Proteinuria Modifies the Relationship Between Urinary Sodium Excretion and Adverse Kidney Outcomes: Findings From KNOW-CKD
Introduction: High sodium intake is associated with increased proteinuria. Herein, we investigated whether proteinuria could modify the association between urinary sodium excretion and adverse kidney outcomes in patients with chronic kidney disease (CKD). Methods: In this prospective observational c...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-05-01
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| Series: | Kidney International Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024923011877 |
| _version_ | 1797833632943964160 |
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| author | Hyo Jeong Kim Chan-Young Jung Hyung Woo Kim Jung Tak Park Tae-Hyun Yoo Shin-Wook Kang Sue K. Park Yeong Hoon Kim Su Ah Sung Young Youl Hyun Kook-Hwan Oh Seung Hyeok Han |
| author_facet | Hyo Jeong Kim Chan-Young Jung Hyung Woo Kim Jung Tak Park Tae-Hyun Yoo Shin-Wook Kang Sue K. Park Yeong Hoon Kim Su Ah Sung Young Youl Hyun Kook-Hwan Oh Seung Hyeok Han |
| author_sort | Hyo Jeong Kim |
| collection | DOAJ |
| description | Introduction: High sodium intake is associated with increased proteinuria. Herein, we investigated whether proteinuria could modify the association between urinary sodium excretion and adverse kidney outcomes in patients with chronic kidney disease (CKD). Methods: In this prospective observational cohort study, we included 967 participants with CKD stages G1 to G5 between 2011 and 2016, who measured 24-hour urinary sodium and protein excretion at baseline. The main predictors were urinary sodium and protein excretion levels. The primary outcome was CKD progression, which was defined as a ≥50% decline in the estimated glomerular filtration rate (eGFR) or the onset of kidney replacement therapy. Results: During a median follow-up period of 4.1 years, the primary outcome events occurred in 287 participants (29.7%). There was a significant interaction between proteinuria and sodium excretion for the primary outcome (P = 0.006). In patients with proteinuria of <0.5 g/d, sodium excretion was not associated with the primary outcome. However, in patients with proteinuria of ≥0.5 g/d, a 1.0 g/d increase in sodium excretion was associated with a 29% higher risk of adverse kidney outcomes. Moreover, in patients with proteinuria of ≥0.5 g/d, the hazard ratios (HRs) (95% confidence intervals[CIs]) for sodium excretion of <3.4 and ≥3.4 g/d were 2.32 (1.50–3.58) and 5.71 (3.58–9.11), respectively, compared with HRs for patients with proteinuria of <0.5 g/d and sodium excretion of <3.4 g/d. In sensitivity analysis with 2 averaged values of sodium and protein excretion at baseline and third year, the results were similar. Conclusion: Higher urinary sodium excretion was more strongly associated with an increased risk of adverse kidney outcomes in patients with higher proteinuria levels. |
| first_indexed | 2024-04-09T14:26:15Z |
| format | Article |
| id | doaj.art-96aae505a3ee466e954be8e0c764e812 |
| institution | Directory Open Access Journal |
| issn | 2468-0249 |
| language | English |
| last_indexed | 2024-04-09T14:26:15Z |
| publishDate | 2023-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj.art-96aae505a3ee466e954be8e0c764e8122023-05-04T04:12:56ZengElsevierKidney International Reports2468-02492023-05-018510221033Proteinuria Modifies the Relationship Between Urinary Sodium Excretion and Adverse Kidney Outcomes: Findings From KNOW-CKDHyo Jeong Kim0Chan-Young Jung1Hyung Woo Kim2Jung Tak Park3Tae-Hyun Yoo4Shin-Wook Kang5Sue K. Park6Yeong Hoon Kim7Su Ah Sung8Young Youl Hyun9Kook-Hwan Oh10Seung Hyeok Han11Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Republic of KoreaDepartment of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Republic of KoreaDepartment of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Republic of KoreaDepartment of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Republic of KoreaDepartment of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Republic of KoreaDepartment of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Republic of KoreaDepartment