How much sodium is safe in CKD?
The Kidney Disease Outcome Quality Initiative (K/DOQI) Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney Disease (Am J Kidney Dis 2004 May;43[5 Suppl 1]:S1-290) recommend restricting dietary sodium to reduce ECF volume expansion and lower BP, and that most CKD patients should reduce sodium intake to less than 100 mmol/day (2.4 g/day). Further reduction in sodium intake to less than 50 mmol/day (less than 1.2 g/ day) might lower BP further, the guidelines state.
The American Heart Association (www.americanheart.org) acknowledges that “since most salt intake comes from eating and drinking prepared and packaged foods, reading food labels to determine how much sodium is in a food or beverage is a great start to lowering sodium intake.” The association suggests practical ways to reduce sodium intake, which include:
- Not using salt at the table or in cooking.
- Avoiding salty seasonings (seasoned salts, sauces, bouillon)
- Choosing fresh fruits/vegetables and other low-sodium foods (less than 140 mg per serving) for canned and processed foods. People needing to limit potassium should check labels to be sure that “salt substitute” (potassium chloride) hasn’t been added to “low-sodium/reduced sodium” soups, etc.
- Avoiding high-sodium foods: canned soups/soup mixes, ham, sausage, bacon, hot dogs, deli meats, salted snacks, frozen dinners (more than 400 mg sodium), “fast foods.”
Patient education and public health efforts to lower the sodium content of our food may be key to achieving improved outcomes for people with CKD.