Dietary sodium in chronic kidney disease: a comprehensive approach

Abstract

Despite existing guidelines, dietary sodium intake among people worldwide often exceeds recommended limits. Research evidence is growing in both animal and human studies showing indirect and direct adverse consequences of high dietary sodium on the kidney. In patients with kidney disease, dietary sodium may have important effects on proteinuria, efficacy of antiproteinuric pharmacologic therapy, hypertension control, maintaining an optimal volume status, and immunosuppressant therapy. Dietary sodium intake is an important consideration in patients with all stages of chronic kidney disease, including those receiving dialysis therapy or those who have received a kidney transplant. We review in detail the dietary sodium recommendations suggested by various organizations for patients with kidney disease. Potential barriers to successfully translating current sodium intake guidelines into practice include poor knowledge about the sodium content of food among both patients and providers, complex labeling information, patient preferences related to taste, and limited support for modifications in public policy. Finally, we offer existing and potential solutions that may assist providers in educating and empowering patients to effectively manage their dietary sodium intake.

Fig. A

Interplay between dietary salt, blood pressure, proteinuria and kidney disease progression. Reprinted with permission (8).

Fig. B

Pressure naturiesis curves for normal, salt resistant, and salt sensitive subjects. The salt sensitive show a significant change in mean arterial pressure associated with changes in salt loading. Reprinted with permission (9, 10).

Figure C

Potential Barriers (in sidebars) to successfully translating sodium guidelines into practice