um Intake, ESRD, and All-Cause Mortality In Patients With Type 1 Diabetes

OBJECTIVE—Manyguidelinesrecommendreducedconsumptionofsaltinpatientswithtype1 diabetes, but it is unclear whether dietary sodium intake is associated with mortality and end-stage renal disease (ESRD).RESEARCH DESIGN AND METHODS—In a nationwide multicenter study (theFinnDiane Study) between 1998 and 2002, 2,807 enrolled adults with type 1 diabetes withoutESRD were prospectively followed. Baseline urinary sodium excretion was estimated on a 24-hurine collection. The predictors of all-cause mortality and ESRD were determined by Coxregression and competing risk modeling, respectively.RESULTS—Themedianfollow-upforsurvivalanalyseswas10years,duringwhich217deathswererecorded(7.7%).Urinarysodiumexcretionwasnonlinearlyassociatedwithall-causemor-tality,suchthatindividualswiththehighestdailyurinarysodiumexcretion,aswellasthelowestexcretion,hadreducedsurvival.Thisassociationwasindependentage,sex,durationofdiabetes,the presence and severity of chronic kidney disease (CKD) (estimated glomerular filtration rate[eGFR] and log albumin excretion rate), the presence of established cardiovascular disease, andsystolic blood pressure. During follow-up, 126 patients developed ESRD (4.5%). Urinary so-dium excretion was inversely associated with the cumulative incidence of ESRD, such thatindividuals with the lowest sodium excretion had the highest cumulative incidence of ESRD.CONCLUSIONS—In patients with type 1 diabetes, sodium was independently associatedwithall-causemortalityandESRD.Althoughwehavenotdemonstratedcausality,thesefindingssupport the calls for caution before applying salt restriction universally. Clinical trials must beperformedindiabeticpatientstoformallytesttheutility/riskofsodiumrestrictioninthissetting.Diabetes Care34:861–866, 2011

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