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Khorramshahi Bayat M, Chan W, Hay K, McKenzie S, Adhikari P, Fincher G, Jordan F, Ranasinghe I. Spot urinary sodium guided titration of intravenous diuretic therapy in acute heart failure: A pilot randomised controlled trial. Eur Heart J Qual Care Clin Outcomes 2024:qcae028. [PMID: 38632053 DOI: 10.1093/ehjqcco/qcae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Spot urinary sodium concentration (UNa) is advocated in guidelines to assess diuretic response and titrate dosage in acute heart failure (AHF). However, no randomised controlled trial data exists to support this approach. We performed a prospective pilot trial to investigate the feasibility of this approach. METHODS 60 patients with AHF (n = 30 in each arm) were randomly assigned to titration of loop diuretics for the first 48 hours of admission according to UNa levels (intervention arm) or based on clinical signs and symptoms of congestion (standard care arm). Diuretic insufficiency was defined as UNa < 50 mmol/L. Endpoints relating to diuretic efficacy, safety and AHF outcomes were evaluated. RESULTS UNa-guided therapy patients experienced less acute kidney injury (20% vs 50%, p = 0.01) and a tendency towards less hypokalaemia (serum K+<3.5 mmol, 7% vs 27%, p = 0.04), with greater weight loss (3.3 kg vs 2.1 kg, p = 0.01). They reported a greater reduction in the clinical congestion score (-4.7 vs -2.6, p < 0.01) and were more likely to report marked symptom improvement (40% vs 13.3%, p = 0.04) at 48 hours. There was no difference in the length of hospital stay (median LOS: 8 days in both groups, p = 0.98), 30-day mortality or readmission rate. CONCLUSION UNa-guided titration of diuretic therapy in AHF is feasible and safer than titration based on clinical signs and symptoms of congestion, with more effective decongestion at 48 hours. Further large-scale trials are needed to determine if the superiority of this approach translates into improved patient outcomes.
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Affiliation(s)
- Maryam Khorramshahi Bayat
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Wandy Chan
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Scott McKenzie
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Polash Adhikari
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Emergency, The Prince Charles Hospital, Brisbane, Australia
| | - Gavin Fincher
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Emergency, The Prince Charles Hospital, Brisbane, Australia
| | - Faye Jordan
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Emergency, The Prince Charles Hospital, Brisbane, Australia
| | - Isuru Ranasinghe
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Bolton KA, Santos JA, Rosewarne E, Trieu K, Reimers J, Nowson C, Neal B, Webster J, Woodward M, Dunford E, Armstrong S, Bolam B, Grimes C. Outcomes of a state-wide salt reduction initiative in adults living in Victoria, Australia. Eur J Nutr 2023; 62:3055-3067. [PMID: 37493681 PMCID: PMC10468945 DOI: 10.1007/s00394-023-03210-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE To assess any effects of a state-wide sodium reduction intervention on sodium intake, sources of dietary sodium and discretionary salt use at a population level. METHODS Data (24-h urinary sodium excretion, self-report survey, a 24-h dietary recall) were collected cross-sectionally at baseline (2016/2017) and follow-up (2020) from adults in Victoria, Australia. Intervention activities included consumer awareness advertising campaign, public debate generation via mass media, strengthening existing policy initiatives and supporting food innovation with industry. RESULTS There were 339 participants at baseline and 211 at follow-up, with 144 and 90 of participants completing a 24-h dietary recall, respectively. There was no difference in adjusted 24-h urinary sodium excretion between baseline and follow-up (134 vs 131 mmol/24 h; p = 0.260). There were no differences in the percentage of participants adding salt during cooking (63% vs 68%; p = 0.244), adding salt at the table (34% vs 37%; p = 0.400) or regularly taking action to control salt/sodium intake (22% vs 21%; p = 0.793). There were large differences in the quantity of dietary sodium sourced from retail stores (57% vs 77%, p < 0.001), and less sodium was sourced from foods at fresh food markets (13% vs 2%; p ≤ 0.001) at follow-up. No large differences were apparent for foods with different levels of processing or for food groups. CONCLUSION There was no clear population-level effect of the 4-year multi-component Victorian Salt Reduction Intervention on sodium intake with Victorian adults continuing to consume sodium above recommended levels. The findings indicate that more intensive and sustained efforts aiming at the retail and food industry with national level support are likely to be required to achieve a measurable improvement in sodium intake at a state level.
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Affiliation(s)
- Kristy A Bolton
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Emalie Rosewarne
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Jenny Reimers
- Victorian Health Promotion Foundation (VicHealth), Melbourne, VIC, Australia
| | - Caryl Nowson
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- School of Public Health, Imperial College London, London, UK
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- School of Public Health, Imperial College London, London, UK
| | - Elizabeth Dunford
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | - Bruce Bolam
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Carley Grimes
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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Miñana G, González-Rico M, de la Espriella R, González-Sánchez D, Montomoli M, Núñez E, Fernández-Cisnal A, Villar S, Górriz JL, Núñez J. Peritoneal and Urinary Sodium Removal in Refractory Congestive Heart Failure Patients Included in an Ambulatory Peritoneal Dialysis Program: Valuable for Monitoring the Course of the Disease. Cardiorenal Med 2023; 13:211-220. [PMID: 37586337 PMCID: PMC10664341 DOI: 10.1159/000531631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/24/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Spot urinary sodium emerged as a useful parameter for assessing decongestion in patients with congestive heart failure (CHF). Growing evidence endorses the therapeutic role of continuous ambulatory peritoneal dialysis (CAPD) in patients with refractory CHF and kidney disease. We aimed to examine the long-term trajectory of urinary, peritoneal, and total (urinary plus peritoneal) sodium removal in a cohort of patients with refractory CHF enrolled in a CAPD program. Additionally, we explored whether sodium removal was associated with the risk of long-term mortality and episodes of worsening heart failure (WHF). METHODS We included 66 ambulatory patients with refractory CHF enrolled in a CAPD program in a single teaching center. 24-h peritoneal, urinary, and total sodium elimination were analyzed at baseline and after CAPD initiation. Its trajectories over time were calculated using joint modeling of longitudinal and survival data. Within the framework of joint frailty models for recurrent and terminal events, we estimated its prognostic effect on recurrent episodes of WHF. RESULTS At the time of enrollment, the mean age and estimated glomerular filtration rate were 72.8 ± 8.4 years and 28.5 ± 14.3 mL/min/1.73 m2, respectively. The median urinary sodium at baseline was 2.34 g/day (1.40-3.55). At a median (p25%-p75%) follow-up of 2.93 (1.93-3.72) years, we registered 0.28 deaths and 0.24 episodes of WHF per 1 person-year. Compared to baseline (urinary), CAPD led to increased sodium excretion (urinary plus dialyzed) since the first follow-up visit (p < 0.001). Over the follow-up, repeated measurements of total sodium removal were associated with a lower risk of death and episodes of WHF. CONCLUSIONS CAPD increased sodium removal in patients with refractory CHF. Elevated sodium removal identified those patients with a lower risk of death and episodes of WHF.
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Affiliation(s)
- Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
- Universitat de València, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Miguel González-Rico
- Nephrology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | | | - Marco Montomoli
- Nephrology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | | | - Sandra Villar
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Jose Luis Górriz
- Universitat de València, Valencia, Spain
- Nephrology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
- Universitat de València, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
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4
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Meekers E, Mullens W. Spot Urinary Sodium Measurements: the Future Direction of the Treatment and Follow-up of Patients with Heart Failure. Curr Heart Fail Rep 2023; 20:88-100. [PMID: 36807114 DOI: 10.1007/s11897-023-00591-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 02/23/2023]
Abstract
PURPOSE OF REVIEW Heart failure is characterized by episodes of congestion with need for hospitalization. The current metrics lack the accuracy to predict and prevent episodes of congestion and to guide diuretic titration to reach euvolemia in case of decompensation. This article aims to provide answers to the role of urinary sodium measurements in acute and chronic heart failure. RECENT FINDINGS In acute heart failure, urinary sodium concentrations at the moment of admission and after diuretic administration are correlated with short- and long-term outcome. As this is a reflection of the degree of sodium retention, it can be used as a guide in the diuretic titration. In chronic heart failure, it might be used to predict and consequently prevent episodes of decompensation. Urinary sodium measurements hold great promises to be a novel diagnostic and therapeutic parameter in patients with acute and chronic heart failure. However, more research is needed.
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Affiliation(s)
- Evelyne Meekers
- Hasselt University, Universiteitslaan 1, 3500, Hasselt, Belgium.
- Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Wilfried Mullens
- Hasselt University, Universiteitslaan 1, 3500, Hasselt, Belgium
- Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
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5
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Khorramshahi Bayat M, Ngo L, Mulligan A, Chan W, McKenzie S, Hay K, Ranasinghe I. The association between urinary sodium concentration (UNa) and outcomes of acute heart failure: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes 2022; 8:709-721. [PMID: 35167676 DOI: 10.1093/ehjqcco/qcac007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
AIMS Urinary sodium concentration (UNa) is a simple test advocated to assess diuretics efficacy and predict outcomes in acute heart failure (AHF). We performed a systematic review and meta-analysis to examine the association of UNa with outcomes of AHF. METHODS AND RESULTS We searched Embase and Medline for eligible studies that reported the association between UNa and outcomes of urinary output, weight loss, worsening renal function, length of hospital stay, re-hospitalization, worsening heart failure, and all-cause mortality in AHF. Nineteen observational studies out of 1592 screened records were included. For meta-analyses of outcomes, we grouped patients into high vs. low UNa, with most studies defining high UNa as >48-65 mmol/L. In the high UNa group, pooled data showed a higher urinary output (mean difference 502 mL, 95% CI 323-681, P < 0.01), greater weight loss (mean difference 1.6 kg, 95% CI 0.3-2.9, P = 0.01), and a shorter length of stay (mean difference -1.4 days, 95% CI -2.8 to -0.1, P = 0.03). There was no significant difference in worsening kidney function (OR 0.54, 95% CI 0.25-1.16, P = 0.1). Due to the small number of studies, we did not report pooled estimates for re-hospitalization and worsening heart failure. High UNa was associated with lower odds of 30-day (OR 0.27; 95% CI 0.14-0.49, P < 0.01), 90-day (OR 0.39,95% CI 0.25-0.59, P < 0.01) and 12-month (OR 0.35; 95% CI 0.20-0.61, P < 0.01) mortality. CONCLUSION High UNa after diuretic administration is associated with higher urinary output, greater weight loss, shorter length of stay, and lower odds of death. UNa is a promising marker of diuretic efficacy in AHF which should be confirmed in randomized trials.
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Affiliation(s)
- Maryam Khorramshahi Bayat
- Department of Cardiology, The Prince Charles Hospital, 627 Rode Rd, Queensland QLD 4032, Australia
- School of Clinical Medicine, The University of Queensland, Queensland QLD 4072, Australia
| | - Linh Ngo
- Department of Cardiology, The Prince Charles Hospital, 627 Rode Rd, Queensland QLD 4032, Australia
- School of Clinical Medicine, The University of Queensland, Queensland QLD 4072, Australia
- Department of Cardiovascular and Thoracic Surgery, Cardiovascular Centre, E Hospital, Hanoi, Vietnam
| | - Andrew Mulligan
- Department of Cardiology, The Prince Charles Hospital, 627 Rode Rd, Queensland QLD 4032, Australia
| | - Wandy Chan
- Department of Cardiology, The Prince Charles Hospital, 627 Rode Rd, Queensland QLD 4032, Australia
- School of Clinical Medicine, The University of Queensland, Queensland QLD 4072, Australia
| | - Scott McKenzie
- Department of Cardiology, The Prince Charles Hospital, 627 Rode Rd, Queensland QLD 4032, Australia
- School of Clinical Medicine, The University of Queensland, Queensland QLD 4072, Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, Queensland QLD 4006, Australia
| | - Isuru Ranasinghe
- Department of Cardiology, The Prince Charles Hospital, 627 Rode Rd, Queensland QLD 4032, Australia
- School of Clinical Medicine, The University of Queensland, Queensland QLD 4072, Australia
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6
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Villatoro-Santos CR, Ramirez-Zea M, Villamor E. Urinary sodium, iodine, and volume in relation to metabolic syndrome in Mesoamerican children and their parents. Nutr Metab Cardiovasc Dis 2022; 32:1774-1783. [PMID: 35637087 DOI: 10.1016/j.numecd.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 04/12/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The roles of sodium or iodine intake on the metabolic syndrome (MetS) etiology remain controversial. We evaluated the associations of 24 h urinary sodium and iodine with MetS among Mesoamerican children and their adult parents. METHODS AND RESULTS We conducted a cross-sectional study among 217 school-age children and 478 parents from 9 Mesoamerican cities. Exposures were high 24 h urinary sodium excretion and concentration (>2000 mg/d or mg/L, respectively) and high 24 h urinary iodine excretion and concentration (≥300 μg/d or μg/L, respectively). In children, the outcome was a standardized metabolic score from five criteria analogous to the Adult Treatment Panel (ATP) III criteria. In adults, MetS was defined according to the ATP III criteria. We estimated adjusted mean differences in the metabolic risk score and adjusted prevalence ratios of MetS between exposure categories using multivariable regression. In children, high sodium concentration was associated with a 0.10 units (43% of a SD) higher score (P = 0.001) and high iodine concentration was related to a 0.09 units (39% of a SD) higher score (P = 0.009). Unexpectedly, high 24 h urinary volume was associated with a lower metabolic score. In adults, high 24 h sodium excretion was related to hypertension and high iodine concentration was related to increased MetS prevalence. CONCLUSION High sodium and iodine concentrations, but not 24 h iodine excretion, are significantly associated with MetS in children, whereas high 24 h urinary volume is related to a decreased metabolic score. In adults, high iodine concentration tends to be related to increased MetS prevalence, but not 24 h iodine excretion.
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Affiliation(s)
- C R Villatoro-Santos
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - M Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - E Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
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Gholami A, Ghanbari A, Rezaei S, Baradaran HR, Khatibzadeh S, Parsaeian M, Hariri M, Zamaninour N, Sheidaei A, Abdollahi M, Mirmiran P, Ghayour-Mobarhan M, Ostovar A, Mohammadifard N, Khosravi A, Namayandeh SM, Farzadfar F. National and sub-national trends of salt intake in Iranians from 2000 to 2016: a systematic analysis. Arch Public Health 2022; 80:120. [PMID: 35418114 PMCID: PMC9006553 DOI: 10.1186/s13690-022-00871-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 03/24/2022] [Indexed: 02/08/2023] Open
Abstract
Background One fifth of the global burden of cardiovascular diseases (CVDs) in 2017 was attributable to excessive salt intake. As a member of the World Health Organization (WHO), Iran has committed itself to a 30% reduction in salt intake by 2025. Evidence on the amount and trend of salt intake among the Iranian population at national and sub-national levels is scarce. This study aimed to estimate the Iranian population’s salt intake during 2000–2016 at the national and sub-national levels, by sex and age groups. Methods Data on national and sub-national mean salt intake was obtained through systematically searching the literature and contacting the research studies’ principal investigators. Data collected through various methods were harmonized using the cross-walk method. Bayesian hierarchical and spatio-temporal-age regression models and simulation analysis were used to estimate the mean salt intake and its uncertainty interval across sex, age, year, and province. Results National age-sex standardized mean salt intake decreased from 10·53 g/day (95% uncertainty interval [UI]: 10·2 to 10·9) in 2000 to 9·41 (9·2 to 10·6) in 2016 (percent change: − 9·8% [− 21·1–3·1]). The age-standardized mean salt intake in women had decreased from 9·8 g/day (95% UI: 9·0–10·6) in 2000 to 9·1 g/day (8·6–9·7) in 2016 (percent change: − 6·6% [− 19·0–7·9]). The same measure in men was 11·1 g/day in 2000 (95% UI: 10·3–11·8) and 9·7 g/day (9·1–10·2) in 2016 (percent change: − 12·7% [− 23·0 – -0·9]). Age-sex standardized mean salt intake at the sub-national level in 2016 varied from 8·0 (95% UI: 7·0–9·0) to 10·5 (10·0–11·1). The difference between the provinces with the highest and the lowest levels of salt intake in 2016 was 31·3%. Conclusion Salt intake decreased in Iran from 2000 to 2016, while persistently exceeding the recommended values. This declining trend was more pronounced between 2010 and 2016, which might be attributed to Iran’s compliance to WHO’s Action Plan for reducing NCDs. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00871-w.
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Affiliation(s)
- Ali Gholami
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.,Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Ghanbari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahabeddin Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.,Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Shahab Khatibzadeh
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Mahboubeh Parsaeian
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Hariri
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Negar Zamaninour
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Abdollahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Ghayour-Mobarhan
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khosravi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyedeh Mahdieh Namayandeh
- Research Center of Prevention and Epidemiology of Non-Communicable Diseases, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. .,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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8
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Dauw J, Lelonek M, Zegri-Reiriz I, Paredes-Paucar CP, Zara C, George V, Cobo-Marcos M, Knappe D, Shchekochikhin D, Lekhakul A, Klincheva M, Frea S, Miró Ò, Barker D, Borbély A, Nasr S, Doghmi N, de la Espriella R, Singh JS, Bovolo V, Fialho I, Ross NT, van den Heuvel M, Benkouar R, Findeisen H, Alhaddad IA, Al Balbissi K, Barge-Caballero G, Ghazi AM, Bruckers L, Martens P, Mullens W. Rationale and Design of the Efficacy of a Standardized Diuretic Protocol in Acute Heart Failure Study. ESC Heart Fail 2021; 8:4685-4692. [PMID: 34708555 PMCID: PMC8712839 DOI: 10.1002/ehf2.13666] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 12/24/2022] Open
Abstract
Aims Although acute heart failure (AHF) with volume overload is treated with loop diuretics, their dosing and type of administration are mainly based upon expert opinion. A recent position paper from the Heart Failure Association (HFA) proposed a step‐wise pharmacologic diuretic strategy to increase the diuretic response and to achieve rapid decongestion. However, no study has evaluated this protocol prospectively. Methods and results The Efficacy of a Standardized Diuretic Protocol in Acute Heart Failure (ENACT‐HF) study is an international, multicentre, non‐randomized, open‐label, pragmatic study in AHF patients on chronic loop diuretic therapy, admitted to the hospital for intravenous loop diuretic therapy, aiming to enrol 500 patients. Inclusion criteria are as follows: at least one sign of volume overload (oedema, ascites, or pleural effusion), use ≥ 40 mg of furosemide or equivalent for >1 month, and a BNP > 250 ng/L or an N‐terminal pro‐B‐type natriuretic peptide > 1000 pg/L. The study is designed in two sequential phases. During Phase 1, all centres will treat consecutive patients according to the local standard of care. In the Phase 2 of the study, all centres will implement a standardized diuretic protocol in the next cohort of consecutive patients. The protocol is based upon the recently published HFA algorithm on diuretic use and starts with intravenous administration of two times the oral home dose. It includes early assessment of diuretic response with a spot urinary sodium measurement after 2 h and urine output after 6 h. Diuretics will be tailored further based upon these measurements. The study is powered for its primary endpoint of natriuresis after 1 day and will be able to detect a 15% difference with 80% power. Secondary endpoints are natriuresis and diuresis after 2 days, change in congestion score, change in weight, in‐hospital mortality, and length of hospitalization. Conclusions The ENACT‐HF study will investigate whether a step‐wise diuretic approach, based upon early assessment of urinary sodium and urine output as proposed by the HFA, is feasible and able to improve decongestion in AHF with volume overload.
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Affiliation(s)
- Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk, 3600, Belgium.,UHasselt-Hasselt University, Doctoral School for Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
| | - Malgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland
| | - Isabel Zegri-Reiriz
- Department of Cardiology, Heart Failure and Heart Transplant Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Marta Cobo-Marcos
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Dorit Knappe
- Centro de Investigación Biomédica en Red, Madrid, Spain.,Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Dmitry Shchekochikhin
- Department of cardiology, sonography and functional diagnostics, First Moscow State Medical University, Moscow, Russia
| | | | | | - Simone Frea
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
| | - Òscar Miró
- Emergency Department, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Diane Barker
- University Hospitals of North Midlands, Stoke on Trent, UK
| | - Attila Borbély
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Samer Nasr
- Department of Cardiology, Mount Lebanon Hospital-Balamand University Medical Center, Hazmiyeh, Lebanon
| | - Nawal Doghmi
- Department of Cardiology, CHU Ibn Sina, Mohammed V University, Rabat, Morocco
| | | | - Jagdeep S Singh
- The Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Virginia Bovolo
- Department of Cardiology, Michele e Pietro Ferrero Hospital, Verduno, Italy
| | - Inês Fialho
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Noel T Ross
- Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Mieke van den Heuvel
- Department of Cardiology, Thorax Centrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Riad Benkouar
- Benyoucef Benkhedda Faculty of Medicine, Mustapha Pacha Hospital, University of Algiers, Algiers, Algeria
| | - Hajo Findeisen
- Department of Internal Medicine, Red Cross Hospital, Bremen, Germany
| | | | | | - Gonzalo Barge-Caballero
- Complexo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Azmee M Ghazi
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,National Heart Institute, Kuala Lumpur, Malaysia
| | - Liesbeth Bruckers
- I-BioStat, Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk, 3600, Belgium
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk, 3600, Belgium.,Faculty of Medicine and Life Sciences, LCRC, UHasselt, Biomedical Research Institute, Diepenbeek, Belgium
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9
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Civera J, de la Espriella R, Heredia R, Miñana G, Santas E, Conesa A, Mollar A, Sastre C, Martínez A, Villaescusa A, Núñez J. Efficacy and Safety of Subcutaneous Infusion of Non-formulated Furosemide in Patients with Worsening Heart Failure: a Real-World Study. J Cardiovasc Transl Res 2021; 15:644-652. [PMID: 34642870 PMCID: PMC9213343 DOI: 10.1007/s12265-021-10173-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022]
Abstract
We aimed to evaluate the efficacy (short-term changes in surrogates of decongestion) and safety following the ambulatory administration of subcutaneous furosemide (SCF) in patients with WHF. Fifty-five ambulatory patients were treated with SCF administered by an elastomeric pump for at least 72 h. Surrogates of congestion were assessed at baseline, 72 h, and 30 days. Spot urinary sodium (uNa+) was assessed at baseline, 24-48-72 h, and 30 days. The median (IQI) of NT-proBNP and uNa+ at baseline was 5218 pg/mL (2856-10878) and 68±3 mmol/L, respectively. Following administration of SCF (median dose of 100 mg/daily), we found a sustained increase in uNa+ during the first 72 h of treatment compared to baseline, paralleled with evidence of decongestion at 72 h, and 30 days. No significant safety concerns were observed. SCF was an effective and safe diuretic strategy for outpatient congestion management.
