Startseite Medizin Urine chloride self-measurement to monitor sodium chloride intake in patients with chronic kidney disease
Artikel
Lizenziert
Nicht lizenziert Erfordert eine Authentifizierung

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 ORCID logo und Carmine Zoccali EMAIL logo
Veröffentlicht/Copyright: 12. Februar 2019
Clinical Chemistry and Laboratory Medicine (CCLM)
Aus der Zeitschrift Clinical Chemistry and Laboratory Medicine (CCLM) Band 57 Heft 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

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: Ministero della Salute Ricerca Finalizzata e Giovani Ricercatori 2010, Grant Number: Project Code: RF-2010-2314890.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. 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.

References

1. Krikken JA, Laverman GD, Navis G. Benefits of dietary sodium restriction in the management of chronic kidney disease. Curr Opin Nephrol Hypertens 2009;18:531–8.10.1097/MNH.0b013e3283312fc8Suche in Google Scholar

2. He J, Mills KT, Appel LJ, Yang W, Chen J, Lee BT, et al. Urinary sodium and potassium excretion and CKD progression. J Am Soc Nephrol 2015;27:1–11.10.1681/ASN.2015010022Suche in Google Scholar

3. Weir MR, Fink JC. Salt intake and progression of chronic kidney disease: an overlooked modifiable exposure? A commentary. Am J Kidney Dis 2005;45:176–88.10.1053/j.ajkd.2004.08.041Suche in Google Scholar

4. Parkin CG, Davidson JA. Value of self-monitoring blood glucose pattern analysis in improving diabetes outcomes. J Diabetes Sci Technol Diabetes Technology Society 2009;3:500–8.10.1177/193229680900300314Suche in Google Scholar

5. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH)and of the European Society of Cardiology (ESC). Eur Heart J 2013;34:2159–219.10.1201/b17072-61Suche in Google Scholar

6. Luft FC, Fineberg NS, Sloan RS. Overnight urine collections to estimate sodium intake. Hypertens 1979:4:494–8.10.1161/01.HYP.4.4.494Suche in Google Scholar

7. Brüngel M, Kluthe R, Fürst P. Evaluation of various rapid chloride tests for assessing urinary NaCl excretion. Ann Nutr Metab 2001;45:169–74.10.1159/000046725Suche in Google Scholar

8. Luft FC, Fineberg NS, Sloan RS. Overnight urine collections to estimate sodium intake. Hypertension 1982;4:494–8.10.1161/01.HYP.4.4.494Suche in Google Scholar

9. Sloan PJ, Beevers G, Baxter FE. The Quantab strip in the measurement of urinary chloride and sodium concentrations. Clin Chem 1984;30:1705–7.10.1093/clinchem/30.10.1705Suche in Google Scholar

10. Minetti EE, Airaghi C, Cozzi MG, Guidi E. Urinary salt titrator stick: a useful and quick estimate of dietary sodium intake? J Hum Hypertens 1992;6:287–9.Suche in Google Scholar

11. Jeffery RW, Mullenbach VA, Bjornson-Benson WM, Prineas RJ, Forster JL, Schlundt DG. Home testing of urine chloride to estimate dietary sodium intake: evaluation of feasibility and accuracy. Addict Behav 1987;12:17–21.10.1016/0306-4603(87)90004-9Suche in Google Scholar

12. Levey AS, Coresh J, Greene T, Stevens L, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006;145:247–54.10.7326/0003-4819-145-4-200608150-00004Suche in Google Scholar PubMed

13. Cho ME, Beddhu S, Curhan GC, Motwani S. Dietary recommendations for patients with nondialysis chronic kidney disease – UpToDate [Internet]. [cited 2018 Nov 29]. Available from: https://www.uptodate.com/contents/dietary-recommendations-for-patients-with-nondialysis-chronic-kidney-disease?search=sodiumintakeCKD&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1.Suche in Google Scholar

14. Mills KT, Chen J, Yang W, Appel LJ, Kusek JW, Alper A, et al. Sodium excretion and the risk of cardiovascular disease in patients with chronic kidney disease. J Am Med Assoc 2016;315:2200.10.1001/jama.2016.4447Suche in Google Scholar PubMed PubMed Central

15. De Nicola L, Minutolo R, Chiodini P, Zoccali C, Castellino P, Donadio C, et al. Global approach to cardiovascular risk in chronic kidney disease: reality and opportunities for intervention. Kidney Int 2006;69:538–45.10.1038/sj.ki.5000085Suche in Google Scholar PubMed

16. Zoccali C. Mallamaci F. Mapping progress in reducing cardiovascular risk with kidney disease managing volume overload. Clin J Am Soc Nephrol 2018;13:1432–4.10.2215/CJN.01360118Suche in Google Scholar PubMed PubMed Central

