Clinical Question

Does reducing dietary salt intake lower blood pressure or albuminuria in patients with chronic kidney disease (CKD)?

Evidence-Based Answer

In patients with CKD, reducing dietary salt intake by approximately 4.2 g per day (73.5 mmol or 1,690 mg of sodium) lowers mean systolic blood pressure by 6.9 mm Hg (95% CI, 5.0 to 8.8 mm Hg) and diastolic blood pressure by 3.9 mm Hg (95% CI, 3.0 to 4.8 mm Hg) compared with patients on a higher salt diet. In patients with CKD who do not have end-stage renal disease, a low-salt diet also decreases mean albuminuria by 36% (95% CI, 26% to 44%) compared with a higher salt diet.¹ (Strength of Recommendation: C, disease-oriented evidence.)

Practice Pointers

CKD is a major global health concern affecting an estimated 9.37% of the world's population, and was the 6th most common cause of non–injury-related death in 2019 in the adult population, accounting for 1.42 million deaths worldwide.² There has been a 42% increase in deaths among patients with CKD from 2009 to 2019, making it one of the fastest rising major causes of death. The risk of cardiovascular disease and death increases with worsening glomerular filtration rate, which is a measurement used to determine the severity of CKD. Effective strategies for prevention of these negative outcomes might improve patient prognosis and reduce health care costs. Dietary salt intake is a modifiable risk factor thought to reduce progression of CKD, so the authors of this review sought to discern the benefits and harms of reducing dietary salt intake in adults with CKD.