17(1): 5.
[http://dx.doi.org/10.1186/s12933-017-0654-z] [PMID: 29301520]
[49]
Gerlach DA, Schopen K, Linz P, et al. Atrophy of calf muscles by unloading results in an increase of tissue sodium concentration and fat fraction decrease: a 23Na MRI physiology study. Eur J Appl Physiol 2017; 117(8): 1585-95.
[http://dx.doi.org/10.1007/s00421-017-3647-4] [PMID: 28534200]
[50]
Mitch WE, Remuzzi G. Diets for patients with chronic kidney disease, should we reconsider? BMC Nephrol 2016; 17(1): 80.
[http://dx.doi.org/10.1186/s12882-016-0283-x] [PMID: 27401192]
[51]
Gómez Candela C, Sastre Gallego A, Eds. Anexo 6 Unidades Fórmulas de conversión y principales electrolitos Pesos y medidas. You & Us SA Madrid 2002; pp. 325-6.
[52]
Raphael KL. Metabolic acidosis and subclinical metabolic acidosis in CKD. J Am Soc Nephrol 2018; 29(2): 376-82.
[http://dx.doi.org/10.1681/ASN.2017040422] [PMID: 29030467]
[53]
Navaneethan SD, Shao J, Buysse J, Bushinsky DA. Effects of treatment of metabolic acidosis in CKD: A systematic review and meta-analysis. Clin J Am Soc Nephrol 2019; 14(7): 1011-20.
[http://dx.doi.org/10.2215/CJN.13091118] [PMID: 31196951]
[54]
Kelly JT, Palmer SC, Wai SN, et al. Healthy dietary patterns and risk of mortality and ESRD in CKD: A meta-analysis of cohort studies. Clin J Am Soc Nephrol 2017; 12(2): 272-9.
[http://dx.doi.org/10.2215/CJN.06190616] [PMID: 27932391]
[55]
Visconti L, Cernaro V, Calimeri S, et al. The myth of water and salt: From aquaretics to tenapanor. J Ren Nutr 2018; 28(2): 73-82.
[http://dx.doi.org/10.1053/j.jrn.2017.06.005] [PMID: 29146141]
[56]
King AJ, Siegel M, He Y, et al. Inhibition of sodium/hydrogen exchanger 3 in the gastrointestinal tract by tenapanor reduces paracellular phosphate permeability. Sci Transl Med 2018; 10(456)eaam6474
[http://dx.doi.org/10.1126/scitranslmed.aam6474] [PMID: 30158152]
[57]
Rukavina Mikusic NL, Kouyoumdzian NM, Choi MR. Gut microbiota and chronic kidney disease: Evidences and mechanisms that mediate a new communication in the gastrointestinal-renal axis. Pflugers Arch 2020; 472(3): 303-20.
[http://dx.doi.org/10.1007/s00424-020-02352-x] [PMID: 32064574]
[58]
Koppe L, Fouque D, Soulage CO. The role of gut microbiota and diet on uremic retention solutes production in the context of chronic kidney disease. Toxins (Basel) 2018; 10(4)E155
[http://dx.doi.org/10.3390/toxins10040155] [PMID: 29652797]
[59]
Mafra D, Borges N, Alvarenga L, et al. Dietary components that may influence the disturbed gut microbiota in chronic kidney disease. Nutrients 2019; 11(3)E496
[http://dx.doi.org/10.3390/nu11030496] [PMID: 30818761]
[60]
Snelson M, Biruete A, McFarlane C, Campbell K. A renal clinician’s guide to the gut microbiota. J Ren Nutr 2020; 30(5): 384-95.
[http://dx.doi.org/10.1053/j.jrn.2019.11.002] [PMID: 31928802]
[61]
Coresh J, Gansevoort RT. CKD Prognosis Consortium. Levin A, Jadoul M; on behalf of KDIGO. Current CKD definition takes into account both relative and absolute risk. J Am Soc Nephrol 2019; 31(2): 447-8.
[62]
Bia D, Galli C, Valtuille R, et al. Hydration status is associated with aortic stiffness, but not with peripheral arterial stiffness, in chronically hemodialysed patients. Int J Nephrol 2015; 2015628654
[http://dx.doi.org/10.1155/2015/628654] [PMID: 26167301]
[63]
Valtuille R, Casos ME, Fernandez EA, Guinsburg A, Marelli C. Nutritional markers and body composition in hemodialysis patients. Int Sch Res Notices 2015; 2015:695263
[http://dx.doi.org/10.1155/2015/695263] [PMID: 27347538]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy