Increased Serum Sodium and Serum Osmolarity Are Independent Risk Factors for Developing Chronic Kidney Disease; 5 Year Cohort Study

• Published in: PloS one Vol. 12; no. 1; p. e0169137
• Main Authors: Kuwabara, Masanari, Hisatome, Ichiro, Roncal-Jimenez, Carlos A., Niwa, Koichiro, Andres-Hernando, Ana, Jensen, Thomas, Bjornstad, Petter, Milagres, Tamara, Cicerchi, Christina, Song, Zhilin, Garcia, Gabriela, Sánchez-Lozada, Laura G., Ohno, Minoru, Lanaspa, Miguel A., Johnson, Richard J.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 12.01.2017; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Aldehyde reductase; Biology and Life Sciences; Body mass; Body mass index; Body size; Cardiology; Chronic kidney failure; Cohort analysis; Complications and side effects; Creatinine; Cross-Sectional Studies; Dehydration; Diabetes; Diabetes mellitus; Drug therapy; Dyslipidemia; Epidemics; Female; Fructokinase; Health care; Health risks; Heart attacks; Heat stress; Heat tolerance; Hospitals; Humans; Hypertension; Hyperuricemia; Injury prevention; Japan; Kidney diseases; Kidney transplantation; Kidneys; Laboratories; Male; Medicine and Health Sciences; Metabolic disorders; Middle Aged; Nephrology; Obesity; Osmolar Concentration; Osmolarity; Osmosis; Osmotic pressure; Physical Sciences; Population; Potassium; Prevalence; Preventive medicine; Regression analysis; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - etiology; Research and Analysis Methods; Retrospective Studies; Risk analysis; Risk Factors; Rodents; Salts; Sex Factors; Sodium; Sodium (Chemical element); Sodium - blood; Studies; Sugarcane; Transplants & implants; Urinary Calculi - blood; Urinary Calculi - complications; Urinary Calculi - epidemiology; Vasopressin
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0169137

Epidemics of chronic kidney disease (CKD) not due to diabetes mellitus (DM) or hypertension have been observed among individuals working in hot environments in several areas of the world. Experimental models have documented that recurrent heat stress and water restriction can lead to CKD, and the mechanism may be mediated by hyperosmolarity that activates pathways (vasopressin, aldose reductase-fructokinase) that induce renal injury. Here we tested the hypothesis that elevated serum sodium, which reflects serum osmolality, may be an independent risk factor for the development of CKD. This study was a large-scale, single-center, retrospective 5-year cohort study at Center for Preventive Medicine, St. Luke's International Hospital, Tokyo, Japan, between 2004 and 2009. We analyzed 13,201 subjects who underwent annual medical examination of which 12,041 subjects (age 35 to 85) without DM and/or CKD were enrolled. This analysis evaluated age, sex, body mass index, abdominal circumference, hypertension, dyslipidemia, hyperuricemia, fasting glucose, BUN, serum sodium, potassium, chloride and calculated serum osmolarity. Elevated serum sodium was an independent risk factor for development of CKD (OR: 1.03, 95% CI, 1.00-1.07) after adjusted regression analysis with an 18 percent increased risk for every 5 mmol/L change in serum sodium. Calculated serum osmolarity was also an independent risk factor for CKD (OR: 1.04; 95% CI, 1.03-1.05) as was BUN (OR: 1.08; 95% CI, 1.06-1.10) (independent of serum creatinine). Elevated serum sodium and calculated serum osmolarity are independent risk factors for developing CKD. This finding supports the role of limiting salt intake and preventing dehydration to reduce risk of CKD.