Sodium Excretion and Cardiovascular Disease Risk in CKD
What is the prospective relationship between urinary sodium excretion and risk of clinical cardiovascular disease (CVD) among patients with chronic kidney disease (CKD) enrolled in the CRIC (Chronic Renal Insufficiency Cohort) study?
The CRIC study is an ongoing, multicenter, prospective, cohort study of adults ages 21-74 years with mild to moderate CKD. The exposure of interest in this study was the cumulative mean of urinary sodium excretion from three 24-hour urinary measurements and calibrated to sex-specific mean 24-hour urinary creatinine excretion. The primary outcome of interest was composite CVD, defined as the first of congestive heart failure, myocardial infarction, and stroke that occurred during follow-up.
A total of 3,757 participants were included in this analysis. Hazard ratios for CVD events in the highest quartile of sodium excretion compared with the lowest quartile were 1.36 (95% confidence interval [CI], 1.09-1.70; p = 0.007) for composite CVD events, 1.34 (95% CI, 1.03-1.74; p = 0.03) for heart failure, and 1.81 (95% CI, 1.08-3.92; p = 0.02) for stroke in adjusted analyses.
Among patients with CKD, higher urinary sodium excretion was associated with increased risk for CVD.
This is an important study and one that is unique in that it establishes the association between sodium excretion and CVD incidence in a population specifically with CKD. As the authors suggest, their findings, "if confirmed by clinical trials, suggest that moderate sodium reduction among patients with CKD and high CKD may lower CVD risk." It should be noted that 2300 mg sodium/day is the recommended sodium target in the general population.
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