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Affiliation(s)
- Jose Civera
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Raquel Heredia
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Adriana Conesa
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Clara Sastre
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Ana Martínez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Amparo Villaescusa
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain. .,Departamento de Medicina, Universitat de València, Valencia, Spain. .,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain.
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10
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Hu J, Wang Y, Chen J, Shen Z, Song N, Zhao S, Li Y, Zou J, Zhang X, Ding X. Rationale and validation of predicting high sodium intake by spot urinary chloride in patients with chronic kidney disease. Clin Nutr ESPEN 2021; 45:284-291. [PMID: 34620330 DOI: 10.1016/j.clnesp.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/30/2021] [Accepted: 08/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze the rationale and evaluate the validity of spot urinary chloride or derived formulas to predict high sodium intake in patients with chronic kidney disease (CKD). METHODS We collected consecutive CKD patients at stages 1-4 who were admitted to our Nephrology department in a single center from January 01, 2014, to December 31, 2017, and tested spot and 24-hour urinary analysis on the same day. The feasibility of urinary chloride to predict urinary sodium was firstly analyzed by calculating their correlations. The validity of predicting excessive sodium intake by spot urinary sodium and chloride, two derived formulas based on spot urinary sodium or chloride, and our previous "CKDSALT" equation were accessed. We finally conducted Receiver operating characteristic (ROC) curves to compare their performance in detecting high sodium intake. RESULTS All 5204 patients were eventually analyzed. In the derivation cohort (n = 2447), a strong positive linear correlation existed between urinary sodium and chloride in both spot urine (R2 = 0.804) and 24-hour urine samples (R2 = 0.905), and two predictive equations based on spot urinary sodium or chloride were derived. In the validation cohort (n = 2757), spot urinary sodium and chloride only showed "fair" performance. However, both urinary sodium and chloride equations had a "good" performance in ICC, Pearson's correlation, Bland-Altman plots, and ROC curves, while and CKDSALT equation showed the best performance. CONCLUSIONS Spot urinary chloride is a feasible method to predict and monitor high sodium intake in CKD patients, while a novel derived formula could elevate its diagnostic accuracy.
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Affiliation(s)
- Jiachang Hu
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Medical Center of Kidney, Shanghai 200032, China; Shanghai Institute of Kidney and Dialysis, Shanghai 200032, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai 200032, China; Hemodialysis Quality Control Center of Shanghai, Shanghai 200032, China
| | - Yimei Wang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Medical Center of Kidney, Shanghai 200032, China; Shanghai Institute of Kidney and Dialysis, Shanghai 200032, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai 200032, China; Hemodialysis Quality Control Center of Shanghai, Shanghai 200032, China
| | - Jing Chen
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Medical Center of Kidney, Shanghai 200032, China; Shanghai Institute of Kidney and Dialysis, Shanghai 200032, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai 200032, China; Hemodialysis Quality Control Center of Shanghai, Shanghai 200032, China
| | - Ziyan Shen
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Medical Center of Kidney, Shanghai 200032, China; Shanghai Institute of Kidney and Dialysis, Shanghai 200032, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai 200032, China; Hemodialysis Quality Control Center of Shanghai, Shanghai 200032, China
| | - Nana Song
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Medical Center of Kidney, Shanghai 200032, China; Shanghai Institute of Kidney and Dialysis, Shanghai 200032, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai 200032, China; Hemodialysis Quality Control Center of Shanghai, Shanghai 200032, China
| | - Shuan Zhao
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Medical Center of Kidney, Shanghai 200032, China; Shanghai Institute of Kidney and Dialysis, Shanghai 200032, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai 200032, China; Hemodialysis Quality Control Center of Shanghai, Shanghai 200032, China
| | - Yang Li
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Medical Center of Kidney, Shanghai 200032, China; Shanghai Institute of Kidney and Dialysis, Shanghai 200032, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai 200032, China; Hemodialysis Quality Control Center of Shanghai, Shanghai 200032, China
| | - Jianzhou Zou
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Medical Center of Kidney, Shanghai 200032, China; Shanghai Institute of Kidney and Dialysis, Shanghai 200032, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai 200032, China; Hemodialysis Quality Control Center of Shanghai, Shanghai 200032, China
| | - Xiaoyan Zhang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Medical Center of Kidney, Shanghai 200032, China; Shanghai Institute of Kidney and Dialysis, Shanghai 200032, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai 200032, China; Hemodialysis Quality Control Center of Shanghai, Shanghai 200032, China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Medical Center of Kidney, Shanghai 200032, China; Shanghai Institute of Kidney and Dialysis, Shanghai 200032, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai 200032, China; Hemodialysis Quality Control Center of Shanghai, Shanghai 200032, China.
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11
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Feng Q, Wong SH, Zheng J, Yang Q, Sung JJ, Tsoi KK. Intake of processed meat, but not sodium, is associated with risk of colorectal cancer: Evidence from a large prospective cohort and two-sample Mendelian randomization. Clin Nutr 2021; 40:4551-4559. [PMID: 34229259 DOI: 10.1016/j.clnu.2021.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/13/2021] [Accepted: 05/31/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Processed meat and high sodium intake are common in Western diet. The objective was to examine their independent effects on the risk of colorectal cancer (CRC). METHODS We performed both observational analysis with UK Biobank and genetic analysis with Mendelian randomization (MR). The 24-h urinary sodium (UNa) and reported intake of processed meat were fitted on incident CRC by multivariable Cox proportional hazard model, adjusted for covariates, such as age, gender, family history, etc. Different sodium measures were used for sensitivity analyses. Two-sample MR analyses were performed using summary data from genome-wide association studies of UNa and CRC. Multivariable MR was adjusted for body mass index. RESULTS We included 415 524 eligible participants from UK Biobank. During a median follow-up of 11.1 years, 2663 participants were diagnosed with CRC. High intake of processed meat independently increased risk of CRC by 23% (HR 1.23; 95% CI: 1.03 to 1.46), but 24-h UNa was not significantly associated with CRC (HR 0.96; 95% CI: 0.87 to 1.06). Furthermore, MR also showed little evidence for the effect of UNa on CRC (OR 1.02; 95% CI: 0.11 to 9.42). Sensitivity analyses showed consistent results across different measurements of sodium intake. CONCLUSIONS Intake of processed meat had an independent effect on the risk of CRC, but the risk was not associated with sodium level. Reduction of processed meat intake may be an effective strategy for CRC prevention, while sodium reduction should still be recommended to achieve other health benefits.
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Affiliation(s)
- Qi Feng
- Division of Epidemiology, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Sunny H Wong
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jie Zheng
- MRC Integrative Epidemiology Unit, Bristol Population Health Science Institute, The University of Bristol, United Kingdom
| | - Qian Yang
- MRC Integrative Epidemiology Unit, Bristol Population Health Science Institute, The University of Bristol, United Kingdom
| | - Joseph Jy Sung
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kelvin Kf Tsoi
- Division of Epidemiology, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; SH Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, China.
