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Association between the urinary sodium-to-potassium ratio and renal outcomes in patients with chronic kidney disease: a prospective cohort study

Hypertension Research volume 44, pages 1492–1504 (2021)Cite this article

Abstract

A higher urinary sodium-to-potassium (UNa/K) ratio has been reported to be associated with high blood pressure and subsequent cardiovascular events. However, the association between the UNa/K ratio and renal outcomes remains uncertain. We prospectively investigated the association between the UNa/K ratio and renal outcomes in patients with chronic kidney disease (CKD). We enrolled 716 patients with CKD, and 24-h urinary sodium and potassium excretion were measured. Patients were divided into UNa/K ratio tertiles (T1–T3). Endpoints were defined as a composite of doubling of serum creatinine (SCr), end-stage kidney disease (ESKD), or death and a composite of doubling of SCr or ESKD (added as an alternative outcome). We investigated the association between the UNa/K ratio and renal outcomes using a Cox proportional hazards model. During a median follow-up of 2.3 years, doubling of SCr, ESKD, or death and doubling of SCr or ESKD occurred in 332 and 293 patients, respectively. After adjustment for covariates including potentially confounding variables such as plasma renin activity, plasma aldosterone concentration, and B-type natriuretic peptide, the hazard ratios (HRs) (95% confidence intervals [CIs]) for the composite of doubling of SCr, ESKD, or death for T2 and T3 were 1.44 (1.06–1.96) and 1.59 (1.14–2.21), respectively, compared with T1. Additionally, compared with T1, the highest tertile (T3) of the UNa/K ratio was associated with a composite of doubling of SCr or ESKD (HR 1.55, 95% CI 1.09–2.20). A higher UNa/K ratio was independently associated with poor renal outcomes in patients with CKD.

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Acknowledgements

We would like to express our gratitude to the 716 participants of the study. We thank Richard Robins, PhD, from Edanz Group (https://en-author-services.edanz.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan

    Yuta Matsukuma, Masaru Nakayama, Susumu Tsuda, Akiko Fukui & Ryota Yoshitomi

  2. Department of Nephrology, Nara Medical University, Nara, Japan

    Kazuhiko Tsuruya

  3. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Toshiaki Nakano & Takanari Kitazono

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  1. Yuta Matsukuma
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Correspondence to Masaru Nakayama.

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Matsukuma, Y., Nakayama, M., Tsuda, S. et al. Association between the urinary sodium-to-potassium ratio and renal outcomes in patients with chronic kidney disease: a prospective cohort study. Hypertens Res 44, 1492–1504 (2021). https://doi.org/10.1038/s41440-021-00741-y

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