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. 2020 Sep 11;12(9):2772.
doi: 10.3390/nu12092772.

Urinary Sodium Excretion and Blood Pressure Relationship across Methods of Evaluating the Completeness of 24-h Urine Collections

Abu Mohd Naser  1   2 , Feng J He  3 , Mahbubur Rahman  4 , K M Venkat Narayan  1 , Norm R C Campbell  5
Affiliations

Urinary Sodium Excretion and Blood Pressure Relationship across Methods of Evaluating the Completeness of 24-h Urine Collections

Abu Mohd Naser et al. Nutrients. .

Abstract

We compared the sodium intake and systolic blood pressure (SBP) relationship from complete 24-h urine samples determined by several methods: self-reported no-missed urine, creatinine index ≥0.7, measured 24-h urine creatinine (mCER) within 25% and 15% of Kawasaki predicted urine creatinine, and sex-specific mCER ranges (mCER 15-25 mg/kg/24-h for men; 10-20 mg/kg/24-h for women). We pooled 10,031 BP and 24-h urine sodium data from 2143 participants. We implemented multilevel linear models to illustrate the shape of the sodium-BP relationship using the restricted cubic spline (RCS) plots, and to assess the difference in mean SBP for a 100 mmol increase in 24-h urine sodium. The RCS plot illustrated an initial steep positive sodium-SBP relationship for all methods, followed by a less steep positive relationship for self-reported no-missed urine, creatinine index ≥0.7, and sex-specific mCER ranges; and a plateaued relationship for the two Kawasaki methods. Each 100 mmol/24-h increase in urinary sodium was associated with 0.64 (95% CI: 0.34, 0.94) mmHg higher SBP for self-reported no-missed urine, 0.68 (95% CI: 0.27, 1.08) mmHg higher SBP for creatinine index ≥0.7, 0.87 (95% CI: 0.07, 1.67) mmHg higher SBP for mCER within 25% Kawasaki predicted urine creatinine, 0.98 (95% CI: -0.07, 2.02) mmHg change in SBP for mCER within 15% Kawasaki predicted urine creatinine, and 1.96 (95% CI: 0.93, 2.99) mmHg higher SBP for sex-specific mCER ranges. Studies examining 24-h urine sodium in relation to health outcomes will have different results based on how urine collections are deemed as complete.

Keywords: blood pressure; complete 24-h urine; salt intake; sodium; urinary sodium.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kernel density plots of measured 24-h urine sodium excretion based on different methods of calculating complete 24-h urine samples. mCER: measured 24-h urine creatinine. excretion; pCER: predicted 24-h urine creatinine excretion.
Figure 2
Figure 2
Restricted cubic spline pots of urinary sodium and blood pressure relationship from different method of evaluating the completeness of 24-h urine collection. Models were adjusted for age, sex, BMI, smoking status, physical activity, sleep, alcohol consumption, religion, and household wealth. Vertical dotted blue dotted lines indicate the 5th, 50th, and 95th percentile distribution of urine sodium excretion. mCER: measured 24-h urine creatinine excretion; pCER: predicted 24-h urine creatinine excretion.
Figure 3
Figure 3
Restricted cubic spline plots of the sex-specific relationship between urinary sodium and blood pressure from different methods of evaluating the completeness of 24-h urine collection. Models were adjusted for age, sex, BMI, smoking status, physical activity, sleep, alcohol consumption, religion, and household wealth. Vertical dotted blue dotted lines indicate the 5th, 50th, and 95th percentile distribution of urine sodium excretion. mCER: measured 24-h urine creatinine excretion; pCER: predicted 24-h urine creatinine excretion.
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