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12
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Ambak R, He FJ, Othman F, Michael V, Mohd Yusoff MF, Aris T. Salt intake was higher among males and those with high BMI and waist circumference: introduction to the Malaysian Community Salt Survey (MyCoSS), a population-based salt intake survey in Malaysia. J Health Popul Nutr 2021; 40:23. [PMID: 34059145 PMCID: PMC8165995 DOI: 10.1186/s41043-021-00229-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Recognising that excessive dietary salt intake is associated with high blood pressure and adverse cardiovascular health, the Ministry of Health Malaysia conducted the Malaysian Community Salt Survey (MyCoSS) among Malaysian adults. This paper introduced MyCoSS projects and presented findings on the salt intake of the Malaysian adult population. METHODS MyCoSS was a nationally representative survey, designed to provide valuable data on dietary salt intake, sources of salt in the diet, and knowledge, perception, and practice about salt among Malaysian adults. It was a cross-sectional household survey, covering Malaysian citizens of 18 years old and above. Multi-stage-stratified sampling was used to warrant national representativeness. Sample size was calculated on all objectives studied, and the biggest sample size was derived from the knowledge on the effect of high salt on health (1300 participants). Salt intake was estimated using a single 24-h urine collection and its sources from a food frequency questionnaire. Knowledge, attitude, and practice were determined from a pre-tested questionnaire. All questionnaires were fully administered by trained interviewers using mobile devices. Anthropometric indices (weight, height, and waist circumference) and blood pressure were measured using a standardised protocol. Ethical approvals were obtained from the Medical Research Ethics Committee, Ministry of Health Malaysia, and Queen Mary University of London prior to conducting the survey. RESULTS Findings showed that the average sodium intake of Malaysian adults (3167 mg/day) was higher than the WHO recommendation of 2000 mg/day. Daily intake was significantly higher among males and individuals with higher BMI and higher waist circumference. CONCLUSION Salt intake in the Malaysian population was higher than the WHO recommendation. MyCoSS's findings will be used for the development and implementation of national salt reduction policy. A successful implementation of a national salt reduction programme in Malaysia will benefit the whole population.
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Affiliation(s)
- Rashidah Ambak
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Fatimah Othman
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Viola Michael
- Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | | | - Tahir Aris
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
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13
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Wang Z, Li N, Heizhati M, Wang L, Li M, Pan F, Yang Z, Abudureyimu R, Hong J, Sun L, Li J, Li W. Association between 24-h urinary sodium to potassium ratio and mild cognitive impairment in community-based general population. Public Health Nutr 2021;:1-10. [PMID: 33821782 DOI: 10.1017/S1368980021001452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To explore the relationship between parameters of Na and K excretion using 24-h urine sample and mild cognitive impairment (MCI) in general population. DESIGN This is a cross-sectional study. SETTING Community-based general population in Emin China. PARTICIPANTS Totally, 1147 subjects aged ≥18 years were selected to complete the study, with a multistage proportional random sampling method. Cognitive status was assessed with Mini Mental State Examination (MMSE) questionnaire and timed 24-h urine specimens were collected. Finally, 561 participants aged ≥35 years with complete urine sample and MMSE data were included for the current analysis and divided into groups by tertiles of 24-h urinary sodium to potassium ratio (24-h UNa/K) as lowest (T1), middle (T2) and highest (T3) groups. RESULTS The MMSE score was significantly lower in T3, compared with the T1 group (26·0 v. 25·0, P = 0·002), and the prevalent MCI was significantly higher in T3 than in T1 group (11·7 % v. 25·8 %, P < 0·001). In multiple linear regression, 24-UNa/K (β: -0·184, 95 % CI -0·319, -0·050, P = 0·007) was negatively associated with MMSE score. In multivariable logistic regression, compared with T1 group, 24-h UNa/K in the T2 and T3 groups showed 2·01 (95 % CI 1·03, 3·93, P = 0·041) and 3·38 (95 % CI 1·77, 6·44, P < 0·001) fold odds for presence of MCI, even after adjustment for confounders. More augmented results were demonstrated in sensitivity analysis by excluding individuals taking anti-hypertensive agents. CONCLUSIONS Higher 24-h UNa/K is in an independent association with prevalent MCI.
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14
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James S, Tyrrell-Price J, Atkinson C, Hunt L, Searle A, Phillips K, Penfold C, Carter J, Ness A. Evaluation of urinary chloride dipsticks for the rapid estimation of hydration status in patients receiving artificial nutrition: Feasibility study. Clin Nutr ESPEN 2021; 42:339-347. [PMID: 33745603 DOI: 10.1016/j.clnesp.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS The home parenteral nutrition (HPN) population face many challenges, especially with respect to fluid balance management. A low urinary sodium concentration of <20 mmol/L is commonly used as an indicator of dehydration that requires clinical assessment in these patients. The Quantab titrator dipstick measures chloride concentration of a solution and correlates with sodium concentration. We assessed whether it would be feasible to use the Quantab dipstick in the HPN population and explored relationships between Quantab dipstick estimated chloride concentration and quality of life (QOL). METHODS Patients on HPN were asked to collect urine samples at 5 specific times points (day 0,7,14, 21 and 28) to send to the laboratory for formal electrolyte analysis. The participant and a member of laboratory staff tested these samples with the Quantab dipstick to estimate urinary chloride concentration. Participants were instructed to complete a QOL questionnaire at each of the 5 time-points in addition to a baseline demographic questionnaire and an end-of-study questionnaire. Six participants completed an interview at the end of the study period. The relationship between participant-derived and laboratory-derived data was assessed using rank correlation coefficients. QOL assessment was correlated with urine dipstick measurements. RESULTS 10 patients on HPN completed the study. Data on chloride concentration as estimated by the dipstick (assessed by participants and by the laboratory) and sodium concentration from the laboratory were available for 47 urine samples. There was a positive relationship between participant dipstick estimated chloride concentration and laboratory sodium (Kendall's τ = 0.45; P < 0.001; Spearman's rs = 0.58 P < 0.001; 47 pairs). There was a strong correlation between chloride concentrations estimated by dipstick in the laboratory and by participants (Kendall 0.58 p < 0.001, Spearman's 0.69 p < 0.001; 47 pairs). In exploratory analyses, there was no relationship between QOL and dipstick estimated chloride concentration. Participants had no issues collecting urine samples but some difficulties were reported with determining the dipstick reading. CONCLUSIONS Patients on HPN are able to collect urine specimens, complete QOL questionnaires, and are capable of using the Quantab dipstick to estimate urinary chloride concentration. The Quantab dipstick correlates with laboratory measured sodium and chloride concentrations. Further work is required to fully establish whether this point-of-care test could be used to guide fluid balance management in the HPN population.
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Affiliation(s)
- S James
- Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - J Tyrrell-Price
- Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - C Atkinson
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - L Hunt
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - A Searle
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - K Phillips
- Department of Biochemistry, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - C Penfold
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - J Carter
- Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - A Ness
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
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15
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Tersalvi G, Dauw J, Gasperetti A, Winterton D, Cioffi GM, Scopigni F, Pedrazzini G, Mullens W. The value of urinary sodium assessment in acute heart failure. Eur Heart J Acute Cardiovasc Care 2020; 10:216-223. [PMID: 33620424 DOI: 10.1093/ehjacc/zuaa006] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/09/2020] [Accepted: 07/22/2020] [Indexed: 01/27/2023]
Abstract
Acute heart failure (AHF) is a frequent medical condition that needs immediate evaluation and appropriate treatment. Patients with signs and symptoms of volume overload mostly require intravenous loop diuretics in the first hours of hospitalization. Some patients may develop diuretic resistance, resulting in insufficient and delayed decongestion, with increased mortality and morbidity. Urinary sodium measurement at baseline and/or during treatment has been proposed as a useful parameter to tailor diuretic therapy in these patients. This systematic review discusses the current sum of evidence regarding urinary sodium assessment to evaluate diuretic efficacy in AHF. We searched Medline, Embase, and Cochrane Clinical Trials Register for published studies that tested urinary sodium assessment in patients with AHF.