of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University, Seoul, Republic of Korea; Department of Biomedical Science, Seoul National University Graduate School, Seoul, Republic of KoreaDepartment of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of KoreaDepartment of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of KoreaDepartment of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, KoreaDepartment of Internal Medicine, Seoul National University Hospital, Seoul, Republic of KoreaDepartment of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Republic of Korea; Correspondence: Seung Hyeok Han, Yonsei University, Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei-ro 50-1, Seodaemun-gu, Seoul, Republic of Korea.Introduction: High sodium intake is associated with increased proteinuria. Herein, we investigated whether proteinuria could modify the association between urinary sodium excretion and adverse kidney outcomes in patients with chronic kidney disease (CKD). Methods: In this prospective observational cohort study, we included 967 participants with CKD stages G1 to G5 between 2011 and 2016, who measured 24-hour urinary sodium and protein excretion at baseline. The main predictors were urinary sodium and protein excretion levels. The primary outcome was CKD progression, which was defined as a ≥50% decline in the estimated glomerular filtration rate (eGFR) or the onset of kidney replacement therapy. Results: During a median follow-up period of 4.1 years, the primary outcome events occurred in 287 participants (29.7%). There was a significant interaction between proteinuria and sodium excretion for the primary outcome (P = 0.006). In patients with proteinuria of <0.5 g/d, sodium excretion was not associated with the primary outcome. However, in patients with proteinuria of ≥0.5 g/d, a 1.0 g/d increase in sodium excretion was associated with a 29% higher risk of adverse kidney outcomes. Moreover, in patients with proteinuria of ≥0.5 g/d, the hazard ratios (HRs) (95% confidence intervals[CIs]) for sodium excretion of <3.4 and ≥3.4 g/d were 2.32 (1.50–3.58) and 5.71 (3.58–9.11), respectively, compared with HRs for patients with proteinuria of <0.5 g/d and sodium excretion of <3.4 g/d. In sensitivity analysis with 2 averaged values of sodium and protein excretion at baseline and third year, the results were similar. Conclusion: Higher urinary sodium excretion was more strongly associated with an increased risk of adverse kidney outcomes in patients with higher proteinuria levels.http://www.sciencedirect.com/science/article/pii/S2468024923011877chronic kidney diseasekidney function declineproteinurianutritionsalt intakeurinary sodium excretion |
| spellingShingle | Hyo Jeong Kim Chan-Young Jung Hyung Woo Kim Jung Tak Park Tae-Hyun Yoo Shin-Wook Kang Sue K. Park Yeong Hoon Kim Su Ah Sung Young Youl Hyun Kook-Hwan Oh Seung Hyeok Han Proteinuria Modifies the Relationship Between Urinary Sodium Excretion and Adverse Kidney Outcomes: Findings From KNOW-CKD Kidney International Reports chronic kidney disease kidney function decline proteinuria nutrition salt intake urinary sodium excretion |
| title | Proteinuria Modifies the Relationship Between Urinary Sodium Excretion and Adverse Kidney Outcomes: Findings From KNOW-CKD |
| title_full | Proteinuria Modifies the Relationship Between Urinary Sodium Excretion and Adverse Kidney Outcomes: Findings From KNOW-CKD |
| title_fullStr | Proteinuria Modifies the Relationship Between Urinary Sodium Excretion and Adverse Kidney Outcomes: Findings From KNOW-CKD |
| title_full_unstemmed | Proteinuria Modifies the Relationship Between Urinary Sodium Excretion and Adverse Kidney Outcomes: Findings From KNOW-CKD |
| title_short | Proteinuria Modifies the Relationship Between Urinary Sodium Excretion and Adverse Kidney Outcomes: Findings From KNOW-CKD |
| title_sort | proteinuria modifies the relationship between urinary sodium excretion and adverse kidney outcomes findings from know ckd |
| topic | chronic kidney disease kidney function decline proteinuria nutrition salt intake urinary sodium excretion |
| url | http://www.sciencedirect.com/science/article/pii/S2468024923011877 |
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