Objective: To investigate the associations between 24-hour urinary sodium excretion (24hUNaE) and all-cause mortality in adult Northern Chinese population. Methods: Data from this study were derived from the prospective urban and rural epidemiology (PURE) study in north China. Baseline information of all participants were obtained by face to face interview through trained research staffs based on questionnaires, and morning fasting urine samples of participants were collected to estimate 24hUNaE and 24-hour potassium excretion (24hUKE). Multivariable frailty Cox regression models were used to explore the association between 24hUNaE (<3.00, 3.00-3.99, 4.00-4.99, 5.00-5.99 and ≥6 g/d) and all-cause death. Results: A total of 27 310 participants were included in this study. The mean 24hUNaE was (5.84±1.73) g/d. After a median follow-up of 8.8 years, 1 024 participants died (3.7%), including 390 cardiovascular related deaths and 591 non-cardiovascular related deaths. The cause of death of the remaining patients could not be determined. Using 24hUNaE level of 4.00-4.99 g/d as the reference group, after fully adjustment, 24hUNaE ≥6.00 g/d was associated with an increased risk of all-cause death (HR=1.24, 95%CI: 1.02-1.49) and cardiovascular related death (HR=1.39, 95%CI: 1.02-1.88). 24hUNaE<3.00 g/d was associated with increased risk of all-cause mortality (HR=1.38, 95%CI: 0.96-1.99). There was no significant association between 24hUNaE and non-cardiovascular related death. Furthermore, using the combination of 24hUNaE 4.00-4.99 g/d and 24hUKE≥2.11 g/d as the reference group, the highest risk occurred in participants with the combination of low sodium (<3.00 g/d) and low potassium (<2.11 g/d). Conclusion: 24hUNaE equal or higher than 6 g/d or lower than 3 g/d is associated with increased risk of all-cause mortality and cardiovascular related death in Northern Chinese population. Besides, moderate sodium intake in combination with increased potassium intake might reduce the risk of all-cause death.
Humans ; Adult ; Sodium/urine* ; Prospective Studies ; Potassium/urine* ; China/epidemiology* ; Proportional Hazards Models ; Cardiovascular Diseases/epidemiology*

BACKGROUND: The low accuracy of equations predicting 24-h urinary sodium excretion using a single spot urine sample contributed to the misclassification of individual sodium intake levels. The application of single spot urine sample is limited by a lack of representativity of urinary sodium excretion, possibly due to the circadian rhythm in urinary excretion. This study aimed to explore the circadian rhythm, characteristics, and parameters in a healthy young adult Chinese population as a theoretical foundation for developing new approaches. METHODS: Eighty-five participants (mean age 32.4 years) completed the 24-h urine collection by successively collecting each of the single-voided specimens within 24 h. The concentrations of the urinary sodium, potassium, and creatinine for each voided specimen were measured. Cosinor analysis was applied to explore the circadian rhythm of the urinary sodium, potassium, and creatinine excretion. The excretion per hour was computed for analyzing the change over time with repeated-measures analysis of variance and a cubic spline model. RESULTS: The metabolism of urinary sodium, potassium, and creatinine showed different patterns of circadian rhythm, although the urinary sodium excretion showed non-significant parameters in the cosinor model. A significant circadian rhythm of urinary creatinine excretion was observed, while the circadian rhythm of sodium was less significant than that of potassium. The circadian rhythm of urinary sodium and creatinine excretion showed synchronization to some extent, which had a nocturnal peak and fell to the lowest around noon to afternoon. In contrast, the peak of potassium was observed in the morning and dropped to the lowest point in the evening. The hourly urinary excretion followed a similar circadian rhythm. CONCLUSION It is necessary to consider the circadian rhythm of urinary sodium, potassium, and creatinine excretion in adults while exploring the estimation model for 24-h urinary sodium excretion using spot urine.
Adult ; China ; Circadian Rhythm ; Creatinine ; Humans ; Potassium ; Sodium ; Urine Specimen Collection ; Young Adult

urine instead of 24-hour (hr) urine collection. Nevertheless, the optimal method for assessing daily sodium intake remains unclear.SUBJECTS/METHODS: Fifteen male (age 32.7 ± 6.5 years) participants were offered 3 meals with a total of 9–10 g salt over 24 hours, and 24-hr urine was collected from the second-void urine of the first day to the first-void urine of the second day. Twenty-four-hr urinary sodium (24UNa) was estimated using Tanaka's equation and the Korean formula, and spot urine Na, potassium (K), chloride (Cl), urea nitrogen (UN), creatinine (Cr), specific gravity (SG) and osmolality (Osm) were measured. The ratios of urinary Na to other parameters were calculated, and correlations with total measured 24UNa were identified.RESULTS: Average 24-hr urine volume was 1,403 ± 475 mL, and measured 24UNa was 143.9 ± 42.1 mEq (range, 87.1–239.4 mEq). Measured 24UNa was significantly correlated with urinary Na/UN (r = 0.560, P < 0.01), urinary Na/Osm (r = 0.510, P < 0.01), urinary Na/Cr (r = 0.392, P < 0.01), urinary Na/K (r = 0.290, P < 0.01), 24UNa estimated using Tanaka's equation (r = 0.452, P < 0.01) and the Korean formula (r = 0.414, P < 0.01), age (r = 0.548, P < 0.01), weight (r = 0.497, P < 0.01), and height (r = 0.393, P < 0.01) in all spot urine samples. Estimated 24UNa based on the second-void spot urine of the first day tended to be more closely correlated with measured 24UNa than were estimates from the other spot urine samples. The significant parameters correlated with the second-void urine of the first day were urinary Na/K (r = 0.647, P < 0.01), urinary Na/Cr (r = 0.558, P < 0.05), and estimated 24UNa using Tanaka's equation (r = 0.616, P < 0.05) and the Korean formula (r = 0.588, P < 0.05).CONCLUSIONS: Second-void urine is more reliable than first-void urine for estimating 24UNa. Urinary Na/K in the second-void urine on the first day is significantly correlated with 24UNa. Further studies are needed to establish the most reliable index and the optimal time of urine sampling for predicting 24UNa.]]>
Creatinine ; Humans ; Male ; Meals ; Methods ; Nitrogen ; Osmolar Concentration ; Potassium ; Sodium ; Sodium, Dietary ; Specific Gravity ; Urea ; Urine Specimen Collection

BACKGROUND: Estimates of daily sodium (Na) and potassium (K) excretion were explicitly biased when using equations for adults. We aimed to develop equations to estimate them using overnight urine from Japanese children and adolescents. METHODS: The subjects comprised 70 students aged 10.49-15.76 years: validation group, n = 34; and verification group, n = 36. Each subject performed two operations of overnight spot urine (U RESULTS: In validation, we formulated Na excretion (mg d CONCLUSION We obtained validated equations to estimate daily Na and K excretion with accessible variables such as Na, K, and Cr concentrations of overnight urine, body height and weight, and age for children and adolescents. When using the obtained equations, caution should be paid to small but definite biases and measurement errors.
Adolescent ; Child ; Creatinine/urine* ; Female ; Humans ; Japan ; Male ; Potassium/urine* ; Sodium/urine*

PURPOSE: We investigated whether C-reactive protein (CRP) levels, urine protein-creatinine ratio (uProt/Cr), and urine electrolytes can be useful for discriminating acute pyelonephritis (APN) from other febrile illnesses or the presence of a cortical defect on 99mTc dimercaptosuccinic acid (DMSA) scanning (true APN) from its absence in infants with febrile urinary tract infection (UTI). MATERIALS AND METHODS: We examined 150 infants experiencing their first febrile UTI and 100 controls with other febrile illnesses consecutively admitted to our hospital from January 2010 to December 2012. Blood (CRP, electrolytes, Cr) and urine tests [uProt/Cr, electrolytes, and sodium-potassium ratio (uNa/K)] were performed upon admission. All infants with UTI underwent DMSA scans during admission. All data were compared between infants with UTI and controls and between infants with or without a cortical defect on DMSA scans. Using multiple logistic regression analysis, the ability of the parameters to predict true APN was analyzed. RESULTS: CRP levels and uProt/Cr were significantly higher in infants with true APN than in controls. uNa levels and uNa/K were significantly lower in infants with true APN than in controls. CRP levels and uNa/K were relevant factors for predicting true APN. The method using CRP levels, u-Prot/Cr, u-Na levels, and uNa/K had a sensitivity of 94%, specificity of 65%, positive predictive value of 60%, and negative predictive value of 95% for predicting true APN. CONCLUSION: We conclude that these parameters are useful for discriminating APN from other febrile illnesses or discriminating true APN in infants with febrile UTI.
Acute Disease ; C-Reactive Protein/*analysis ; Case-Control Studies ; Fever/microbiology ; Humans ; Infant ; Male ; Potassium/*urine ; Predictive Value of Tests ; Prospective Studies ; Proteinuria/diagnosis ; Pyelonephritis/*diagnosis/radionuclide imaging ; Sensitivity and Specificity ; Sodium/*urine ; *Technetium Tc 99m Dimercaptosuccinic Acid ; Urinary Tract Infections/drug therapy/microbiology/*radionuclide imaging

Sodium and potassium intake was assessed on the basis of its respective excretion levels in 24 hr urine samples. However, owing to the inconvenience of collection, we evaluated random spot urine for alternative sodium and potassium excretion markers. We included 250 patients who submitted 24 hr- and spot urine for clinical tests. However, 22 patients who showed 24 hr urine creatinine excretion levels <500 mg/day were excluded, because these samples possibly resulted from incomplete urine collection. Moreover, 24 patients were excluded because of their use of diuretics during the urine collection period. We observed significant correlations between 24 hr urine sodium excretion and both the sodium/creatinine (r=0.34, P<0.0001) and the sodium/specific gravity unit (SGU) ratios (r=0.19, P=0.007) in random urine samples. Similarly, 24 hr urine potassium excretion and both the spot urine potassium/creatinine (r=0.47, P<0.0001) and potassium/SGU ratios (r=0.28, P<0.0001) were significantly correlated. Although the estimated sodium/creatinine and potassium/creatinine ratios showed a significant correlation with 24 hr urine sodium and potassium excretion, respectively, further studies are required to develop a spot urine test for individualized monitoring of sodium and potassium excretion.
Biomarkers/urine ; Creatinine/*urine ; Humans ; Hypertension/pathology/urine ; Potassium/*urine ; Sodium/*urine ; Urinalysis ; Urine Specimen Collection

To study the function of expelling water retention with drastic purgative of different polarities of Kansui Radix stir-baked with vinegar on the cancerous ascites model rats, the furosemide was taken as positive control drug, and the cancerous ascites model rats were respectively orally administered with different polarities of Kansui Radix stir-baked with vinegar for 7 d. The amount of urine and ascites, the level of urinary sodium, potassium, chloride ion and pH, and the content of PRL1, AII, ALD in serum were investigated. Compared with model groups, ethyl acetate extract group showed a decreasing trend in ascites; the amount of urine of showed a significant increase (P < 0.05); the level of urinary sodium, potassium, chloride ion (P < 0.05, P < 0.01), pH (P < 0.05), and the content of PRL1, AII, ALD in serum all showed a significant decrease (P < 0.01). The effects of petroleum ether extract and n-butanol extract were weaker than that of ethyl acetate extract. The water exact was the weakest. The results showed that ethyl acetate extract is the active part of Kansui Radix stir-baked with vinegar on the function of expelling water retention with drastic purgative on the cancerous ascites model rats, alleviating the water-electrolyte disorder and body fluid acid-base imbalance, regulating the renin angiotensin aldosterone system.
Animals ; Ascites ; drug therapy ; metabolism ; Cathartics ; administration & dosage ; chemistry ; isolation & purification ; Chemistry, Pharmaceutical ; Drugs, Chinese Herbal ; administration & dosage ; chemistry ; isolation & purification ; Euphorbia ; chemistry ; Humans ; Male ; Plant Roots ; chemistry ; Potassium ; urine ; Rats ; Rats, Sprague-Dawley ; Sodium ; urine ; Water ; metabolism

PURPOSE: The purpose of this study was to examine the effects of a face-to-face self-management educational program on knowledge, self-care practice and kidney function in patients with chronic kidney disease (CKD) before kidney replacement therapy. METHODS: This study employed a nonequivalent control group, non-synchronized design. Data were collected from 61 patients with CKD visiting an outpatient department of nephrology in a university hospital in Seoul, South Korea. The experimental group (n=31) took the pre-test, then after 3 weeks, face-to-face education and individualized consultation (1st intervention), after a week of self-practice, the 1st post-test, followed by re-enforcement education and consultation (2nd intervention), and 4 weeks later, the 2nd post-test. The control group (n=30) took the pre-test and post-tests at 4 and 8 weeks. RESULTS: Scores for knowledge of CKD and self-care practice over time improved significantly in the experimental group compared to the control group. Kidney function did not improve significantly in the experimental group. CONCLUSION: Health care providers can identify various and individualized needs, and provide effective education and consultation through face to face self-management for patients with chronic irreversible illnesses. Nurses can coordinate for these program by designing and providing systematic and effective education.
Adult ; Aged ; Blood Urea Nitrogen ; Calcium/blood ; Creatinine/blood ; Female ; Glomerular Filtration Rate ; *Health Knowledge, Attitudes, Practice ; Hemoglobins/analysis ; Humans ; Kidney/*metabolism ; Male ; Middle Aged ; *Patient Education as Topic ; Phosphates/blood ; Potassium/urine ; Program Evaluation ; Renal Insufficiency, Chronic/*psychology ; Renal Replacement Therapy ; *Self Care ; Sodium/urine

