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. 2024 Oct 7;16(19):3400.
doi: 10.3390/nu16193400.

Association of Urinary Sodium, Potassium, and the Sodium-to-Potassium Ratio with Impaired Kidney Function Assessed with 24-H Urine Analysis

Urte Zakauskiene  1   2 , Nomeda Bratcikoviene  3   4 , Ernesta Macioniene  1   2 , Lina Zabuliene  1 , Diana Sukackiene  1   2 , Ausra Linkeviciute-Dumce  2 , Dovile Karosiene  2 , Valdas Banys  3 , Vilma Migline  5 , Algirdas Utkus  3 , Marius Miglinas  1   2
Affiliations

Association of Urinary Sodium, Potassium, and the Sodium-to-Potassium Ratio with Impaired Kidney Function Assessed with 24-H Urine Analysis

Urte Zakauskiene et al. Nutrients. .

Abstract

Background: Albuminuria and albumin excretion rate (AER) are important risk factors for chronic kidney disease (CKD) development. Despite the extensive evidence of the influence of sodium and potassium on cardiovascular health, the existing evidence regarding their impact on albuminuria and kidney disease is limited and inconsistent. Our study aimed to assess the correlation between urinary sodium and potassium excretion, and the sodium-to-potassium ratio (Na/K ratio) with impaired kidney function, particularly the AER and albuminuria. Materials and Methods: Data were collected from the Lithuanian NATRIJOD study. A total of 826 single 24-h urine samples from individuals aged 18 to 69 were collected and analyzed for their sodium and potassium levels, Na/K ratio, and AER. Albuminuria was defined as an AER exceeding 30 mg/24 h. Results: The participant mean age was 47.2 ± 12.1 years; 48.5% of the participants were male. The prevalence of albuminuria was 3%. Correlation analysis revealed a positive correlation between AER and urinary sodium excretion (rs = 0.21; p < 0.001) and urinary potassium excretion (rs = 0.28; p < 0.001). In univariate linear regression analysis, sodium and potassium excretion and the Na/K ratio were significant AER predictors with β coefficients of 0.028 (95% CI: 0.015; 0.041; p < 0.001), 0.040 (95% CI: 0.003; 0.077; p = 0.035), and 1.234 (95% CI: 0.210; 2.259; p = 0.018), respectively. In the multivariable model, only urinary sodium excretion remained significant, with a β coefficient of 0.028 (95% CI: 0.016; 0.041). Potential albuminuria predictive factors identified via univariate logistic regression included urinary sodium excretion (OR 1.00; 95% CI: 1:00; 1.01) and the Na/K ratio (OR 1.53; 95% CI: 1.11; 2.05). However, these factors became statistically insignificant in the multivariate model. Conclusions: Urinary sodium and potassium excretion and the Na/K ratio are significantly associated with kidney damage, considering the assessed 24-h albumin excretion rate and presence of albuminuria content.

Keywords: 24-h urine collection; AER; albumin excretion rate; albuminuria; potassium; sodium; sodium-to-potassium ratio.

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Conflict of interest statement

M.M. is the president of the Lithuanian Hypertension Society and the Lithuanian Kidney Foundation Chairmen. The other authors declare no conflicts of interest. The funders had no role in the study’s design, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results. The authors alone are responsible for the views expressed in this publication, and they do not necessarily represent the views, decisions, or stated policies of the institutions to which they are affiliated.

Figures

Figure 1
Figure 1
Flowchart of the study. n—number of participants, M—male, F—female.
Figure 2
Figure 2
The 24-h urinary albumin excretion rate box plots for the sodium, potassium, and Na/K ratio quartiles. The value 1 corresponds to interval (min, Q1], 2—(Q1, Q2], 3—(Q2, Q3], and 4—(Q3, max). The lines at the top of the plot highlight statistically significant differences between quartile groups as determined using the Kruskal–Wallis test. Significance levels are indicated as follows: * p-value < 0.05, ** p-value < 0.001, *** p-value < 0.0001.
Figure 3
Figure 3
Correlogram showing the pairwise correlations between urinary sodium and potassium excretion, the Na/K ratio, and AER. Positive and negative correlations are represented in blue and red, respectively. Color intensity and circle size are proportional to the correlation coefficients. Na/K ratio—sodium-to-potassium ratio, AER—albumin excretion rate.
Figure 4
Figure 4
Forest plot showing the crude and adjusted odds ratios of predictors in the ordinal logistic regression models.
See this image and copyright information in PMC

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