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Affiliation(s)
- Gregorio Tersalvi
- Department of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland.,Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | | | - Dario Winterton
- Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy
| | - Giacomo Maria Cioffi
- Department of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland.,Department of Cardiology, Kantonsspital Luzern, Lucerne, Switzerland
| | - Francesca Scopigni
- Department of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland
| | - Giovanni Pedrazzini
- Department of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland.,Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium
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16
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Miñana G, Llàcer P, Sanchis I, García-Blas S, Bonanad C, Ventura S, Sánchez R, de la Espriella R, Bodi V, Fácila L, Mollar A, Sanchís J, Bayés-Genís A, Chorro FJ, Núñez J. Early Spot Urinary Sodium and Diuretic Efficiency in Acute Heart Failure and Concomitant Renal Dysfunction. Cardiorenal Med 2020; 10:362-372. [PMID: 32721973 DOI: 10.1159/000508178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/22/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE In acute heart failure (AHF), early assessment of spot urinary sodium (UNa) has emerged as a useful biomarker for risk stratification and monitoring. The objective of this study was to investigate (a) whether early spot UNa predicts 24-h diuretic efficiency and (b) the clinical factors associated with early spot UNa in patients with AHF and concomitant renal dysfunction (RD). METHODS This is a post hoc analysis of the IMPROVE-HF trial, in which 160 patients with AHF and RD (estimated glomerular filtrate rate [eGFR] <60 mL/min/1.73 m2) were included. Diuretic efficiency was calculated as the net fluid output produced per 40 mg of furosemide equivalents in 24 h. The association between early spot UNa and diuretic efficiency and clinical variables associated with UNa were evaluated using multivariate linear regression analysis. The contribution of the exposures in the predictability of the models was assessed with the coefficient of determination (R2). RESULTS The mean age of the study population was 78 ± 8 years. The median (interquartile range) diuretic efficiency, early spot UNa, aminoterminal pro-brain natriuretic peptide, and eGFR were 747 (490-1,167) mL, 90 mmol/L (65-111), 7,765 pg/mL (3,526-15,369), and 33.7 ± 11.3 mL/min/1.73 m2, respectively. In a multivariate setting, lower UNa was significantly and nonlinearly associated with lower diuretic efficiency (p = 0.001), explaining the 44.4% of the model predictability. Natremia and surrogates of congestion emerged as the main factors related to UNa. CONCLUSIONS In patients with AHF and RD at presentation, early spot UNa was inversely related to 24-h diuretic efficiency.
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Affiliation(s)
- Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Pau Llàcer
- Internal Medicine Department, Hospital de Manises, Manises, Spain
| | - Ignacio Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Sergio García-Blas
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Clara Bonanad
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Silvia Ventura
- Internal Medicine Department, Hospital de La Plana, Villa-Real, Spain
| | - Ruth Sánchez
- Internal Medicine Department, Hospital Virgen de Los Lirios, Alcoy, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Vicent Bodi
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Lorenzo Fácila
- Cardiology Department, Hospital General Universitario de Valencia, Valencia, Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Juan Sanchís
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Antoni Bayés-Genís
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Francisco J Chorro
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain, .,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain,
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Damman K, Ter Maaten JM, Coster JE, Krikken JA, van Deursen VM, Krijnen HK, Hofman M, Nieuwland W, van Veldhuisen DJ, Voors AA, van der Meer P. Clinical importance of urinary sodium excretion in acute heart failure. Eur J Heart Fail 2020; 22:1438-1447. [PMID: 32086996 PMCID: PMC7540361 DOI: 10.1002/ejhf.1753] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/22/2019] [Accepted: 01/12/2020] [Indexed: 12/11/2022] Open
Abstract
Aims Urinary sodium assessment has recently been proposed as a target for loop diuretic therapy in acute heart failure (AHF). We aimed to investigate the time course, clinical correlates and prognostic importance of urinary sodium excretion in AHF. Methods and results In a prospective cohort of 175 consecutive patients with an admission for AHF we evaluated urinary sodium excretion 6 h after initiation of loop diuretic therapy. Clinical outcome was all‐cause mortality or heart failure rehospitalization. Mean age was 71 ± 14 years, and 44% were female. Median urinary sodium excretion was 130 (67–229) mmol at 6 h, 347 (211–526) mmol at 24 h, and decreased from day 2 to day 4. Lower urinary sodium excretion was independently associated with male gender, younger age, renal dysfunction and pre‐admission loop diuretic use. There was a strong association between urinary sodium excretion at 6 h and 24 h urine volume (beta = 0.702, P < 0.001). Urinary sodium excretion after 6 h was a strong predictor of all‐cause mortality after a median follow‐up of 257 days (hazard ratio 3.81, 95% confidence interval 1.92–7.57; P < 0.001 for the lowest vs. the highest tertile of urinary sodium excretion) independent of established risk factors and urinary volume. Urinary sodium excretion was not associated with heart failure rehospitalization. Conclusion In a modern, unselected, contemporary AHF population, low urinary sodium excretion during the first 6 h after initiation of loop diuretic therapy is associated with lower urine output in the first day and independently associated with all‐cause mortality.
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Affiliation(s)
- Kevin Damman
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jozine M Ter Maaten
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jenifer E Coster
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan A Krikken
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Vincent M van Deursen
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Hidde K Krijnen
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Mischa Hofman
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Wybe Nieuwland
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Dirk J van Veldhuisen
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter van der Meer
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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18
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Payne Riches S, Piernas C, Aveyard P, Sheppard JP, Rayner M, Jebb SA. The Salt Swap intervention to reduce salt intake in people with high blood pressure: protocol for a feasibility randomised controlled trial. Trials 2019; 20:584. [PMID: 31604477 PMCID: PMC6787994 DOI: 10.1186/s13063-019-3691-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/30/2019] [Indexed: 11/15/2022] Open
Abstract
Background High salt intake is a risk factor for hypertension and cardiovascular disease. Reducing salt intake has been shown to reduce blood pressure. Despite population-level interventions, including product reformulation and public awareness campaigns, adult salt consumption in the UK still exceeds recommendations; this is primarily due to salt consumed in processed and pre-packaged foods. Moderate or high-intensity dietary advice to encourage individuals to reduce their salt intake has been shown to be effective at reducing blood pressure, but evidence of the effectiveness of interventions that are suitable for delivery at scale in routine primary care is scarce. This feasibility trial investigates a complex behavioural change intervention to reduce dietary salt intake and blood pressure by encouraging individuals to purchase lower-salt foods when grocery shopping. Methods This randomised controlled trial will test the feasibility of a novel intervention to reduce salt intake, and the trial procedures to assess its effectiveness. We will recruit participants through UK general practices and randomise 40 participants with high blood pressure, in a 2:1 allocation to receive either the Salt Swap intervention or a control information leaflet. The primary outcomes relate to the criteria for progression to a large-scale trial. These include follow-up rates at 6 weeks, fidelity of intervention delivery and use of the intervention mobile app. Secondary outcomes include the effect of the intervention on the salt content of purchased foods (grams per 100 g), urinary sodium excretion assessed through 24-hour urine samples and blood pressure. Trial process measures will be collected and qualitative assessment will provide insights into participant engagement with the intervention content and perceived barriers to and facilitators of salt reduction dietary behavioural change. Discussion If the outcomes indicate the trial is feasible and there is evidence that behavioural change may result in salt reduction, we will proceed to a definitive trial to test the effectiveness of the intervention to lower blood pressure. If successful, this intervention approach could be applied not only to people with high blood pressure, but also to the wider population with normal blood pressure in whom dietary salt intake exceeds recommendations. Trial registration ISRCTN, 20910962. Registered on 5 April 2017.