17. Staal S, Ungerer M, Floris A, Ten Brinke HW, Helmhout R, Tellegen M, et al. A versatile electrophoresis-based self-test platform. Electrophoresis 2015;36:712–21.10.1002/elps.201400428Suche in Google Scholar PubMed

18. MACHEREY-NAGEL GmbH & Co. KG·Neumann-Neander-Str. 6–8·52355 Düren·Germany. QUANTOFIX® Chloride [Internet]. Available from: ftp://ftp.mn-net.com/english/Instruction_leaflets/QUANTOFIX/91321en.pdf.Suche in Google Scholar

19. Sackett DL, Richardson WS, Rosenberg W, Haynes RB. How to practice and teach evidence-based medicine. First. New York: Churchill Livingstone, 1997:118–28.Suche in Google Scholar

20. Ji C, Sykes L, Paul C, Dary O, Legetic B, Campbell NR, et al. Systematic review of studies comparing 24-hour and spot urine collections for estimating population salt intake. Rev Panam Salud Publica 2012;32:307–15.10.1590/S1020-49892012001000010Suche in Google Scholar PubMed

Received: 2018-11-16
Accepted: 2019-01-08
Published Online: 2019-02-12
Published in Print: 2019-07-26

©2019 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Editorials
  3. CCLM Award for the Most Cited Paper
  4. Folate and vitamin B12 assays after recalibration to the WHO International Standard 03/178: making the interpretation as simple as possible, but not simpler
  5. Reviews
  6. Blood contamination in salivary diagnostics: current methods and their limitations
  7. Central adrenal insufficiency: open issues regarding diagnosis and glucocorticoid treatment
  8. Genetics and Molecular Diagnostics
  9. Measuring the chronology of the translational process of molecular genetic discoveries
  10. Development and interlaboratory evaluation of a NIST Reference Material RM 8366 for EGFR and MET gene copy number measurements
  11. General Clinical Chemistry and Laboratory Medicine
  12. Post-translational modification-derived products are associated with frailty status in elderly subjects
  13. Urine chloride self-measurement to monitor sodium chloride intake in patients with chronic kidney disease
  14. Estimated urinary osmolality based on combined urinalysis parameters: a critical evaluation
  15. Measurement of S100B protein: evaluation of a new prototype on a bioMérieux Vidas® 3 analyzer
  16. Measuring thyroglobulin in patients with thyroglobulin autoantibodies: evaluation of the clinical impact of BRAHMS Kryptor® Tg-minirecovery test in a large series of patients with differentiated thyroid carcinoma
  17. Human chorionic gonadotropin suspected heterophile interference investigations in immunoassays: a recommended approach
  18. Certified reference material against PR3 ANCA IgG autoantibodies. From development to certification
  19. Diagnostic accuracy of a fully automated multiplex celiac disease antibody panel for serum and plasma
  20. Fasting serum bile acids concentration is associated with insulin resistance independently of diabetes status
  21. Hematology and Coagulation
  22. The association between activated protein C ratio and Factor V Leiden are gender-dependent
  23. Reference Values and Biological Variations
  24. Determination of sigma score based on biological variation for haemostasis assays: fit-for-purpose for daily practice?
  25. Calcitonin measurement in pediatrics: reference ranges are gender-dependent, validation in medullary thyroid cancer and thyroid diseases
  26. Cancer Diagnostics
  27. Uncovering the clinical impact of kallikrein-related peptidase 5 (KLK5) mRNA expression in the colorectal adenoma-carcinoma sequence
  28. Cardiovascular Diseases
  29. Performance of a novel high sensitivity cardiac troponin I assay in asymptomatic hemodialysis patients – evidence for sex-specific differences
  30. Infectious Diseases
  31. Rapid susceptibility testing of multi-drug resistant Escherichia coli and Klebsiella by glucose metabolization monitoring
  32. Letters to the Editor
  33. Vitamin B12 and folate levels in a healthy population: establishing reference intervals
  34. Reference values of a new serum folate assay traceable to the WHO International Standard
  35. Serum protein electrophoresis and complement deficiencies: a veteran but very versatile test in clinical laboratories
  36. Introduction of a novel ELISA assay for serum AMH determination
  37. Bone alkaline phosphatase on the IDS-iSYS automated analyser; cross-reactivity with intestinal ALP
  38. Evaluation of the MULTISURE HIV Rapid Test in a Korean population with low human immunodeficiency virus prevalence
  39. Vancomycin immunoassay: does the Advia Centaur XPT underestimate the exposure of patients? A method comparison study
  40. Hb Hunan and Hb Hengyang: Two unexpected discoveries during HbA1c measurements
  41. Analytical performance of a CE-marked immunoassay to quantify phosphorylated neurofilament heavy chains
  42. Implementation of an automated method for direct quantification of urinary ammonium
  43. Congress Abstracts
  44. Proceedings of ACBI 2018 41ST Annual Conference Association of Clinical Biochemists in Ireland
https://doi.org/10.1515/cclm-2018-1227
Schlagwörter für diesen Artikel
chronic kidney disease (CKD); hypertension; urine chloride; urine sodium

