title: Dietary sodium adherence is poor in chronic heart failure patients.
abstract: BACKGROUND
  We sought to determine the rates and predictors of dietary sodium restriction and to evaluate the reliability of 24-hour urine collection as a tool to estimate dietary sodium intake in heart failure (HF) patients.
  
  
  RESULTS
  We evaluated the 24-hour urinary sodium excretion of 305 outpatients with HF and reduced ejection fraction who were educated on following a <2 g sodium diet. The mean sodium excretion according to a single sample from each participant was 3.15 ± 1.58 g, and 23% were adherent to the <2 g recommendation. One hundred sixty-eight participants provided 2 samples with urinary creatinine excretion within normative range. Averaging both resulted in a mean sodium excretion of 3.21 ± 1.20 g and lower adherence rates to the <2-gram diet: 14% versus 23% (P = .019). Multivariate logistic regression showed only male sex and higher body mass index (BMI) to be associated with nonadherence (male: odds ratio [OR] 2.20, 95% confidence interval [CI] 1.25-3.88; 1 unit BMI: OR 1.05, 95% CI 1.01-1.10). Bland-Altman plots of urinary sodium and creatinine showed poor reproducibility between samples.
  
  
  CONCLUSIONS
  In this chronic HF population, sodium consumption probably exceeds recommended amounts, particularly in men and those with higher BMI. Urine analyses were not highly reproducible, suggesting variation in both diet and urine collection.
authors.affiliation: OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio. Electronic address: anupambasuray@gmail.com.
authors.forename: Anupam
authors.initials: A
authors.lastname: Basuray
authors.affiliation: Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Mary
authors.initials: M
authors.lastname: Dolansky
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio.
authors.forename: Richard
authors.initials: R
authors.lastname: Josephson
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Abdus
authors.initials: A
authors.lastname: Sattar
authors.affiliation: Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Grady
authors.affiliation: Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Anton
authors.initials: A
authors.lastname: Vehovec
authors.affiliation: Department of Psychology, Kent State University, Kent, Ohio.
authors.forename: John
authors.initials: J
authors.lastname: Gunstad
authors.affiliation: Summa Health System, Akron City Hospital, Akron, Ohio.
authors.forename: Joseph
authors.initials: J
authors.lastname: Redle
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University Hospital, Salt Lake City, Utah.
authors.forename: James
authors.initials: J
authors.lastname: Fang
authors.affiliation: Department of Psychology, Kent State University, Kent, Ohio.
authors.forename: Joel W
authors.initials: JW
authors.lastname: Hughes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004039:Diet, Sodium-Restricted; D018450:Disease Progression; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000178:diet therapy* / Q000523:psychology / Q000652:urine; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D015203:Reproducibility of Results; D012964:Sodium / Q000652:urine*; D017673:Sodium Chloride, Dietary / Q000494:pharmacology*
chemical_list: D017673:Sodium Chloride, Dietary; D012964:Sodium
keywords: Sodium; compliance; diet; salt