Measured sodium excretion is associated with CKD progression: Results from the KNOW-CKD study

Minjung Kang, Eunjeong Kang, Hyunjin Ryu, Yeji Hong, Seung Seok Han, Sue K. Park, Young Youl Hyun, Su Ah Sung, Soo Wan Kim, Tae Hyun Yoo, Jayoun Kim, Curie Ahn, Kook Hwan Oh

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


Background: Diet is a modifiable factor of chronic kidney disease (CKD) progression. However, the effect of dietary salt intake on CKD progression remains unclear. Therefore, we analyzed the effect of dietary salt intake on renal outcome in Korean patients with CKD. Methods: We measured 24-h urinary sodium (Na) excretion as a marker of dietary salt intake in the prospective, multi-center, longitudinal KoreaN cohort study for Outcome in patients With CKD (KNOW-CKD). Data were analyzed from CKD patients at Stages G3a to G5 (n = 1254). We investigated the association between dietary salt intake and CKD progression. Patients were divided into four quartiles of dietary salt intake, which was assessed using measured 24-h urinary Na excretion. The study endpoint was composite renal outcome, which was defined as either halving the estimated glomerular filtration rate or developing end-stage renal disease. Results: During a median (interquartile range) follow-up of 4.3 (2.8-5.8) years, 480 (38.7%) patients developed the composite renal event. Compared with the reference group (Q2, urinary Na excretion: 104.2 ≤ Na excretion < 145.1 mEq/day), the highest quartile of measured 24-h urinary Na excretion was associated with risk of composite renal outcome [Q4, urinary Na excretion ≥192.9 mEq/day, hazard ratio 1.8 (95% confidence interval 1.12-2.88); P = 0.015] in a multivariable hazards model. Subgroup analyses showed that high-salt intake was particularly associated with a higher risk of composite renal outcome in women, in patients <60 years of age, in those with uncontrolled hypertension and in those with obesity. Conclusions: High salt intake was associated with increased risk of progression in CKD.

Original languageEnglish
Pages (from-to)512-519
Number of pages8
JournalNephrology Dialysis Transplantation
Issue number3
Publication statusPublished - 2021 Mar 1

Bibliographical note

Funding Information:
This research was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention (grants 2011E3300300, 2012E3301100, 2013E3301600, 2013E3301601, 2013E3301602, 2016E3300200 and 2016E3300201). The funders had no role in study design, data collection or analysis, decision to publish or preparation of the manuscript.

Publisher Copyright:
© 2020 The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation


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