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• The Possible Association of the Incidence of ESRD in the Patient with Diabetic Nephropathy with Salt Intake in the World
  Haruhito A. Uchida
  Published on: 10 August 2016
• Salt intake and Blood Pressure
  Dr. Yashoda R Kattimani
  Published on: 23 November 2015

• Published on: 10 August 2016

  The Possible Association of the Incidence of ESRD in the Patient with Diabetic Nephropathy with Salt Intake in the World

  • Haruhito A. Uchida, Associate Professor
  • Other Contributors:
    • Jun Wada and Hirofumi Makino

  Increasing number of the patients with endstage renal disease (ESRD) is nowadays a serious problem in each country, including many Western countries and Asian countries. Diabetic nephropathy (DMN) is the major cause of the incidence of ESRD in worldwide. In Japan, DMN has been the leading cause of dialysis since 1998 despite many innovative achievements in the pharmacological treatment for diabetes mellitus. Excessive...

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  Increasing number of the patients with endstage renal disease (ESRD) is nowadays a serious problem in each country, including many Western countries and Asian countries. Diabetic nephropathy (DMN) is the major cause of the incidence of ESRD in worldwide. In Japan, DMN has been the leading cause of dialysis since 1998 despite many innovative achievements in the pharmacological treatment for diabetes mellitus. Excessive salt intake causes hypertension and increases the risk for cerebro-cardio- vascular disease as well as ESRD [1]. However, the association of salt intake and the incidence of ESRD in the patients with DMN remains unknown. It is reported that many Asian countries, such as Singapore, Malaysia, Republic of Korea, Hong Kong, Taiwan, Philippines and Japan, head the list of the percentage of incident patients of ESRD due to diabetes [2]. Meanwhile, many Western countries, such as United States, Iceland, Canada, Finland, Portugal, Croatia, Czech Republic, Austria, Greece, Denmark, Bosnia/Herzegovina, United Kingdom, Sweden, Spain, Scotland, France, Serbia, Belgium, Netherlands, Norway and Romania, run after Asian countries. A report of global national sodium intakes shows that these East Asian countries consume more salt than these Western countries [3]. We simply analyzed the relationship between percent incidence of DMN in ESRD and salt intake(Figure, not shown). It clearly demonstrated a significant relationship between them (r = 0.483, P = 0.009). The average percent incidence of DMN in ESRD in East Asian countries was significantly higher than that in Western countries (47.5 % vs 27 %, p < 0.001) as well as salt intake (11.8 g/day vs 9.5 g/day, p < 0.001), suggesting the link between progression of DMN and salt intake in East Asian countries, while the protection of DMN by low salt consumptions in Western countries. A multiple linear regression analysis adjusted by salt intake demonstrated that the average percent incidence of DMN in ESRD in East Asian countries was still significantly higher than that in Western countries (p < 0.001). The result indicated that DMN patients in East Asian countries are genetically salt-sensitive compared with Western countries. A few reports supported the idea that there is a certain difference of salt sensitivity between East Asian and Western countries [4]. Further studies are required to confirm the association of the incidence of ESRD in the patients with DMN and salt intake.

  References

  1. Mozaffarian D, Fahimi S, Singh GM, et al. Global sodium consumption and death from cardiovascular causes. N Engl J Med 2014;371:624-34.

  2. U S Renal Data System. USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2013.

  3. Powles J, Fahimi S, Micha R, et al, Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ Open, 2013, 3:e003733.

  4.Mente A, O'Donnell MJ, Rangarajan S, et al. Association of urinary sodium and potassium excretion with blood pressure. N Engl J Med 2014;371:601-611

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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• Published on: 23 November 2015

  Salt intake and Blood Pressure

  • Dr. Yashoda R Kattimani, Assistnt Professor
  • Other Contributors:
    • Dr. Mahantayya V Math Dr. Rita M Khadkikar Dr. Sanhita R Walawlkar

  Salt intake and Blood Pressure We have read the excellent article by Dr Powles and collagues in your journal on the Global, regional and national sodium intake in 1990 and 2010 (BMJ open 2013;3(12):e003733) (1). Approximately 1 billion people in the world had high blood pressure (>140/90 mm Hg) in 2000 and this is likely to increase to about 1.5 billion by 2025 (2,3).The increase in dietary salt intake in many coun...

