Key result
A high sodium to creatinine ratio (≥24.8) in spot urine was significantly associated with an increased risk of hospitalization for heart failure (HR 2.49) in Japanese high-risk patients.
Why the study?
Estimating daily sodium excretion from spot urine is complex, so the authors investigated whether the simpler spot urine sodium to creatinine ratio was associated with heart failure hospitalization.
Does a high sodium to creatinine ratio in spot urine predict hospitalization for heart failure in high-risk patients?
Observational (n=520)
No
Does a high sodium to creatinine ratio in spot urine predict hospitalization for heart failure in high-risk patients?
A high sodium to creatinine ratio in spot urine is a simple, independent predictor of heart failure hospitalization in high-risk patients.
Answers are grounded in this paper and cite their sources.
High Na/Cr ratio may support risk stratification in high-risk patients; leaves open incremental value and need for prospective validation.
Our previous study [Evaluation of sodium intake for the prediction of cardiovascular events in Japanese high-risk patients (ESPRIT study)] reported that increased sodium excretion ≥4.0 g/day was associated with composite cardiovascular events in hospitalization for heart failure (HF), acute coronary syndrome, cerebrovascular events and documented cardiovascular-related mortality in Japanese high-risk patients with either stable and compensated HF, coronary artery disease, cerebrovascular disease, chronic kidney disease or atrial fibrillation. However, the method of estimating sodium excretion levels using spot urine is complex, requiring age, body weight, height and multiplier factors for calculation. The aim of the present study was to elucidate whether the sodium to creatinine ratio in spot urine, a key component in estimating daily sodium excretion, was associated with hospitalization for HF. The present study performed a post-hoc analysis of the ESPRIT study (n=520; 60 hospitalizations for HF). Receiver operating curve analysis yielded an optimal sodium to creatinine ratio cut-off value of 24.8 for detecting hospitalization for HF. Kaplan-Meier curve analysis revealed that a high sodium to creatinine ratio in spot urine was associated with an increased hospitalization for HF (P<0.001). Cox regression analysis revealed that a high sodium to creatinine ratio was associated with hospitalization for HF with a hazard ratio (HR) of 2.49 [95% confidence interval (95% CI), 1.47-4.16]. Following adjustment for age, sex and body weight, the HR was as high as 2.74 (95% CI, 1.51-4.71). This association remained following further adjustment for brain natriuretic peptide, estimated glomerular filtration rate, diabetes mellitus or the use of diuretics. Overall, the present study demonstrated that the sodium to creatinine ratio in spot urine is associated with hospitalization for HF in Japanese high-risk patients.
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Sadanaga et al. (2022) conducted an observational in High cardiovascular risk (n=520). High sodium to creatinine ratio in spot urine (≥24.8) vs. Low sodium to creatinine ratio in spot urine (<24.8) was evaluated on Hospitalization for heart failure (HR 2.49, 95% CI 1.47-4.16, p=<0.001). A high sodium to creatinine ratio (≥24.8) in spot urine was significantly associated with an increased risk of hospitalization for heart failure (HR 2.49) in Japanese high-risk patients.
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