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Cited by 198Sodium Intake and HealthDialysis and Renal Disease ManagementChronic Kidney Disease and Diabetes

Altered dietary salt intake for people with chronic kidney disease

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McMahon, Emma, Campbell, Katrina, Bauer, Judith, Mudge, David·2015·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd010070.pub2PMC PMC8222708
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Abstract

BACKGROUND: Evidence indicates that reducing dietary salt may reduce the incidence of heart disease and delay decline in kidney function in people with chronic kidney disease (CKD). This is an update of a review first published in 2015. OBJECTIVES: To evaluate the benefits and harms of altering dietary salt for adults with CKD. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 6 October 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: Randomised controlled trials comparing two or more levels of salt intake in adults with any stage of CKD. DATA COLLECTION AND ANALYSIS: Two authors independently assessed studies for eligibility, conducted risk of bias evaluation and evaluated confidence in the evidence using GRADE. Results were summarised using random effects models as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). MAIN RESULTS: We included 21 studies (1197 randomised participants), 12 in the earlier stages of CKD (779 randomised participants), seven in dialysis (363 randomised participants) and two in post-transplant (55 randomised participants). Selection bias was low in seven studies, high in one and unclear in 13. Performance and detection biases were low in four studies, high in two, and unclear in 15. Attrition and reporting biases were low in 10 studies, high in three and unclear in eight. Because duration of the included studies was too short (1 to 36 weeks) to test the effect of salt restriction on endpoints such as death, cardiovascular events or CKD progression, changes in salt intake on blood pressure and other secondary risk factors were examined. Reducing salt by mean -73.51 mmol/day (95% CI -92.76 to -54.27), equivalent to 4.2 g or 1690 mg sodium/day, reduced systolic/diastolic blood pressure by -6.91/-3.91 mm Hg (95% CI -8.82 to -4.99/-4.80 to -3.02; 19 studies, 1405 participants; high certainty evidence). Albuminuria was reduced by 36% (95% CI 26 to 44) in six studies, five of which were carried out in people in the earlier stages of CKD (MD -0.44, 95% CI -0.58 to -0.30; 501 participants; high certainty evidence). The evidence is very uncertain about the effect of lower salt intake on weight, as the weight change observed (-1.32 kg, 95% CI -1.94 to -0.70; 12 studies, 759 participants) may have been due to fluid volume, lean tissue, or body fat. Lower salt intake may reduce extracellular fluid volume in the earlier stages of CKD (-0.87 L, 95% CI -1.17 to -0.58; 3 studies; 187 participants; low certainty evidence). The evidence is very uncertain about the effect of lower salt intake on reduction in antihypertensive dose (RR 2.45, 95% CI 0.98 to 6.08; 8 studies; 754 participants). Lower salt intake may lead to symptomatic hypotension (RR 6.70, 95% CI 2.40 to 18.69; 6 studies; 678 participants; moderate certainty evidence). Data were sparse for other types of adverse events. AUTHORS' CONCLUSIONS: We found high certainty evidence that salt reduction reduced blood pressure in people with CKD, and albuminuria in people with earlier stage CKD in the short-term. If such reductions could be maintained long-term, this effect may translate to clinically significant reductions in CKD progression and cardiovascular events. Research into the long-term effects of sodium-restricted diet for people with CKD is warranted.

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  • A review of eight studies on long-term salt restriction in people with chronic kidney disease was unable to determine the direct effects of sodium restriction on primary endpoints such as mortality and progression to end-stage kidney disease.

    “A review of eight studies studying the long‐term effects of salt restriction in people with chronic”

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Authors
McMahon, E., Campbell, K., Bauer, J., & Mudge, D.
Affiliations
  • Princess Alexandra Hospital (AU)
  • The University of Queensland (AU)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2015-02-18
Volume
6
Issue
2
Pages
CD010070-CD010070
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd010070.pub2
PMC
PMC8222708
OpenAlex
W2101612128
Cited by
198
References
105
Citations by year
2026: 1 · 2025: 12 · 2024: 15 · 2023: 29 · 2022: 22 · 2021: 31 · 2020: 21 · 2019: 13 · 2018: 15 · 2017: 18 · 2016: 11 · 2015: 10
FWCI
2.30
Type
journal article
Language
en
Update notices
new_version (2021-06-24)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Griffith Research Online (submittedVersion)
Funders
  • Australian Government
  • Queensland Government
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Keywords
dietary salt restriction, chronic kidney disease, sodium intake, blood pressure, albuminuria, proteinuria, dialysis, kidney transplantation, cardiovascular risk, chronic kidney disease progression, heart failure, mortality, risk of bias, renal function decline, post-transplant hypertension, post-transplant proteinuria, post-transplant mortality
MeSH terms
Antihypertensive Agents, Blood Pressure, Diet, Sodium-Restricted, Edema, Humans, Hypertension, Selection Bias, Randomized Controlled Trials as Topic, Sodium Chloride, Dietary, Renal Insufficiency, Chronic

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