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  Salt intake and Blood Pressure We have read the excellent article by Dr Powles and collagues in your journal on the Global, regional and national sodium intake in 1990 and 2010 (BMJ open 2013;3(12):e003733) (1). Approximately 1 billion people in the world had high blood pressure (>140/90 mm Hg) in 2000 and this is likely to increase to about 1.5 billion by 2025 (2,3).The increase in dietary salt intake in many countries is a major cause of raised blood pressure and the salt intake in many countries is above 6 gm/day(4). There is an increase in the salt intake in the developing countries in the last three decades. Salt is the major source of sodium in the diet (=90%) and many studies have shown that a reduction in salt intake lowers the blood pressure in all ethnic groups(5-7). The dietary approach to study hypertension (DASH) demonstrated a dose response relationship when salt intake was reduced from 8 gm/ day to 4 gm / day(6). A reduction in salt intake lowers blood pressure and this is of help in reducing the risk of cardiovascular diseases. In Finland a reduction in salt intake (from 14 gm/ day to less than 9gm / day) was achieved with the help of mass media campaign and food industry and this resulted in significant reduction in both systolic and diastolic blood pressure (8-10). Branded food products also have large variations in salt content in the products marked in different countries(11).In India , National Institution of Nutrition has recommended that salt intake should be reduced from 10gm/day to 5gm/ day in 2010 (12). Dr.Pal and colleagues have observed that ratio of Low frequency power to high frequency power (LF/HF ratio) in heart rate variability (HRV) an indicator of sympathovagal balance was significantly increased in individuals with salt preference. Sympathovagal imbalance is more intense in salt preferring prehypertensives than salt preferring normotensives and this is independent of Body Mass Index (BMI)(13). In India, the commercially prepared foods like sandwiches, samosas, soups, sauces, ketchups, chutneys, chips, pickles, papads, biscuits etc have high sodium content(14). In South Africa, the government has passed Mandatory regulations to affect the salt content of processed food to fight against the rising burden of hypertension (15).

  References 1.Powles J, Fahimi S, Micha R, Khatibzadeh S, Shi P, Ezzati M, Engell RE, Lim SS, Danaei G, Mozaffarian D, on behalf of the Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE). Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ Open 2013; 3(12):e003733. 2 He FJ, Campbell NRC, MacGregor GA. Reducing salt intake to prevent hypertension and cardiovascular disease. Special Report. Rev Panam Salud Publica. 2012; 32:265-300. 3.Kearney PM, Whelton M, Reynolds K, MuntnerP, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365:217- 23. 4.Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. Int J Epidemiol. 2009;38:791-813. 5. Forte JG, Miguel JM, Miguel MJ, de P?dua F, Rose G. Salt and blood pressure: a community trial. J Hum Hypertens. 1989;3:179-84. 6. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH- Sodium Collaborative Research Group. N Engl J Med. 2001;344: 3-10. 7. He FJ, Markandu ND, Sagnella GA, MacGregor GA. Importance of the renin system in determining blood pressure fall with salt restriction in black and white hypertensives. Hypertension. 1998;32: 820-4. 8.Karppanen H, Mervaala E. Sodium intake and hypertension. Prog Cardiovasc Dis. 2006;49: 59-75. 9. Larsson SC, Virtanen MJ, Mars M, M?nnist? S, Pietinen P, Albanes D, et al. Magnesium, calcium, potassium, and sodium intakes and risk of stroke in male smokers. Arch Intern Med. 2008;168: 459-65. 10. Laatikainen T, Pietinen P, Valsta L, Sundvall J, Reinivuo H, Tuomilehto J. Sodium in the Finnish diet: 20-year trends in urinary sodium excretion among the adult population. Eur J Clin Nutr. 2006;60:965-70. 11.World Action on Salt and Health. Press release--medical experts launch global campaign against salt to prevent over 2.5 million deaths worldwide each year. London: WASH; 2006. Available from: http://www.worldactiononsalt.com/news/saltnews/2007/60497.html 12. DietaryguidelinesforIndians. Available from: http://ninindia.org/DietaryguidelinesforIndians-Finaldraft.pdf. 13. Pal GK, Adithan C, Dutta T K, Pal P, Nanda N, Syamsundara Kiran A N, Lalitha V and Amudharaj D Preference for salt contributes to sympathovagal imbalance in the genesis of prehypertension. European Journal of Clinical Nutrition. 2013June, 67, 586-591 14.Antia F P, Abraham P. Clinical Dietetics and Nutrition. 4th Edition: Oxford University Press .2002. Mumbai, India 15.Hofman K J, Tollman S M. Population health in South Africa: a view from the salt mines. The Lancet Global Health, 2013 August Vol 1(2): e66 - e67.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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