title: Altered dietary salt intake for preventing and treating diabetic kidney disease.
abstract: BACKGROUND
  There is strong evidence that our current consumption of salt is a major factor for increased blood pressure (BP) and a modest reduction in salt intake lowers BP whether BP levels are normal or raised. Tight control of BP in diabetics lowers the risk of strokes, heart attacks and heart failure and slows the progression of diabetic kidney disease (DKD). Currently there is no consensus in restricting salt intake in diabetic patients.
  
  
  OBJECTIVE
  To evaluate the effect of altered salt intake on BP and markers of cardiovascular disease and DKD.
  
  
  METHODS
  In January 2010, we searched the Cochrane Renal Group's Specialised Register, CENTRAL (in The Cochrane Library), MEDLINE (from 1966) and EMBASE (from 1980) to identify appropriate articles.
  
  
  METHODS
  We included all randomised controlled trials of salt reduction in individuals with type 1 and type 2 diabetes.
  
  
  METHODS
  Two authors independently assessed studies and resolved differences by discussion with a third independent author. We calculated mean effect sizes using both the fixed-effect and random-effects models.
  
  
  RESULTS
  Thirteen studies (254 individuals) met our inclusion criteria. These included 75 individuals with type 1 diabetes and 158 individuals with type 2 diabetes. The median reduction in urinary sodium was 203 mmol/24 h (11.9 g/day) in type 1 diabetes and 125 mmol/24 h (7.3 g/day) in type 2 diabetes. The median duration of salt restriction was one week in both type 1 and type 2 diabetes. BP was reduced in both type 1 and type 2 diabetes. In type 1 diabetes (56 individuals), salt restriction reduced BP by -7.11/-3.13 mm Hg (systolic/diastolic); 95% CI: systolic BP (SBP) -9.13 to -5.10; diastolic BP (DBP) -4.28 to -1.98). In type 2 diabetes (56 individuals), salt restriction reduced BP by -6.90/-2.87 mm Hg (95% CI: SBP -9.84 to -3.95; DBP -4.39 to -1.35). There was a greater reduction in BP in normotensive patients, possibly due to a larger decrease in salt intake in this group.
  
  
  CONCLUSIONS
  Although the studies are not extensive, this meta-analysis shows a large fall in BP with salt restriction, similar to that of single drug therapy. All diabetics should consider reducing salt intake at least to less than 5-6 g/day in keeping with current recommendations for the general population and may consider lowering salt intake to lower levels, although further studies are needed.
authors.affiliation: Blood Pressure Unit, St. George's Hospital Medical School, Crammer Terrace, London, UK, SW17 0RE.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Suckling
authors.forename: Feng J
authors.initials: FJ
authors.lastname: He
authors.forename: Graham A
authors.initials: GA
authors.lastname: Macgregor
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003928:Diabetic Nephropathies / Q000178:diet therapy* / Q000517:prevention & control; D004039:Diet, Sodium-Restricted / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000178:diet therapy / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D017673:Sodium Chloride, Dietary