Artikel in diesem Heft

  1. Frontmatter
  2. Editorials
  3. CCLM Award for the Most Cited Paper
  4. Folate and vitamin B12 assays after recalibration to the WHO International Standard 03/178: making the interpretation as simple as possible, but not simpler
  5. Reviews
  6. Blood contamination in salivary diagnostics: current methods and their limitations
  7. Central adrenal insufficiency: open issues regarding diagnosis and glucocorticoid treatment
  8. Genetics and Molecular Diagnostics
  9. Measuring the chronology of the translational process of molecular genetic discoveries
  10. Development and interlaboratory evaluation of a NIST Reference Material RM 8366 for EGFR and MET gene copy number measurements
  11. General Clinical Chemistry and Laboratory Medicine
  12. Post-translational modification-derived products are associated with frailty status in elderly subjects
  13. Urine chloride self-measurement to monitor sodium chloride intake in patients with chronic kidney disease
  14. Estimated urinary osmolality based on combined urinalysis parameters: a critical evaluation
  15. Measurement of S100B protein: evaluation of a new prototype on a bioMérieux Vidas® 3 analyzer
  16. Measuring thyroglobulin in patients with thyroglobulin autoantibodies: evaluation of the clinical impact of BRAHMS Kryptor® Tg-minirecovery test in a large series of patients with differentiated thyroid carcinoma
  17. Human chorionic gonadotropin suspected heterophile interference investigations in immunoassays: a recommended approach
  18. Certified reference material against PR3 ANCA IgG autoantibodies. From development to certification
  19. Diagnostic accuracy of a fully automated multiplex celiac disease antibody panel for serum and plasma
  20. Fasting serum bile acids concentration is associated with insulin resistance independently of diabetes status
  21. Hematology and Coagulation
  22. The association between activated protein C ratio and Factor V Leiden are gender-dependent
  23. Reference Values and Biological Variations
  24. Determination of sigma score based on biological variation for haemostasis assays: fit-for-purpose for daily practice?
  25. Calcitonin measurement in pediatrics: reference ranges are gender-dependent, validation in medullary thyroid cancer and thyroid diseases
  26. Cancer Diagnostics
  27. Uncovering the clinical impact of kallikrein-related peptidase 5 (KLK5) mRNA expression in the colorectal adenoma-carcinoma sequence
  28. Cardiovascular Diseases
  29. Performance of a novel high sensitivity cardiac troponin I assay in asymptomatic hemodialysis patients – evidence for sex-specific differences
  30. Infectious Diseases
  31. Rapid susceptibility testing of multi-drug resistant Escherichia coli and Klebsiella by glucose metabolization monitoring
  32. Letters to the Editor
  33. Vitamin B12 and folate levels in a healthy population: establishing reference intervals
  34. Reference values of a new serum folate assay traceable to the WHO International Standard
  35. Serum protein electrophoresis and complement deficiencies: a veteran but very versatile test in clinical laboratories
  36. Introduction of a novel ELISA assay for serum AMH determination
  37. Bone alkaline phosphatase on the IDS-iSYS automated analyser; cross-reactivity with intestinal ALP
  38. Evaluation of the MULTISURE HIV Rapid Test in a Korean population with low human immunodeficiency virus prevalence
  39. Vancomycin immunoassay: does the Advia Centaur XPT underestimate the exposure of patients? A method comparison study
  40. Hb Hunan and Hb Hengyang: Two unexpected discoveries during HbA1c measurements
  41. Analytical performance of a CE-marked immunoassay to quantify phosphorylated neurofilament heavy chains
  42. Implementation of an automated method for direct quantification of urinary ammonium
  43. Congress Abstracts
  44. Proceedings of ACBI 2018 41ST Annual Conference Association of Clinical Biochemists in Ireland
Jetzt anmelden und 20% sparen
Institutioneller Zugang
Wie funktioniert Authentifizierung?
Haben Sie eine Idee, wie wir unsere Website verbessern können?
Bitte schreiben Sie uns.
© 2026 De Gruyter Brill
Heruntergeladen am 26.1.2026 von https://www.degruyterbrill.com/document/doi/10.1515/cclm-2018-1227/html?lang=de
Button zum nach oben scrollen