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Affiliation(s)
- Sarah Payne Riches
- Nuffield Department of Primary Care Health Sciences, University of Oxford Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Carmen Piernas
- Nuffield Department of Primary Care Health Sciences, University of Oxford Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - James P Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Mike Rayner
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Headington, Oxford, OX3 7LF, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
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19
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Hamilton FW, Penfold CM, Ness AR, Stevenson KP, Atkinson C, Day AM, Sebepos-Rogers GM, Tyrrell-Price J. Can Quantab titrator sticks reliably predict urinary sodium? Clin Nutr ESPEN 2018; 23:217-221. [PMID: 29460802 DOI: 10.1016/j.clnesp.2017.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 06/09/2017] [Accepted: 09/26/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Urinary sodium concentration is a commonly used marker for extracellular fluid depletion which is often associated with dehydration. A point of care test for urinary sodium may reduce delays in clinical decision making by offering more timely guidance leading to improved salt and fluid management. We compared laboratory assessed urinary sodium with a potential point of care measure of urinary chloride in a variety of in- and outpatient specialities, to explore its use as an indicator of low urine sodium. METHODS Urinary chloride concentrations were estimated using a Quantab titrator stick in samples from patients that had been sent for urinary sodium assays. We validated the results of this titrator stick with laboratory-assessed sodium concentrations by deriving correlation coefficients between these methods and using limits of agreement testing. We determined the optimal titrator stick cut-point for identifying low urinary sodium (urinary sodium <20 mmol/L) by maximising the product of the sensitivity and specificity. This level of urinary sodium was used to mirror the British Society of Gastroenterology guidance on short bowel patients Nightingale and Woodward, 2006. RESULTS We obtained laboratory urinary sodium concentration and Quantab stick chloride measures on 127 samples. Twenty three percent had a urinary sodium below 20 mmol/L so were regarded as biochemically dehydrated. A threshold of <4.3 on the Quantab scale had a positive predictive value for low sodium of 56% (95%CI 40%-71%) and a negative predictive value of 94% (95%CI 87%-98%). CONCLUSIONS These data suggest that the Quantab stick could be used as a point of care test to aid fluid and salt management decisions in an outpatient setting. Further work to explore the use of the titrator stick in specific patient populations at risk of salt and water depletion is justified.
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Affiliation(s)
| | - Chris M Penfold
- National Institute for Health Research (NIHR), Biomedical Research Centre Nutrition Theme, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK; School of Oral and Dental Sciences, University of Bristol, Bristol, UK.
| | - Andrew R Ness
- National Institute for Health Research (NIHR), Biomedical Research Centre Nutrition Theme, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK; School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Kirsty P Stevenson
- Department of Biochemistry, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Charlotte Atkinson
- National Institute for Health Research (NIHR), Biomedical Research Centre Nutrition Theme, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK; School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Andrew M Day
- Department of Biochemistry, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Jonathan Tyrrell-Price
- Department of Gastroenterology and Nutrition, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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20
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Nowson C, Lim K, Land MA, Webster J, Shaw JE, Chalmers J, Flood V, Woodward M, Grimes C. Salt intake and dietary sources of salt on weekdays and weekend days in Australian adults. Public Health Nutr 2018; 21:2174-82. [PMID: 29388516 DOI: 10.1017/S1368980017004104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess if there is a difference in salt intake (24 h urine collection and dietary recall) and dietary sources of salt (Na) on weekdays and weekend days. DESIGN A cross-sectional study of adults who provided one 24 h urine collection and one telephone-administered 24 h dietary recall. SETTING Community-dwelling adults living in the State of Victoria, Australia. SUBJECTS Adults (n 598) who participated in a health survey (53·5 % women; mean age 57·1 (95 % CI 56·2, 58·1) years). RESULTS Mean (95 % CI) salt intake (dietary recall) was 6·8 (6·6, 7·1) g/d and 24 h urinary salt excretion was 8·1 (7·8, 8·3) g/d. Mean dietary and 24 h urinary salt (age-adjusted) were 0·9 (0·1, 1·6) g/d (P=0·024) and 0·8 (0·3, 1·6) g/d (P=0·0017), respectively, higher at weekends compared with weekdays. There was an indication of a greater energy intake at weekends (+0·6 (0·02, 1·2) MJ/d, P=0·06), but no difference in Na density (weekday: 291 (279, 304) mg/MJ; weekend: 304 (281, 327) mg/MJ; P=0·360). Cereals/cereal products and dishes, meat, poultry, milk products and gravy/sauces accounted for 71 % of dietary Na. CONCLUSIONS Mean salt intake (24 h urine collection) was more than 60 % above the recommended level of 5 g salt/d and 8-14 % more salt was consumed at weekends than on weekdays. Substantial reductions in the Na content of staple foods, processed meat, sauces, mixed dishes (e.g. pasta), convenience and takeaway foods are required to achieve a significant consistent reduction in population salt intake throughout the week.
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21
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Zazzeron L, Ottolina D, Scotti E, Ferrari M, Bruzzone P, Sibilla S, Marenghi C, Gattinoni L, Caironi P. Real-time urinary electrolyte monitoring after furosemide administration in surgical ICU patients with normal renal function. Ann Intensive Care 2016; 6:72. [PMID: 27447787 PMCID: PMC4958084 DOI: 10.1186/s13613-016-0168-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/28/2016] [Indexed: 11/29/2022] Open
Abstract
Background Although the loop-diuretic furosemide is widely employed in critically ill patients with known long-term effects on plasma electrolytes, accurate data describing its acute effects on renal electrolyte handling and the generation of plasma electrolyte alterations are lacking. We hypothesized that the long-term effects of furosemide on plasma electrolytes and acid–base depend on its immediate effects on electrolyte excretion rate and patient clinical baseline characteristics. By monitoring urinary electrolytes quasi-continuously, we aimed to verify this hypothesis in a cohort of surgical ICU patients with normal renal function. Methods We retrospectively enrolled 39 consecutive patients admitted to a postoperative ICU after major surgery, and receiving single low-dose intravenous administration of furosemide. Urinary output, pH, sodium [Na+], potassium [K+], chloride [Cl−] and ammonium [NH4+] concentrations were measured every 10 min for three to 8 h. Urinary anion gap (AG), electrolyte excretion rate, fractional excretion (Fe) and time constant of urinary [Na+] variation (τNa+) were calculated. Results Ten minutes after furosemide administration (12 ± 5 mg), urinary [Na+] and [Cl−], and their excretion rates, increased to similar levels (P < 0.001). After the first hour, urinary [Cl−] decreased less rapidly than [Na+], leading to a reduction in urinary AG and pH and an increment in urinary [NH4+] (P < 0.001). Median urinary [Cl−] over the first 3-h period was higher than baseline urinary and plasmatic [Cl−] (P < 0.001). During the first 2 h, difference between FeCl− and FeNa+ increased (P < 0.05). Baseline higher values of central venous pressure and FeNa+ were associated with greater increases in FeNa+ after furosemide (P = 0.03 and P = 0.007), whereas higher values of mean arterial and central venous pressures were associated with a longer τNa+ (P < 0.05). In patients receiving multiple administrations (n = 11), arterial pH, base excess and strong ion difference increased, due to a decrease in plasmatic [Cl−]. Conclusions Low-dose furosemide administration immediately modifies urinary electrolyte excretion rates, likely in relation to the ongoing proximal tubular activity, unveiled by its inhibitory action on Henle’s loop. Such effects, when cumulative, found the bases for the long-term alterations observed. Real-time urinary electrolyte monitoring may help in tailoring patient diuretic and hemodynamic therapies. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0168-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luca Zazzeron
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy
| | - Davide Ottolina
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy
| | - Eleonora Scotti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy
| | - Michele Ferrari
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy
| | - Paola Bruzzone
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvio Sibilla
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Marenghi
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Luciano Gattinoni
- Department of Anesthesiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Pietro Caironi
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy. .,Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
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22
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Kelly C, Geaney F, Fitzgerald AP, Browne GM, Perry IJ. Validation of diet and urinary excretion derived estimates of sodium excretion against 24-h urine excretion in a worksite sample. Nutr Metab Cardiovasc Dis 2015; 25:771-779. [PMID: 26044517 DOI: 10.1016/j.numecd.2015.04.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS To validate diet and urinary excretion derived estimates of sodium intake against those derived from 24-h urine collections in an Irish manufacturing workplace sample. METHODS AND RESULTS We have compared daily sodium (Na) excretion from PABA validated 24-h urine collections with estimated daily sodium excretion derived from the following methods: a standard Food Frequency Questionnaire (FFQ), a modified 24-h dietary recall method, arithmetic extrapolations from morning and evening spot urine samples, predicted sodium excretion from morning and evening spot urine samples using Tanaka's, Kawasaki's and the INTERSALT formula. All were assessed using mean differences (SD), Bland-Altman plots, correlation coefficients and ROC Area under the Curve (AUC) for a cut off of ≥100 mmol of Na/day. The Food Choice at Work study recruited 802 participants aged 18-64 years, 50 of whom formed the validation sample. The mean measured 24-h urinary sodium (gold standard) was 138 mmol/day (8.1 g salt). At the group level, mean differences were small for both dietary methods and for the arithmetic extrapolations from morning urine samples. The Tanaka, Kawasaki and INTERSALT methods provided biased estimates of 24-h urinary sodium. R(2) values for all methods ranged from 0.1 to 0.48 and AUC findings from 0.57 to 0.76. CONCLUSION Neither dietary nor spot urine sample methods provide adequate validity in the estimation of 24-h urinary sodium at the individual level. However, group mean errors from dietary methods are small and random and compare favourably with those from spot urine samples in this population.
