title: Dietary sodium restriction: a neglected therapeutic opportunity in chronic kidney disease.
abstract: OBJECTIVE
  Restriction of dietary sodium is recommended at a population level as well as for groups at high cardiovascular risk, and chronic kidney disease (CKD). This review addresses recent evidence for the protective effect of dietary sodium restriction in CKD patients specifically.
  
  
  RESULTS
  Sodium intake in CKD populations is generally high, and often above population average. Recent data demonstrated that moderately lower sodium intake in CKD patients is associated with substantially better long-term outcome of renin-angiotensin-aldosterone system (RAAS)-blockade, in diabetic and nondiabetic CKD, related to better effects of RAAS-blockade on proteinuria, independent of blood pressure. This is in line with better short-term efficacy of RAAS-blockade during moderate sodium restriction in diabetic and nondiabetic CKD. This effect of sodium restriction is likely mediated by its effects on volume status. Sustainable sodium restriction can be achieved by approaches on the basis of behavioral sciences.
  
  
  CONCLUSIONS
  Moderate restriction of dietary sodium can substantially improve the protective effects of RAAS-blockade in CKD, by specific renal effects apparent from proteinuria reduction. The latter precludes straightforward extrapolation of data from nonrenal populations to CKD. Concerns regarding the adverse effects of a very low sodium intake should not distract from the protective effects of moderate sodium restriction. Prospective studies should assess the efficacy and sustainability of different strategies to target high sodium intake in CKD, along with measures at population level.
  http://links.lww.com/CONH/A14.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Jelmer K
authors.initials: JK
authors.lastname: Humalda
authors.forename: Gerjan
authors.initials: G
authors.lastname: Navis
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D004039:Diet, Sodium-Restricted / Q000009:adverse effects; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008019:Life Style; D010353:Patient Education as Topic; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000178:diet therapy* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D012084:Renin-Angiotensin System; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D017673:Sodium Chloride, Dietary / Q000009:adverse effects*; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D017673:Sodium Chloride, Dietary