Urine chloride self-measurement to monitor sodium chloride intake in patients with chronic kidney disease

Vincenzo Panuccio; Patrizia Pizzini; Giovanna Parlongo; Graziella Caridi; Rocco Tripepi; Angela Mafrica; Sebastiano Cutrupi; Graziella D’Arrigo; Gaetana Porto; Carlo Garofalo; Michele Provenzano; Giovanni Tripepi; Francesca Mallamaci; Mario Plebani; Carmine Zoccali

doi:10.1515/cclm-2018-1227

Article

Urine chloride self-measurement to monitor sodium chloride intake in patients with chronic kidney disease

Vincenzo Panuccio , Patrizia Pizzini , Giovanna Parlongo , Graziella Caridi , Rocco Tripepi , Angela Mafrica , Sebastiano Cutrupi , Graziella D’Arrigo , Gaetana Porto , Carlo Garofalo , Michele Provenzano , Giovanni Tripepi , Francesca Mallamaci , Mario Plebani and Carmine Zoccali

Published/Copyright: February 12, 2019

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From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 57 Issue 8

Abstract

Background

Excessive sodium intake is a risk factor for hypertension, cardiovascular disease and the risk for kidney failure in chronic kidney disease (CKD) patients.

Methods

We tested the diagnostic performance and the feasibility of an inexpensive method based on urine chloride strips for self-monitoring sodium intake in a series of 72 CKD patients.

Results

Twenty-four hour urinary chloride as measured by the reactive strips and 24 h urinary sodium were interrelated (r=0.59, p<0.001). Forty-nine out of 72 patients (78%) had a 24 h urinary sodium >100 mmol/24 h, i.e. the upper limit recommended by current CKD guidelines. The strip method had 75.5% sensitivity and 82.6% specificity to correctly classify patients with urine sodium >100 mmol/24 h. The positive and the negative predictive values were 90.2% and 61.3%, respectively. The overall accuracy (ROC curve analysis) of urine chloride self-measurement for the >100 mmol/24 h sodium threshold was 87% (95% CI: 77%–97%). The large majority of patients (97%) perceived the test as useful to help compliance with the prescribed dietary sodium and considered the test as simple and of immediate application (58%) or feasible but requiring attention (39%).

Conclusions

A simple and inexpensive test for urine chloride measurement has a fairly good performance for the diagnosis of excessive sodium intake. The test is feasible and it is perceived by CKD patients as helpful for enhancing compliance to the dietary sodium recommendations. The usefulness of this test for improving hypertension control in CKD patients will be tested in a clinical trial (Clinicaltrials.gov RF-2010-2314890).

Keywords: chronic kidney disease (CKD); hypertension; urine chloride; urine sodium

Corresponding author: Prof. Carmine Zoccali, CNR-IFC Research Unit of Reggio Calabria, c/o EUROLINE di Barillà Francesca, Via Vallone Petrara 55-57, 89124 Reggio Calabria, Italy, Phone: +0039 0965 397010, Fax: +0039 0965 26879

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: Ministero della Salute Ricerca Finalizzata e Giovani Ricercatori 2010, Grant Number: Project Code: RF-2010-2314890.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2018-11-16

Accepted: 2019-01-08

Published Online: 2019-02-12

Published in Print: 2019-07-26

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Articles in the same Issue

https://doi.org/10.1515/cclm-2018-1227

Keywords for this article

chronic kidney disease (CKD); hypertension; urine chloride; urine sodium