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Randomized Controlled Trial
. 2019 Sep 12;11(9):2204.
doi: 10.3390/nu11092204.

Impact of Moderate Sodium Restriction and Hydrochlorothiazide on Iodine Excretion in Diabetic Kidney Disease: Data from a Randomized Cross-Over Trial

S Heleen Binnenmars  1 , Eva Corpeleijn  2 , Arjan J Kwakernaak  3 , Daan J Touw  4 , Ido P Kema  5 , Gozewijn D Laverman  6 , Stephan J L Bakker  7 , Gerjan Navis  8
Affiliations
Randomized Controlled Trial

Impact of Moderate Sodium Restriction and Hydrochlorothiazide on Iodine Excretion in Diabetic Kidney Disease: Data from a Randomized Cross-Over Trial

S Heleen Binnenmars et al. Nutrients. .

Abstract

Sodium restriction may potentially reduce iodine intake. This study aimed to determine the effect of sodium restriction (dietary counseling) on 24-h urinary iodine excretion. Diuretics provide an alternative to sodium restriction and are frequently added to sodium restriction, so the effects of hydrochlorothiazide (50 mg daily) and combined therapy were also studied. We performed a post-hoc analysis of a Dutch multi-center, randomized cross-over trial in 45 patients with diabetic kidney disease with a mean age of 65 ± 9 years, mean eGFR of 65 ± 27 mL/min/1.73 m2, median albuminuria of 648 [230-2008] mg/24 h and 84% were male. During regular sodium intake with placebo, mean 24 h urinary sodium and iodine excretion were 224 ± 76 mmol/24 h and 252 ± 94 ug/24 h, respectively (r = 0.52, p < 0.001). Mean iodine excretion did not change significantly if sodium restriction and hydrochlorothiazide were applied separately; mean difference -8 ug/day (95% CI -38, 22; p = 0.6) and 14 ug/day (95% CI -24, 52; p = 0.5), respectively. Combined therapy induced a significant decrease in mean iodine excretion (-37 ug/day; 95% CI -67, -7; p = 0.02), yet this was not seen to a clinically meaningful level. The number of patients with an estimated intake below recommended daily allowances did not differ significantly between the four treatment periods (p = 0.3). These findings show that sodium restriction is not a risk factor for iodine deficiency.

Keywords: 24-h urinary excretion; diabetic kidney disease; iodine; sodium.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Participant flowchart.
Figure 2
Figure 2
Schematic overview of the trial design.
Figure 3
Figure 3
Correlation of 24-h sodium excretion and 24-h iodine excretion during the four different treatment periods. (A): regular salt intake with placebo. (B): salt restriction with placebo. (C): regular salt intake with hydrochlorothiazide. (D): salt restriction with hydrochlorothiazide.
See this image and copyright information in PMC

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