Reducing salt intake by urine chloride self-measurement in non-compliant patients with chronic kidney disease followed in nephrology clinics: a randomized trial

Author:

Panuccio Vincenzo1,Mallamaci Francesca12,Pizzini Patrizia2,Tripepi Rocco2,Garofalo Carlo3,Parlongo Giovanna1,Caridi Graziella1,Provenzano Michele3,Mafrica Angela1,Simone Giuseppina4,Cutrupi Sebastiano1,D’Arrigo Graziella1,Porto Gaetana1,Tripepi Giovanni1,Nardellotto Antonella5,Meneghel Gina5,Dattolo Piero4,Pizzarelli Francesco4ORCID,Rapisarda Francesco6,Ricchiuto Anna7,Fatuzzo Pasquale6,Verdesca Simone8,Gallieni Maurizio9ORCID,Gesualdo Loreto9,Conte Giuseppe3,Plebani Mario10,Zoccali Carmine2

Affiliation:

1. Nephrology, Dialysis and Transplantation Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy

2. Institute of Clinical Physiology (IFC), Clinical Epidemiology of Renal Diseases and Hypertension Unit, Reggio Calabria, Italy

3. Division of Nephrology Azienda, Ospedaliera Universitaria Napoli, Naples, Italy

4. Division of Nephrology, Azienda Ospedaliera “Santa Maria Annunziata” Firenze, Florence, Italy

5. Division of Nephrology, Ospedale Dolo, Mirano-Venezia, Italy

6. Department of Medicine, Nephrology Unit, Policlinico Universitario Vittorio Emanuele, Catania, Italy

7. Division of Nephrology, Ospedale Universitario Sacco, Milano, Italy

8. Department of Laboratory Medicine, University-Hospital of Padova, Padua, Italy

9. Division of Nephrology, Università Consorziale Policlinico, Bari, Italy

10. Department of Medicine-DIMED, University of Padova and Department of Laboratory Medicine, University Hospital of Padova, Italy

Abstract

Abstract Background Adherence to low salt diets and control of hypertension remain unmet clinical needs in chronic kidney disease (CKD) patients. Methods We performed a 6-month multicentre randomized trial in non-compliant patients with CKD followed in nephrology clinics testing the effect of self-measurement of urinary chloride (69 patients) as compared with standard care (69 patients) on two primary outcome measures, adherence to a low sodium (Na) diet (<100 mmol/day) as measured by 24-h urine Na (UNa) excretion and 24-h ambulatory blood pressure (ABPM) monitoring. Results In the whole sample (N = 138), baseline UNa and 24-h ABPM were143 ± 64 mmol/24 h and 131 ± 18/72 ± 10 mmHg, respectively, and did not differ between the two study arms. Patients in the active arm of the trial used >80% of the chloride strips provided to them at the baseline visit and at follow-up visits. At the third month, UNa was 35 mmol/24 h (95% CI 10.8–58.8 mmol/24 h; P = 0.005) lower in the active arm than the control arm, whereas at 6 months the between-arms difference in UNa decreased and was no longer significant [23 mmol/24 h (95% CI −5.6–50.7); P = 0.11]. The 24-h ABPM changes as well as daytime and night-time BP changes at 3 and 6 months were similar in the two study arms (Month 3, P = 0.69–0.99; Month 6, P = 0.73–0.91). Office BP, the use of antihypertensive drugs, estimated Glomerular Filtration Rate (eGFR) and proteinuria remained unchanged across the trial. Conclusions The application of self-measurement of urinary chloride to guide adherence to a low salt diet had a modest effect on 24-h UNa and no significant effect on 24-h ABPM.

Funder

Italian Ministry of Health

Publisher

Oxford University Press (OUP)

Subject

Transplantation,Nephrology

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