Dietary Sodium Reduction Reduces Albuminuria: A Cluster Randomized Trial.

OBJECTIVES The objective of the study was to assess the impact of sustained dietary salt reduction on albuminuria in nearly 2000 community-dwelling adults. DESIGN AND METHODS The present study is a prespecified secondary analysis of the China Rural Health Initiative Salt Reduction Study cluster randomized trial undertaken in 120 villages in rural China. Villages were randomized to a sodium reduction program of education and access to reduced-sodium salt substitute or control. Urinary albumin-to-creatinine ratio (uACR) and albuminuria (uACR ≥22.1 or 31.0 mg/g for men and women, respectively) were assessed at 18 months in a stratified random sample of predominantly older individuals living in participating rural villages. RESULTS A total of 2,566 participants from 119 villages provided 1,903 eligible urine samples. The sodium reduction program reduced sodium intake by an equivalent of 0.82g of salt/day (0.06-1.68 g) (322 [24-661] mg sodium/day). The mean uACR was 8.85 (8.05-9.82) mg/g (1.00 [0.91-1.11] mg/mmol) in intervention participants compared with 10.53 (9.73-11.33) mg/g (1.19 [1.10-1.28] mg/mmol) in control participants (p=0.008). The corresponding odds ratio for albuminuria was 0.67 (0.46-0.99). CONCLUSIONS Dietary sodium reduction was associated with significantly lower uACR and less albuminuria after 18 months. Whether CKD progression can be slowed by dietary sodium reduction should be a global research priority. CLINICALTRIALS.GOV: NCT01259700.

[1]  P. Elliott,et al.  The Effects of a Community-Based Sodium Reduction Program in Rural China – A Cluster-Randomized Trial , 2016, PloS one.

[2]  M. Woodward,et al.  Prediction of 10‐year vascular risk in patients with diabetes: the AD‐ON risk score , 2016, Diabetes, obesity & metabolism.

[3]  David W. Johnson,et al.  A randomized trial of dietary sodium restriction in CKD. , 2013, Journal of the American Society of Nephrology : JASN.

[4]  P. Elliott,et al.  A large-scale cluster randomized trial to determine the effects of community-based dietary sodium reduction--the China Rural Health Initiative Sodium Reduction Study. , 2013, American heart journal.

[5]  H. Parving,et al.  Moderation of dietary sodium potentiates the renal and cardiovascular protective effects of angiotensin receptor blockers. , 2012, Kidney international.

[6]  Hong Wang,et al.  Connecting tubule glomerular feedback mediates acute tubuloglomerular feedback resetting. , 2012, American journal of physiology. Renal physiology.

[7]  G. Navis,et al.  Moderate dietary sodium restriction added to angiotensin converting enzyme inhibition compared with dual blockade in lowering proteinuria and blood pressure: randomised controlled trial , 2011, BMJ : British Medical Journal.

[8]  Ian J. Brown,et al.  Dietary sources of sodium in China, Japan, the United Kingdom, and the United States, women and men aged 40 to 59 years: the INTERMAP study. , 2010, Journal of the American Dietetic Association.

[9]  J. Kaski,et al.  Effects of Potassium Chloride and Potassium Bicarbonate on Endothelial Function, Cardiovascular Risk Factors, and Bone Turnover in Mild Hypertensives , 2010, Hypertension.

[10]  N. Markandu,et al.  Effect of Modest Salt Reduction on Blood Pressure, Urinary Albumin, and Pulse Wave Velocity in White, Black, and Asian Mild Hypertensives , 2009, Hypertension.

[11]  M. Woodward,et al.  Combined Effects of Routine Blood Pressure Lowering and Intensive Glucose Control on Macrovascular and Microvascular Outcomes in Patients With Type 2 Diabetes , 2009, Diabetes Care.

[12]  R. MacIsaac,et al.  Effects of Salt Supplementation on the Albuminuric Response to Telmisartan With or Without Hydrochlorothiazide Therapy in Hypertensive Patients With Type 2 Diabetes Are Modulated by Habitual Dietary Salt Intake , 2009, Diabetes Care.

[13]  G. Navis,et al.  Effects of dietary sodium and hydrochlorothiazide on the antiproteinuric efficacy of losartan. , 2008, Journal of the American Society of Nephrology : JASN.

[14]  S. Bakker,et al.  Metabolic aspects of dietary sodium restriction as a therapeutic intervention , 2010 .

[15]  F. Beyer,et al.  Potassium supplementation for the management of primary hypertension in adults. , 2006, The Cochrane database of systematic reviews.

[16]  A. Aviv,et al.  Sodium glomerulopathy: tubuloglomerular feedback and renal injury in African Americans. , 2004, Kidney international.

[17]  B. Brenner,et al.  Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. , 2001, The New England journal of medicine.

[18]  P. Whelton,et al.  Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. , 1997, Journal of the American Medical Association (JAMA).

[19]  G. Jerums,et al.  Salt Restriction Reduces Hyperfiltration, Renal Enlargement, and Albuminuria in Experimental Diabetes , 1997, Diabetes.

[20]  L. Dworkin,et al.  Salt restriction inhibits renal growth and stabilizes injury in rats with established renal disease. , 1996, Journal of the American Society of Nephrology : JASN.

[21]  C. Pollock,et al.  Tubular sodium handling and tubuloglomerular feedback in experimental diabetes mellitus. , 1991, The American journal of physiology.

[22]  L. Dworkin,et al.  Superiority of salt restriction over diuretics in reducing renal hypertrophy and injury in uninephrectomized SHR. , 1990, The American journal of physiology.