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Affiliation(s)
- C Kelly
- Department of Epidemiology and Public Health, University College Cork, Ireland.
| | - F Geaney
- Department of Epidemiology and Public Health, University College Cork, Ireland.
| | - A P Fitzgerald
- Department of Epidemiology and Public Health, University College Cork, Ireland.
| | - G M Browne
- Department of Epidemiology and Public Health, University College Cork, Ireland.
| | - I J Perry
- Department of Epidemiology and Public Health, University College Cork, Ireland.
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23
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Ji C, Miller MA, Venezia A, Strazzullo P, Cappuccio FP. Comparisons of spot vs 24-h urine samples for estimating population salt intake: validation study in two independent samples of adults in Britain and Italy. Nutr Metab Cardiovasc Dis 2014; 24:140-147. [PMID: 24119990 DOI: 10.1016/j.numecd.2013.06.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 06/25/2013] [Accepted: 06/27/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To assess the reliability and reproducibility of estimations of group mean 24-h urinary sodium (Na) excretion through timed spot urines compared to 24 h urinary Na output in two independent cross-sectional population samples including men and women and different ethnic groups. METHODS AND RESULTS Study 1 was carried out in Britain and included 915 untreated 40-59 yrs male and female participants (297 white, 326 of black African origin and 292 South Asian). Study 2 was carried out in Italy and included 148 white men (mean age 58.3 yrs). All participants provided both a 24-h urine collection and a timed urine sample as part of population surveys. Na, creatinine (Cr) and volume (V) were measured in all samples. Age, body mass index (BMI) and blood pressure (BP) were also measured. We compared the daily Na excretion through 24-h urine (gold standard) with its estimate from timed urine samples with two methods: Tanaka's predictions and Arithmetic extrapolations, and assessed them with correlation coefficients, Bland-Altman plot, prediction of quintile position and Receiver Operating Characteristic (ROC) Areas Under the Curve (AUC) for a cut-off of <100 mmol of Na/day. In Study 1 (discovery study) with the Tanaka method there were poor correlations between predicted and measured 24-h Na excretions in different ethnic groups and genders (r Spearman from 0.055 [R(2) = 0.003] in black women to 0.330 [R(2) = 0.11] in white women). The Bland-Altman plots indicated consistent bias with overestimate for low and underestimate for high intakes. ROC AUCs varied from 0.521 to 0.652 with good sensitivity (95-100%) but very poor specificity (0-9%). With the Arithmetic extrapolations correlations varied from 0.116 [R(2) = 0.01] to 0.367 [R(2) = 0.13]. Bias was detected with both Bland-Altman plots and through quintile analyses (underestimate at low levels and overestimate at high levels). Finally, ROC AUCs varied from 0.514 to 0.640 with moderate sensitivity (64-70%) but low specificity (20-53%). In Study 2 (validation study) results were consistent with the discovery phase in white men. CONCLUSION Based on these results, 24-h urinary collection for the measurement of Na excretion remains the preferred tool for assessing salt intake when compared with reported methods based on timed spot urine samples.
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Affiliation(s)
- C Ji
- University of Warwick, W.H.O. Collaborating Centre for Nutrition, Warwick Medical School, Division of Mental Health & Wellbeing, Coventry, UK
| | - M A Miller
- University of Warwick, W.H.O. Collaborating Centre for Nutrition, Warwick Medical School, Division of Mental Health & Wellbeing, Coventry, UK
| | - A Venezia
- Department of Clinical & Experimental Medicine, Federico II University of Naples, Naples, Italy
| | - P Strazzullo
- Department of Clinical & Experimental Medicine, Federico II University of Naples, Naples, Italy
| | - F P Cappuccio
- University of Warwick, W.H.O. Collaborating Centre for Nutrition, Warwick Medical School, Division of Mental Health & Wellbeing, Coventry, UK.
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El-Bokl MA, Senousy BE, El-Karmouty KZ, Mohammed IEK, Mohammed SM, Shabana SS, Shalaby H. Spot urinary sodium for assessing dietary sodium restriction in cirrhotic ascites. World J Gastroenterol 2009; 15:3631-5. [PMID: 19653340 PMCID: PMC2721236 DOI: 10.3748/wjg.15.3631] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the accuracy of spot urinary Na/K and Na/creatinine (Cr) ratios as an alternative to 24-h urinary sodium in monitoring dietary compliance in patients with liver cirrhosis and ascites treated with diuretics.
METHODS: The study was carried on 40 patients with liver cirrhosis and ascites treated with diuretic therapy. Patients were divided into two groups according to 24-h urinary sodium. We measured spot urine Na/K ratio, Na/Cr ratio and 24-h urinary sodium. Student’s t test was used to compare the interval variables and χ2 test to compare the nominal variables between the two groups. Receiver operator characteristic curve was used to identify the best cutoff point for Na/K and Na/Cr ratio.
RESULTS: The best cutoff point for Na/K ratio was 2.5 (P < 0.001) and area under the curve (AUC) was 0.9, and for Na/Cr ratio, the best cutoff point was 35 (P < 0.001) and AUC was 0.885. Na/K ratio showed higher sensitivity and accuracy compared to Na/Cr ratio (87.5% and 87% for Na/K ratio; 81% and 85% for Na/Cr ratio, respectively).
CONCLUSION: Spot urine Na/K ratio has adequate accuracy for assessment of dietary sodium restriction compared with 24-h urinary sodium in patients with liver cirrhosis and ascites.
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