Hwang, Jin Ho; Chin, Ho Jun; Kim, Sejoong; Kim, Dong Ki; Kim, Suhnggwon; Park, Jung Hwan; Shin, Sung Joon; Lee, Sang Ho; Choi, Bum Soon; Lim, Chun Soo
Clinical journal of the American Society of Nephrology : CJASN
2014Dec ; 9 ( 12 ) :2059-69.
PMID : 25332317
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Hwang, Jin Ho -
Chin, Ho Jun -
Kim, Sejoong -
Kim, Dong Ki -
Kim, Suhnggwon -
Park, Jung Hwan -
Shin, Sung Joon -
Lee, Sang Ho -
Choi, Bum Soon -
Lim, Chun Soo -
ABSTRACT
BACKGROUND AND OBJECTIVES: The antiproteinuric effect of a renin-angiotensin-aldosterone system blockade can be magnified by dietary salt restriction. This study sought to determine the effect of intensive low-salt diet education on BP and urine albumin excretion in nondiabetic patients with hypertension and albuminuria. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study was conducted between March of 2012 and March of 2013 as an open-label, randomized, controlled trial. After a run-in period of 8 weeks, all patients received the angiotensin II receptor blocker olmesartan (40 mg daily). Patients were then divided into two groups. One group was treated for another 8 weeks with angiotensin II receptor blocker plus conventional low-salt diet education, and the other group was treated for 8 weeks with angiotensin II receptor blocker plus intensive low-salt diet education. The final analyses was performed with 245 completed patients.
RESULTS: The amount of daily albuminuria was significantly decreased from 0 (566.0 [25.0-5398.6] mg/d) to 8 weeks (282.5 [16.1-4898.5] mg/d; P<0.001). From 8 to 16 weeks, the 24-hour urinary sodium excretion was decreased by 36.0±5.9 mmol/d in the intensive education group and 8.8±4.9 mmol/d in the conventional education group (interaction P<0.001). Patients who completed intensive low-salt diet education exhibited greater decreases in urinary albumin excretion than the control group (change in albuminuria from 8 to 16 weeks, -154.0 versus 0.4 mg/d; P=0.01). Urinary albumin excretion tended to decrease as the 24-hour urinary sodium excretion amount decreased (R=0.32; 95% confidence interval, 0.20 to 0.43; P<0.001).
CONCLUSIONS: The 24-hour urinary albumin excretion was decreased more in patients in the intensive low-salt diet education group than patients in the conventional education group. Weekly intensive education on a low-salt diet would be a suitable method for clinical practice. CI - Copyright ??2014 by the American Society of Nephrology.
keyword
CKD; albuminuria; angiotensin system; hypertension; nutrition; rennin
MESH
Adult, Aged, Albuminuria/etiology/*therapy/urine, Angiotensin II Type 1 Receptor Blockers/*therapeutic use, Blood Pressure, *Diet, Sodium-Restricted, Female, Food, Humans, Hypertension/complications/physiopathology/*therapy, Imidazoles/*therapeutic use, Male, Medication Adherence, Middle Aged, Patient Education as Topic/*methods, Renal Insufficiency, Chronic/complications/*urine, Single-Blind Method, Sodium/urine, Sodium, Dietary, Surveys and Questionnaires, Tetrazoles/*therapeutic use
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