Serum sodium chloride levels may be an independent predictor of chronic kidney disease (CKD) progression, especially among individuals with CKD stage G4 and those with anemia, new findings suggest.

Yuichi Maruta, MD, of Showa University School of Medicine in Yokohama, Japan, and colleagues evaluated the association between low sodium chloride concentration (less than 34 mmol/L) and a composite outcome of renal function decline events (initiation of renal replacement therapy or a 50% decrease in estimated glomerular filtration rate) in a cohort of 2143 patients with CKD stage G3a–4.

The investigators observed the composite outcome in 405 patients (18.9%) over a 4-year follow-up period. A low serum sodium chloride level was associated with a significant 38% increased risk of the composite outcome in the overall cohort, but subgroup analysis showed that it was significantly associated with the composite outcome only among those with CKD stage G4, who had a 44% increased risk, Dr Maruta and colleagues reported online ahead of print in Clinical and Experimental Nephrology.

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The investigators also looked at the effect of hemoglobin level on the association between sodium chloride concentration and the composite outcome. Among patients with low sodium chloride levels, those with hemoglobin level below 12 g/dL (anemia) had a significant 1.5-fold increased risk of the composite outcome, whereas those with a level of 12 g/dL or higher had a non-significant 18% increased risk.


Maruta Y, Hasegawa T, Yamakoshi E, et al. Association between Na–Cl level and renal function decline in chronic kidney disease: results from the chronic kidney disease Japan cohort (CKD-JAC) study. Clin Exp Nephrol. 2018; published online ahead of print.