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Cited by 308Sodium Intake and HealthBlood Pressure and Hypertension StudiesChronic Kidney Disease and Diabetes

A Randomized Trial of Dietary Sodium Restriction in CKD

Open access
McMahon, Emma J., Bauer, Judith D., Hawley, Carmel M., Isbel, Nicole M., Stowasser, Michael, Johnson, David W., Campbell, Katrina L.·2013·Journal of the American Society of Nephrology
DOI 10.1681/asn.2013030285PMC PMC3839553
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Abstract

There is a paucity of quality evidence regarding the effects of sodium restriction in patients with CKD, particularly in patients with pre-end stage CKD, where controlling modifiable risk factors may be especially important for delaying CKD progression and cardiovascular events. We conducted a double-blind placebo-controlled randomized crossover trial assessing the effects of high versus low sodium intake on ambulatory BP, 24-hour protein and albumin excretion, fluid status (body composition monitor), renin and aldosterone levels, and arterial stiffness (pulse wave velocity and augmentation index) in 20 adult patients with hypertensive stage 3-4 CKD as phase 1 of the LowSALT CKD study. Overall, salt restriction resulted in statistically significant and clinically important reductions in BP (mean reduction of systolic/diastolic BP, 10/4 mm Hg; 95% confidence interval, 5 to 15 /1 to 6 mm Hg), extracellular fluid volume, albuminuria, and proteinuria in patients with moderate-to-severe CKD. The magnitude of change was more pronounced than the magnitude reported in patients without CKD, suggesting that patients with CKD are particularly salt sensitive. Although studies with longer intervention times and larger sample sizes are needed to confirm these benefits, this study indicates that sodium restriction should be emphasized in the management of patients with CKD as a means to reduce cardiovascular risk and risk for CKD progression.

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  • The most compelling support for a role of excess dietary sodium in resistant hypertension comes from the few clinical trials demonstrating marked reductions in blood pressure among patients with resistant hypertension following a reduced sodium diet.

    “Perhaps the most compelling support comes from the few clinical trials demonstrating marked reductions in BP among patients with RH following a reduced sodium diet.58,161”

    From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [161]

  • In patients with resistant hypertension, 2 recent small studies have demonstrated the efficacy of a reduced dietary sodium intake for BP lowering.

    “In patients with RH, 2 recent small studies have demonstrated the efficacy of a reduced dietary sodium intake for BP lowering.58,161”

    From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [161]

  • Available studies support that sodium restriction, even to low levels <65 to 100 mmol/d (1.5-3.0 g/d), yields significant linear reductions in BP among patients with high BP and resistant hypertension.

    “For the time being, the available studies (albeit of short-term duration) support that sodium restriction, even to low levels <65 to 100 mmol/d (1.5–3.0 g/d), yields significant linear reductions in BP among patients with high BP153–155,349 and RH.58,161”

    From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [161]

  • In a 6-week-long double-blind placebo-controlled crossover trial of 20 patients with stage 3 to 4 CKD, many of whom had resistant hypertension, a low-sodium versus high-sodium diet significantly reduced 24-hour ambulatory BP (−9.7/−3.9 mm Hg).

    “In a 6-week-long double-blind placebo-controlled crossover trial of 20 patients with stage 3 to 4 CKD, many of whom had RH (average, 3.2 ± 1.1 antihypertensive medications), a low-sodium (75 mmol/24-hour urine) versus a high-sodium (168 mmol/24-hour urine) diet significantly reduced 24-hour ambulatory BP (−9.7/−3.9 mm Hg).161”

    From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [161]

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Authors
McMahon, E. J., Bauer, J. D., Hawley, C. M., Isbel, N. M., Stowasser, M., Johnson, D. W., & Campbell, K. L.
Affiliations
The University of Queensland (AU)
Corresponding author
  • McMahon, Emma J.
  • Hawley, Carmel M.
  • Isbel, Nicole M.
  • Stowasser, Michael
  • Johnson, David W.
  • Campbell, Katrina L.
ORCID
Venue
Journal of the American Society of Nephrology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2013-12
Volume
24
Issue
12
Pages
2096-2103
ISSN
1046-6673 (ISSN-L)
DOI
10.1681/asn.2013030285
PMC
PMC3839553
OpenAlex
W2144043457
Cited by
308
References
45
Citations by year
2026: 12 · 2025: 9 · 2024: 20 · 2023: 20 · 2022: 24 · 2021: 29 · 2020: 34 · 2019: 21 · 2018: 31 · 2017: 30 · 2016: 21 · 2015: 32 · 2014: 24 · 2013: 1
FWCI
24.04
Type
journal article
Language
en
Open access
Locations
  • Journal of the American Society of Nephrology (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Funders
Fresenius Medical Care North America
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Keywords
dietary sodium restriction, chronic kidney disease, hypertension, blood pressure reduction, albuminuria, proteinuria, extracellular volume, arterial stiffness, pulse wave velocity, augmentation index, renin, aldosterone, salt sensitivity, cardiovascular risk, chronic kidney disease progression, volume status
MeSH terms
Aged, Blood Pressure, Diet, Sodium-Restricted, Double-Blind Method, Female, Humans, Hypertension, Renal, Male, Middle Aged, New Zealand, Patient Compliance, Risk Factors, Treatment Outcome, Sodium Chloride, Dietary, Cross-Over Studies, Risk Reduction Behavior, Renal Insufficiency, Chronic

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