Association between urinary salt excretion and albuminuria in Japanese patients with chronic kidney disease: the Fukuoka
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ORIGINAL ARTICLE
Association between urinary salt excretion and albuminuria in Japanese patients with chronic kidney disease: the Fukuoka kidney disease registry study Akiko Fukui1 · Masaru Nakayama1 · Shigeru Tanaka2 · Yuta Matsukuma1 · Ryota Yoshitomi1 · Toshiaki Nakano2 · Kazuhiko Tsuruya3 · Takanari Kitazono2 Received: 1 July 2020 / Accepted: 29 July 2020 © Japanese Society of Nephrology 2020
Abstract Background Several large population-based studies have demonstrated that urinary salt excretion (USALT) is associated with albuminuria. However, this relationship has not been assessed in a large cohort study of patients with chronic kidney disease (CKD). Thus, the present study aimed to elucidate whether USALT was independently associated with albuminuria in a large cohort of patients with CKD. Methods This cross-sectional study was conducted in 4075 patients with CKD not on dialysis. USALT (g/day) was estimated from spot urine. Patients were divided into quartiles (Q1–Q4) according to estimated USALT. Multivariable regression models were used to determine whether USALT was independently related to urinary albumin-to-creatinine ratio (UACR) or the presence of macroalbuminuria. Results In multivariable linear regression analyses, 1-g/day increment in USALT was significantly associated with log UACR [coefficient 0.098, 95% confidence interval (CI) 0.075–0.121]. In addition, compared with the first USALT quartile, the third and fourth quartiles exhibited significant associations with log UACR (Q3: coefficient 0.305, 95% CI 0.154–0.456; Q4: coefficient 0.601, 95% CI 0.447–0.756). Furthermore, multivariable logistic regression analyses showed that USALT (1-g/day increment) was significantly associated with the presence of macroalbuminuria [odds ratio (OR) 1.11, 95% CI 1.07–1.14]; the third and fourth USALT quartiles exhibited significantly greater risks of macroalbuminuria, compared with the first quartile (Q3: OR 1.33, 95% CI 1.09–1.62; Q4: OR 1.89, 95% CI 1.54–2.32). Conclusions This significant association of USALT with UACR and macroalbuminuria suggests that higher USALT may cause increased albuminuria, thereby contributing to kidney disease progression. Keywords Urinary salt excretion · Albuminuria · Macroalbuminuria · Chronic kidney disease · Fukuoka kidney disease registry study
Introduction
* Kazuhiko Tsuruya tsuruya@naramed‑u.ac.jp 1
Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center, 1‑8‑1 Jigyohama, Chuo‑ku, Fukuoka 810‑8563, Japan
2
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3‑1‑1 Maidashi, Higashi‑ku, Fukuoka 812‑8582, Japan
3
Department of Nephrology, Nara Medical University, 840 Shijo‑cho, Kashihara, Nara 634‑8521, Japan
High salt intake is presumed to increase blood pressure and contribute to endothelial dysfunction, vascular remodeling and dysregulation, albuminuria and kidney disease progression, and cardiovascular events and mo
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