title: Sodium and fluid management in the conservative management of chronic kidney disease.
abstract: Chronic kidney disease (CKD) imposes a significant global health burden. In the United States, one in three adults are at risk for CKD currently affecting over 28 million Americans. While several studies have demonstrated the benefit of treating traditional risk factors in CKD, including hypertension with pharmacologic agents such as blockade of the renin-angiotensin system (RAAS), there is scarce data on the advantages of sodium and fluid management in this population. Both experimental and observational studies have shown improvement in hypertension and cardiovascular outcomes with sodium restriction to ≤2.3 grams per day, however, to date there are very few randomized controlled trials demonstrating a benefit in sodium reduction for the prevention or progression of CKD. Similarly, studies on increasing fluid consumption have shown to be advantageous in polycystic kidney disease as well as chronic nephrolithiasis, yet no randomized controlled trials exist on the fluid management in patients with kidney disease. This review aims to explore the evidence of sodium restriction and fluid management in the CKD population as well as underlying mechanisms and clinical barriers of sodium and water management as conservative therapy.
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado, Aurora, CO, USA.
authors.forename: Morgan
authors.initials: M
authors.lastname: Marcuccilli
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado, Aurora, CO, USA.|Denver Health Medical Center, Denver, CO, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kendrick
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado, Aurora, CO, USA - Michel.Chonchol@ucdenver.edu.
authors.forename: Michel
authors.initials: M
authors.lastname: Chonchol
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors; D002318:Cardiovascular Diseases / Q000628:therapy; D000072700:Conservative Treatment / Q000379:methods*; D018450:Disease Progression; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000628:therapy; D017379:Hypertrophy, Left Ventricular; D007010:Hyponatremia / Q000628:therapy; D007690:Polycystic Kidney Diseases / Q000628:therapy; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012307:Risk Factors; D012965:Sodium Chloride / Q000737:chemistry*; D014481:United States; D014667:Vasopressins / Q000627:therapeutic use
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D014667:Vasopressins; D012965:Sodium Chloride