A randomized trial of sodium-restriction on kidney function, fluid volume and adipokines in CKD patients

Katrina L Campbell, David W Johnson, Judith D Bauer, Carmel M Hawley, Nicole M Isbel, Michael Stowasser, Jonathan P Whitehead, Goce Dimeski, Emma McMahon

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Abstract

BACKGROUND: Dietary sodium restriction is a key management strategy in chronic kidney disease (CKD). Recent evidence has demonstrated short-term reduction in blood pressure (BP) and proteinuria with sodium restriction, however the effect on other cardiovascular-related risk factors requires investigation in CKD.

METHODS: The LowSALT CKD study involved 20 hypertensive Stage III-IV CKD patients counselled by a dietitian to consume a low-sodium diet (<100 mmol/day). The study was a randomised crossover trial comparing 2 weeks of high-sodium (additional 120 mmol sodium tablets) and low-sodium intake (placebo). Measurements were taken after each crossover arm including BP (peripheral and central), adipokines (inflammation markers and adiponectin), volume markers (extracellular-to-intracellular [E/I] fluid ratio; N-terminal pro-brain natriuretic peptide [NT-proBNP]), kidney function (estimated Glomerular Filtration Rate [eGFR]) and proteinuria (urine protein-creatinine ratio [PCR] and albumin-creatinine ratio [ACR]). Outcomes were compared using paired t-test for each cross-over arm.

RESULTS: BP-lowering benefits of a low-sodium intake (peripheral BP (mean ± SD) 148/82 ± 21/12 mmHg) from high-sodium (159/87 ± 15/10 mmHg) intake were reflected in central BP and a reduction in eGFR, PCR, ACR, NTproBNP and E/I ratio. There was no change in inflammatory markers, total or high molecular weight adiponectin.

CONCLUSIONS: Short-term benefits of sodium restriction on BP were reflected in significant change in kidney function and fluid volume parameters. Larger, long-term adequately powered trials in CKD are necessary to confirm these results.

TRIAL REGISTRATION: Universal Trial Number U1111-1125-2149 registered on 13/10/2011; Australian New Zealand Clinical Trials Registry Number ACTRN12611001097932 registered on 21/10/2011.

Original languageEnglish
Pages (from-to)57
JournalBMC Nephrology
Volume15
DOIs
Publication statusPublished - 4 Apr 2014
Externally publishedYes

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Adipokines
Chronic Renal Insufficiency
Sodium
Kidney
Blood Pressure
Creatinine
Adiponectin
Glomerular Filtration Rate
Proteinuria
Albumins
Intracellular Fluid
Dietary Sodium
Sodium-Restricted Diet
Nutritionists
Brain Natriuretic Peptide
New Zealand
Cross-Over Studies
Tablets
Registries
Proteins

Cite this

Campbell, K. L., Johnson, D. W., Bauer, J. D., Hawley, C. M., Isbel, N. M., Stowasser, M., ... McMahon, E. (2014). A randomized trial of sodium-restriction on kidney function, fluid volume and adipokines in CKD patients. BMC Nephrology, 15, 57. https://doi.org/10.1186/1471-2369-15-57
Campbell, Katrina L ; Johnson, David W ; Bauer, Judith D ; Hawley, Carmel M ; Isbel, Nicole M ; Stowasser, Michael ; Whitehead, Jonathan P ; Dimeski, Goce ; McMahon, Emma. / A randomized trial of sodium-restriction on kidney function, fluid volume and adipokines in CKD patients. In: BMC Nephrology. 2014 ; Vol. 15. pp. 57.
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abstract = "BACKGROUND: Dietary sodium restriction is a key management strategy in chronic kidney disease (CKD). Recent evidence has demonstrated short-term reduction in blood pressure (BP) and proteinuria with sodium restriction, however the effect on other cardiovascular-related risk factors requires investigation in CKD.METHODS: The LowSALT CKD study involved 20 hypertensive Stage III-IV CKD patients counselled by a dietitian to consume a low-sodium diet (<100 mmol/day). The study was a randomised crossover trial comparing 2 weeks of high-sodium (additional 120 mmol sodium tablets) and low-sodium intake (placebo). Measurements were taken after each crossover arm including BP (peripheral and central), adipokines (inflammation markers and adiponectin), volume markers (extracellular-to-intracellular [E/I] fluid ratio; N-terminal pro-brain natriuretic peptide [NT-proBNP]), kidney function (estimated Glomerular Filtration Rate [eGFR]) and proteinuria (urine protein-creatinine ratio [PCR] and albumin-creatinine ratio [ACR]). Outcomes were compared using paired t-test for each cross-over arm.RESULTS: BP-lowering benefits of a low-sodium intake (peripheral BP (mean ± SD) 148/82 ± 21/12 mmHg) from high-sodium (159/87 ± 15/10 mmHg) intake were reflected in central BP and a reduction in eGFR, PCR, ACR, NTproBNP and E/I ratio. There was no change in inflammatory markers, total or high molecular weight adiponectin.CONCLUSIONS: Short-term benefits of sodium restriction on BP were reflected in significant change in kidney function and fluid volume parameters. Larger, long-term adequately powered trials in CKD are necessary to confirm these results.TRIAL REGISTRATION: Universal Trial Number U1111-1125-2149 registered on 13/10/2011; Australian New Zealand Clinical Trials Registry Number ACTRN12611001097932 registered on 21/10/2011.",
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Campbell, KL, Johnson, DW, Bauer, JD, Hawley, CM, Isbel, NM, Stowasser, M, Whitehead, JP, Dimeski, G & McMahon, E 2014, 'A randomized trial of sodium-restriction on kidney function, fluid volume and adipokines in CKD patients' BMC Nephrology, vol. 15, pp. 57. https://doi.org/10.1186/1471-2369-15-57

