title: The role of salt intake and salt sensitivity in the management of hypertension in South Asian people with chronic kidney disease: a randomised controlled trial.
abstract: BACKGROUND
  The effectiveness of salt restriction to lower blood pressure (BP) in Bangladeshi patients with chronic kidney disease (CKD) is uncertain.
  
  
  OBJECTIVE
  To test the hypothesis that a tailored intervention intended to reduce salt intake in addition to standard care will achieve a greater reduction in BP in UK Bangladeshi patients with CKD than standard care alone.
  
  
  METHODS
  A randomised parallel-group controlled trial conducted over a 6 month period.
  
  
  METHODS
  A tertiary renal unit based in acute care hospital in East London.
  
  
  METHODS
  56 adult participants of Bangladeshi origin with CKD and BP >130/80 mm Hg or on antihypertensive medication.
  
  
  METHODS
  Participants were randomly allocated to receive a tailored low-salt diet or the standard low-salt advice. BP medication, physical activity and weight were monitored.
  
  
  METHODS
  The primary outcome was change in ambulatory BP. Adherence to dietary advice was assessed by measurement of 24 h urinary salt excretion.
  
  
  RESULTS
  Of 56 participants randomised, six withdrew at the start of the study. During the study, one intervention group participant died, one control group participant moved to Bangladesh. Data were available for the primary endpoint on 48 participants. Compared with control group the intervention urinary sodium excretion fell from 260 mmol/d to 103 mmol/d (-131 to -76, p<0.001) at 6 months and resulted in mean (95% CI) falls in 24 h systolic/diastolic BP of -8 mm Hg (-11 to -5)/2 (-4 to -2) both p<0.001.
  
  
  CONCLUSIONS
  A tailored intervention can achieve moderate salt restriction in patients with CKD, resulting in clinically meaningful falls in BP independent of hypertensive medication.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00702312.
authors.affiliation: Diabetes & Nutritional Science Division, Kings College London, Franklin-Wilkins Building, London, UK. i.ashurst@rbht.nhs.uk
authors.forename: Ione
authors.initials: I
authors.lastname: de Brito-Ashurst
authors.forename: Lin
authors.initials: L
authors.lastname: Perry
authors.forename: Thomas A B
authors.initials: TA
authors.lastname: Sanders
authors.forename: Jane E
authors.initials: JE
authors.lastname: Thomas
authors.forename: Hamish
authors.initials: H
authors.lastname: Dobbie
authors.forename: Mira
authors.initials: M
authors.lastname: Varagunam
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Yaqoob
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001459:Bangladesh / Q000208:ethnology; D004039:Diet, Sodium-Restricted; D005260:Female; D006801:Humans; D006973:Hypertension / Q000178:diet therapy / Q000208:ethnology / Q000209:etiology*; D008131:London / Q000453:epidemiology; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012965:Sodium Chloride / Q000652:urine
chemical_list: D000959:Antihypertensive Agents; D012965:Sodium Chloride
keywords: Renal Disease