{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T15:43:34Z","timestamp":1790005414725,"version":"4.0.1"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2017,3]]},"abstract":"\n Background and objectives<\/jats:title>\n Patients with chronic kidney disease (CKD) are often volume expanded and hypertensive. Few controlled studies have assessed the effects of a sodium-restricted diet (SRD) in CKD.<\/jats:p>\n <\/jats:sec>\n \n Design, setting, participants, & measurements<\/jats:title>\n \n We conducted a randomized crossover trial to evaluate the effect of SRD (target <2 g sodium per day) versus usual diet on hydration status (by bioelectrical impedance spectroscopy) and blood pressure (BP) between May of 2009 and May of 2013. A total of 58 adults with stage 3\u20134 CKD were enrolled from two academic sites: University of Michigan (\n n<\/jats:italic>\n =37) and University of North Carolina at Chapel Hill (\n n<\/jats:italic>\n =21); 60% were men, 43% were diabetic, 93% were hypertensive, and mean age was 61 years. Participants followed SRD or usual diet for 4 weeks, followed by a 2-week washout period and a 4-week crossover phase. During the SRD, dieticians provided counseling every 2 weeks, using motivational interviewing techniques.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Whole-body extracellular volume and calf intracellular volume decreased by 1.02 L (95% confidence interval [95% CI], \u22121.48 to \u22120.56;\n P<\/jats:italic>\n <0.001) and \u22120.06 L (95% CI, \u22120.12 to \u22120.01;\n P<\/jats:italic>\n =0.02), respectively, implying decreased fluid content on the SRD compared with usual diet. Significant reductions in urinary sodium (\u221257.3 mEq\/24 h; 95% CI, \u221281.8 to \u221232.9), weight (\u22122.3 kg; 95% CI, \u22123.2 to \u22121.5), and 24-hour systolic BP (\u221210.8 mmHg; 95% CI, \u221217.0 to \u22124.6) were also observed (all\n P<\/jats:italic>\n <0.01). Albumin-to-creatinine ratio did not change significantly and mean serum creatinine increased slightly (0.1 mg\/dl; 95% CI, \u22120.01 to 0.2;\n P<\/jats:italic>\n =0.06). No period or carryover effects were observed. Results were similar when analyzed from phase 1 only before crossover, although\n P<\/jats:italic>\n values were modestly larger because of the loss of power.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this randomized crossover trial, implementation of SRD in patients with CKD stage 3\u20134 resulted in clinically and statistically significant improvement in BP and hydration status. This simple dietary intervention merits a larger trial in CKD to evaluate effects on major clinical outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.01120216","type":"journal-article","created":{"date-parts":[[2017,2,16]],"date-time":"2017-02-16T20:10:23Z","timestamp":1487275823000},"page":"399-407","source":"Crossref","is-referenced-by-count":82,"title":["A Randomized Crossover Trial of Dietary Sodium Restriction in Stage 3\u20134 CKD"],"prefix":"10.2215","volume":"12","author":[{"given":"Rajiv","family":"Saran","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin L.","family":"Padilla","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Kidney Epidemiology and Cost Center,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda W.","family":"Gillespie","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Consulting for Statistics, Computing and Analytics Research, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Heung","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott L.","family":"Hummel","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan;"},{"name":"Division Cardiology, Department of Internal Medicine, Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vimal Kumar","family":"Derebail","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertram","family":"Pitt","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan W.","family":"Levin","sequence":"additional","affiliation":[{"name":"Renal Research Institute, Research Division, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fansan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Renal Research Institute, Research Division, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samer R.","family":"Abbas","sequence":"additional","affiliation":[{"name":"Renal Research Institute, Research Division, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Liu","sequence":"additional","affiliation":[{"name":"Renal Research Institute, Research Division, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kotanko","sequence":"additional","affiliation":[{"name":"Renal Research Institute, Research Division, New York, New York; and"},{"name":"Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Klemmer","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2017,2,16]]},"reference":[{"key":"B1-20230813","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1053\/j.ackd.2014.09.004","article-title":"Epidemiology of hypertension in CKD.","volume":"22","author":"Horowitz","year":"2015","journal-title":"Adv Chronic 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