Thiazide is known to decrease urinary calcium excretion. We hypothesized that thiazide shows different hypocalciuric effects depending on the stimuli causing hypercalciuria. The hypocalciuric effect of hydrochlorothiazide (HCTZ) and the expression of transient receptor potential vanilloid 5 (TRPV5), calbindin-D(28K), and several sodium transporters were assessed in hypercalciuric rats induced by high calcium diet and vitamin D3. Urine calcium excretion and the expression of transporters were measured from 4 groups of Sprague-Dawley rats; control, HCTZ, high calcium-vitamin D, and high calcium-vitamin D with HCTZ groups. HCTZ decreased urinary calcium excretion by 51.4% in the HCTZ group and only 15% in the high calcium-vitamin D with HCTZ group. TRPV5 protein abundance was not changed by HCTZ in the high calcium-vitamin D with HCTZ group compared to the high calcium-vitamin D group. Protein abundance of NHE3, SGLT1, and NKCC2 decreased in the hypercalciuric rats, and only SGLT1 protein abundance was increased by HCTZ in the hypercalciuric rats. The hypocalciuric effect of HCTZ is attenuated in high calcium and vitamin D-induced hypercalciuric rats. This attenuation seems to have resulted from the lack of HCTZ's effect on protein abundance of TRPV5 in severe hypercalciuric condition induced by high calcium and vitamin D.
Animals ; Calcium/therapeutic use/urine ; Calcium Channels/genetics/metabolism ; Cholecalciferol/*toxicity ; Hydrochlorothiazide/*therapeutic use ; Hypercalciuria/chemically induced/*drug therapy ; Rats ; Rats, Sprague-Dawley ; Sodium Chloride Symporter Inhibitors/*therapeutic use ; Sodium-Glucose Transporter 1/genetics/metabolism ; Sodium-Hydrogen Antiporter/genetics/metabolism ; Sodium-Potassium-Chloride Symporters/genetics/metabolism ; TRPV Cation Channels/genetics/metabolism

BACKGROUND/AIMS: Twenty-four hour urinary sodium excretion (24-h UNa) of greater than 78 mmol/day is important in the management of cirrhotic ascites. Although the random urine sodium-to-potassium ratio (UNa/K) is strongly correlated with 24-h UNa, and approximately 95% of patients with a random UNa/K greater than 1 have 24-h UNa greater than 78 mmol, few data have been published on the correlation between 24-h UNa and random UNa/K. We evaluated diagnostic value of morning and afternoon random UNa/K (AM UNa/K and PM UNa/K, respectively) with 24-h UNa. METHODS: A total of 42 male patients were enrolled from October 2007 to March 2008. Each patient collected 5 mL of urine twice at random times during 24-h urine collection (at 10-12 a.m. and 3-5 p.m.). ROC curve analysis was performed to evaluate the feasibility of AM and PM UNa/K for differentiating 24-h UNa greater than 78 mmol/day. RESULTS: Forty patients with a 24-h urinary creatinine of greater than 15 mg/kg were analyzed. The 24-h UNa, AM UNa/K, and PM UNa/K were 107.9+/-91.2 mmol (mean+/-SD), 3.44+/-3.64, and 3.97+/-4.60, respectively. When compared with 24-h UNa greater than 78 mmol, AUROC values for AM and PM UNa/K were 0.861 (95% CI, 0.715-0.950) and 0.929 (95% CI, 0.802-0.986), respectively (P=0.0001). No difference was found between the AUROC for AM and PM UNa/K (95% CI, -0.161-0.153, P=0.113). UNa/K greater than 1.25 was sensitive and specific for prediction of 24-h UNa greater than 78 mmol. CONCLUSIONS: The results suggest that anytime random UNa/K greater than 1.25 is an accurate, cost-effective, and convenient method for replacing 24-h UNa. Large multicentered cohort studies are needed to confirm our results.
Adult ; Aged ; Ascites/*diagnosis/etiology ; Creatinine/urine ; Data Interpretation, Statistical ; Humans ; Liver Cirrhosis/complications/*diagnosis ; Male ; Middle Aged ; Pilot Projects ; Potassium/*urine ; Predictive Value of Tests ; ROC Curve ; Sodium/*urine ; Time Factors