期刊
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
卷 315, 期 20, 页码 2200-2210出版社
AMER MEDICAL ASSOC
DOI: 10.1001/jama.2016.4447
关键词
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资金
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [R01DK074615]
- NIDDK [U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, U01DK060902]
- University of Pennsylvania Clinical and Translational Science Award [NIH/NCATS UL1TR000003]
- Johns Hopkins University [UL1 TR-000424]
- University of Maryland [GCRC M01 RR-16500]
- Clinical and Translational Science Collaborative of Cleveland [UL1TR000439]
- Michigan Institute for Clinical and Health Research [UL1TR000433]
- University of Illinois at Chicago [CTSA UL1RR029879]
- Tulane COBRE for Clinical and Translational Research in Cardiometabolic Diseases [P20 GM109036]
- Kaiser [NIH/NCRR UCSF-CTSI UL1 RR-024131]
- National Heart, Lung, and Blood Institute [T32HL007024]
IMPORTANCE Patients with chronic kidney disease (CKD) are at an increased risk of cardiovascular disease (CVD) compared with the general population. Prior studies have produced contradictory results on the association of dietary sodium intake with risk of CVD, and this relationship has not been investigated in patients with CKD. OBJECTIVE To evaluate the association between urinary sodium excretion and clinical CVD events among patients with CKD. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study of patients with CKD from 7 locations in the United States enrolled in the Chronic Renal Insufficiency Cohort Study and followed up from May 2003 to March 2013. EXPOSURES The cumulative mean of urinary sodium excretion from three 24-hour urinary measurements and calibrated to sex-specific mean 24-hour urinary creatinine excretion. MAIN OUTCOMES AND MEASURES A composite of CVD events defined as congestive heart failure, stroke, or myocardial infarction. Events were reported every 6 months and confirmed by medical record adjudication. RESULTS Among 3757 participants (mean age, 58 years; 45% women), 804 composite CVD events (575 heart failure, 305 myocardial infarction, and 148 stroke) occurred during a median 6.8 years of follow-up. From lowest (<2894 mg/24 hours) to highest (>= 4548 mg/24 hours) quartile of calibrated sodium excretion, 174, 159, 198, and 273 composite CVD events occurred, and the cumulative incidence was 18.4%, 16.5%, 20.6%, and 29.8% at median follow-up. In addition, the cumulative incidence of CVD events in the highest quartile of calibrated sodium excretion compared with the lowest was 23.2% vs 13.3% for heart failure, 10.9% vs 7.8% for myocardial infarction, and 6.4% vs 2.7% for stroke at median follow-up. Hazard ratios of the highest quartile compared with the lowest quartile were 1.36 (95% CI, 1.09-1.70; P = .007) for composite CVD events, 1.34 (95% CI, 1.03-1.74; P = .03) for heart failure, and 1.81 (95% CI, 1.08-3.02; P = .02) for stroke after multivariable adjustment. Restricted cubic spline analyses of the association between sodium excretion and composite CVD provided no evidence of a nonlinear association (P = .11) and indicated a significant linear association (P < .001). CONCLUSIONS AND RELEVANCE Among patients with CKD, higher urinary sodium excretion was associated with increased risk of CVD.
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