A randomized trial of sodium-restriction on kidney function, fluid volume and adipokines in CKD patients. / Campbell, Katrina L; Johnson, David W; Bauer, Judith D; Hawley, Carmel M; Isbel, Nicole M; Stowasser, Michael; Whitehead, Jonathan P; Dimeski, Goce; McMahon, Emma.

In: BMC Nephrology, Vol. 15, 04.04.2014, p. 57.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - A randomized trial of sodium-restriction on kidney function, fluid volume and adipokines in CKD patients

AU - Campbell, Katrina L

AU - Johnson, David W

AU - Bauer, Judith D

AU - Hawley, Carmel M

AU - Isbel, Nicole M

AU - Stowasser, Michael

AU - Whitehead, Jonathan P

AU - Dimeski, Goce

AU - McMahon, Emma

PY - 2014/4/4

Y1 - 2014/4/4

N2 - BACKGROUND: Dietary sodium restriction is a key management strategy in chronic kidney disease (CKD). Recent evidence has demonstrated short-term reduction in blood pressure (BP) and proteinuria with sodium restriction, however the effect on other cardiovascular-related risk factors requires investigation in CKD.METHODS: The LowSALT CKD study involved 20 hypertensive Stage III-IV CKD patients counselled by a dietitian to consume a low-sodium diet (<100 mmol/day). The study was a randomised crossover trial comparing 2 weeks of high-sodium (additional 120 mmol sodium tablets) and low-sodium intake (placebo). Measurements were taken after each crossover arm including BP (peripheral and central), adipokines (inflammation markers and adiponectin), volume markers (extracellular-to-intracellular [E/I] fluid ratio; N-terminal pro-brain natriuretic peptide [NT-proBNP]), kidney function (estimated Glomerular Filtration Rate [eGFR]) and proteinuria (urine protein-creatinine ratio [PCR] and albumin-creatinine ratio [ACR]). Outcomes were compared using paired t-test for each cross-over arm.RESULTS: BP-lowering benefits of a low-sodium intake (peripheral BP (mean ± SD) 148/82 ± 21/12 mmHg) from high-sodium (159/87 ± 15/10 mmHg) intake were reflected in central BP and a reduction in eGFR, PCR, ACR, NTproBNP and E/I ratio. There was no change in inflammatory markers, total or high molecular weight adiponectin.CONCLUSIONS: Short-term benefits of sodium restriction on BP were reflected in significant change in kidney function and fluid volume parameters. Larger, long-term adequately powered trials in CKD are necessary to confirm these results.TRIAL REGISTRATION: Universal Trial Number U1111-1125-2149 registered on 13/10/2011; Australian New Zealand Clinical Trials Registry Number ACTRN12611001097932 registered on 21/10/2011.

AB - BACKGROUND: Dietary sodium restriction is a key management strategy in chronic kidney disease (CKD). Recent evidence has demonstrated short-term reduction in blood pressure (BP) and proteinuria with sodium restriction, however the effect on other cardiovascular-related risk factors requires investigation in CKD.METHODS: The LowSALT CKD study involved 20 hypertensive Stage III-IV CKD patients counselled by a dietitian to consume a low-sodium diet (<100 mmol/day). The study was a randomised crossover trial comparing 2 weeks of high-sodium (additional 120 mmol sodium tablets) and low-sodium intake (placebo). Measurements were taken after each crossover arm including BP (peripheral and central), adipokines (inflammation markers and adiponectin), volume markers (extracellular-to-intracellular [E/I] fluid ratio; N-terminal pro-brain natriuretic peptide [NT-proBNP]), kidney function (estimated Glomerular Filtration Rate [eGFR]) and proteinuria (urine protein-creatinine ratio [PCR] and albumin-creatinine ratio [ACR]). Outcomes were compared using paired t-test for each cross-over arm.RESULTS: BP-lowering benefits of a low-sodium intake (peripheral BP (mean ± SD) 148/82 ± 21/12 mmHg) from high-sodium (159/87 ± 15/10 mmHg) intake were reflected in central BP and a reduction in eGFR, PCR, ACR, NTproBNP and E/I ratio. There was no change in inflammatory markers, total or high molecular weight adiponectin.CONCLUSIONS: Short-term benefits of sodium restriction on BP were reflected in significant change in kidney function and fluid volume parameters. Larger, long-term adequately powered trials in CKD are necessary to confirm these results.TRIAL REGISTRATION: Universal Trial Number U1111-1125-2149 registered on 13/10/2011; Australian New Zealand Clinical Trials Registry Number ACTRN12611001097932 registered on 21/10/2011.

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DO - 10.1186/1471-2369-15-57

M3 - Article

VL - 15

SP - 57

JO - BMC Nephrology

JF - BMC Nephrology

SN - 1471-2369

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