Key result
Higher 24-hour urinary sodium is linked to ~0.6-mmHg higher SBP per 100 mmol.
Why the study?
The study compared the sodium intake and systolic blood pressure relationship across complete 24-h urine samples determined by several methods of evaluating collection completeness.
Does the method used to evaluate the completeness of 24-hour urine collections alter the estimated relationship between 24-hour urinary sodium excretion and blood pressure in a Bangladeshi cohort?
Cohort (n=2,143)
Yes
Does the method used to evaluate the completeness of 24-hour urine collections alter the estimated relationship between 24-hour urinary sodium excretion and blood pressure in a Bangladeshi cohort?
Different creatinine-based and self-reported methods for assessing 24-hour urine collection completeness yield substantially different sample inclusions, mean sodium estimates, and magnitudes of association between urinary sodium and blood pressure.
Answers are grounded in this paper and cite their sources.
Urine completeness method alters sodium-SBP association magnitude; leaves open optimal assessment approach in observational cohorts.
We compared the sodium intake and systolic blood pressure (SBP) relationship from complete 24-h urine samples determined by several methods: self-reported no-missed urine, creatinine index ≥0.7, measured 24-h urine creatinine (mCER) within 25% and 15% of Kawasaki predicted urine creatinine, and sex-specific mCER ranges (mCER 15-25 mg/kg/24-h for men; 10-20 mg/kg/24-h for women). We pooled 10,031 BP and 24-h urine sodium data from 2143 participants. We implemented multilevel linear models to illustrate the shape of the sodium-BP relationship using the restricted cubic spline (RCS) plots, and to assess the difference in mean SBP for a 100 mmol increase in 24-h urine sodium. The RCS plot illustrated an initial steep positive sodium-SBP relationship for all methods, followed by a less steep positive relationship for self-reported no-missed urine, creatinine index ≥0.7, and sex-specific mCER ranges; and a plateaued relationship for the two Kawasaki methods. Each 100 mmol/24-h increase in urinary sodium was associated with 0.64 (95% CI: 0.34, 0.94) mmHg higher SBP for self-reported no-missed urine, 0.68 (95% CI: 0.27, 1.08) mmHg higher SBP for creatinine index ≥0.7, 0.87 (95% CI: 0.07, 1.67) mmHg higher SBP for mCER within 25% Kawasaki predicted urine creatinine, 0.98 (95% CI: -0.07, 2.02) mmHg change in SBP for mCER within 15% Kawasaki predicted urine creatinine, and 1.96 (95% CI: 0.93, 2.99) mmHg higher SBP for sex-specific mCER ranges. Studies examining 24-h urine sodium in relation to health outcomes will have different results based on how urine collections are deemed as complete.
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Naser et al. (2020) conducted a cohort in Blood pressure and dietary sodium intake assessment (n=2,143). 24-hour urinary sodium excretion (per 100 mmol/24-h increase) across completeness evaluation methods vs. Different methods of evaluating 24-h urine completeness (self-reported no-missed urine, creatinine index >=0.7, Kawasaki 15% and 25%, and sex-specific mCER ranges) was evaluated on Difference in mean systolic blood pressure (SBP, mmHg) per 100 mmol/24-h increase in urinary sodium (using self-reported no-missed urine reference method) (MD 0.64 mmHg, 95% CI 0.34, 0.94). Each 100 mmol/24-h urinary sodium increase was associated with 0.64 mmHg (95% CI: 0.34, 0.94) to 1.96 mmHg (95% CI: 0.93, 2.99) higher SBP depending on the urine completeness evaluation method.
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