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Urinary Na/K ratio is a predictor of developing chronic kidney disease in the general population

Hypertension Research volume 47, pages 225–232 (2024)Cite this article

A Comment to this article was published on 16 September 2023

Abstract

Chronic kidney disease (CKD) is a major risk factor for cardiovascular diseases as well as end-stage kidney disease. Increased dietary sodium (Na) or decreased dietary potassium (K) deteriorates kidney function; however, findings regarding the association of dietary Na/K ratio with kidney function are limited and conflicting. Therefore, the present study investigated the impact of urinary Na/K ratio on the development of CKD, defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, in the Japanese general population. In total, 14,549 subjects without CKD who participated in our medical checkup were enrolled. The urinary Na/K ratio was measured using a sample of overnight urine. The subjects were followed up until the endpoint (onset of CKD). During the median follow-up period of 61.4 months, CKD developed in 2096 participants (25.9 per 1000 person-years). The risk of developing CKD increased across the quartiles of baseline urinary Na/K ratio in the Kaplan–Meier analysis (log-rank, P < 0.001). In multivariate Cox proportional hazard regression analysis, urinary Na/K ratio was a significant predictor of new-onset CKD after adjustment for important factors including eGFR at baseline (hazard ratio, 2.013; 95% confidence interval, 1.658–2.445; p < 0.001). Moreover, baseline urinary Na/K ratio was found to be independently correlated with yearly decline in eGFR. Similar results were obtained in subgroups of participants with and without hypertension. Thus, urinary Na/K ratio is significantly associated with the development of CKD in the general population.

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Authors and Affiliations

  1. Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan

    Hiroyuki Takase, Naomi Kawakatsu, Kazusa Hayashi, Fumihiko Kin & Takeru Isogaki

  2. Division of Internal Medicine, Faculty of Rehabilitation Sciences, Nagoya Gakuin University, Nagoya, Japan

    Yasuaki Dohi

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Takase, H., Kawakatsu, N., Hayashi, K. et al. Urinary Na/K ratio is a predictor of developing chronic kidney disease in the general population. Hypertens Res 47, 225–232 (2024). https://doi.org/10.1038/s41440-023-01399-4

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