{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:46:15Z","timestamp":1760240775963,"version":"build-2065373602"},"reference-count":45,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2019,9,12]],"date-time":"2019-09-12T00:00:00Z","timestamp":1568246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Sodium restriction may potentially reduce iodine intake. This study aimed to determine the effect of sodium restriction (dietary counseling) on 24-h urinary iodine excretion. Diuretics provide an alternative to sodium restriction and are frequently added to sodium restriction, so the effects of hydrochlorothiazide (50 mg daily) and combined therapy were also studied. We performed a post-hoc analysis of a Dutch multi-center, randomized cross-over trial in 45 patients with diabetic kidney disease with a mean age of 65 \u00b1 9 years, mean eGFR of 65 \u00b1 27 mL\/min\/1.73 m2, median albuminuria of 648 [230\u20132008] mg\/24 h and 84% were male. During regular sodium intake with placebo, mean 24 h urinary sodium and iodine excretion were 224 \u00b1 76 mmol\/24 h and 252 \u00b1 94 ug\/24 h, respectively (r = 0.52, p &lt; 0.001). Mean iodine excretion did not change significantly if sodium restriction and hydrochlorothiazide were applied separately; mean difference \u22128 ug\/day (95% CI \u221238, 22; p = 0.6) and 14 ug\/day (95% CI \u221224, 52; p = 0.5), respectively. Combined therapy induced a significant decrease in mean iodine excretion (\u221237 ug\/day; 95% CI \u221267, \u22127; p = 0.02), yet this was not seen to a clinically meaningful level. The number of patients with an estimated intake below recommended daily allowances did not differ significantly between the four treatment periods (p = 0.3). These findings show that sodium restriction is not a risk factor for iodine deficiency.<\/jats:p>","DOI":"10.3390\/nu11092204","type":"journal-article","created":{"date-parts":[[2019,9,12]],"date-time":"2019-09-12T10:56:06Z","timestamp":1568285766000},"page":"2204","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of Moderate Sodium Restriction and Hydrochlorothiazide on Iodine Excretion in Diabetic Kidney Disease: Data from a Randomized Cross-Over Trial"],"prefix":"10.3390","volume":"11","author":[{"given":"S. Heleen","family":"Binnenmars","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Corpeleijn","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arjan J.","family":"Kwakernaak","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, Amsterdam University Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daan J.","family":"Touw","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ido P.","family":"Kema","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8716-7115","authenticated-orcid":false,"given":"Gozewijn D.","family":"Laverman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, ZGT Hospital, 7600 SZ Almelo\/Hengelo, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3356-6791","authenticated-orcid":false,"given":"Stephan J. L.","family":"Bakker","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerjan","family":"Navis","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,9,12]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2012). Guideline: Sodium Intake for Adults and Children, World Health Organization."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1056\/NEJMsb1607161","article-title":"Dietary Sodium and Cardiovascular Disease Risk\u2014Measurement Matters","volume":"375","author":"Cogswell","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1093\/ajh\/hpu028","article-title":"Compared With Usual Sodium Intake, Low- and Excessive-Sodium Diets Are Associated With Increased Mortality: A Meta-Analysis","volume":"27","author":"Graudal","year":"2014","journal-title":"Am. J. Hypertens."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/S0140-6736(16)30467-6","article-title":"Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies","volume":"388","author":"Mente","year":"2016","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.1001\/jama.2011.574","article-title":"Fatal and Nonfatal Outcomes, Incidence of Hypertension, and Blood Pressure Changes in Relation to Urinary Sodium Excretion","volume":"305","author":"Kuznetsova","year":"2011","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1001\/jama.2010.69","article-title":"Reducing dietary sodium: the case for caution","volume":"303","author":"Alderman","year":"2010","journal-title":"JAMA"},{"key":"ref_7","first-page":"CD004022","article-title":"Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride","volume":"2017","author":"Jurgens","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1017\/S0007114517000733","article-title":"Decreased, but still sufficient, iodine intake of children and adults in the Netherlands","volume":"117","author":"Dekkers","year":"2017","journal-title":"Br. J. Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ershow, A.G., Skeaff, S.A., Merkel, J.M., and Pehrsson, P.R. (2018). Development of Databases on Iodine in Foods and Dietary Supplements. Nutrients, 10.","DOI":"10.3390\/nu10010100"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1016\/S0140-6736(08)61005-3","article-title":"Iodine-deficiency disorders","volume":"372","author":"Zimmermann","year":"2008","journal-title":"Lancet"},{"key":"ref_11","unstructured":"Mannar, M.G.V., and Dunn, J.T. (2019, June 11). Salt Iodization for the Elimination of Iodine Deficiency. Available online: http:\/\/www.ceecis.org\/iodine\/08_production\/00_mp\/SI_elim_IDD_1994venkatesh.pdf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/j.nut.2012.09.010","article-title":"A lowered salt intake does not compromise iodine status in Cape Town, South Africa, where salt iodization is mandatory","volume":"29","author":"Charlton","year":"2013","journal-title":"Nutrition"},{"key":"ref_13","first-page":"142","article-title":"Salt intake and iodine status of women in Samoa","volume":"25","author":"Land","year":"2016","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1017\/S0007114510002722","article-title":"Reduction of salt: will iodine intake remain adequate in The Netherlands?","volume":"104","year":"2010","journal-title":"Br. J. Nutr."},{"key":"ref_15","first-page":"147","article-title":"Effectiveness of iodine prophylaxis in hypertensive patients on salt restricted diet","volume":"113","author":"Grzesiuk","year":"2005","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1038\/ajh.2010.120","article-title":"Hypertension, Dietary Salt Restriction, and Iodine Deficiency among Adults","volume":"23","author":"Tayie","year":"2010","journal-title":"Am. J. Hypertens."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e020404","DOI":"10.1136\/bmjopen-2017-020404","article-title":"How will South Africa\u2019s mandatory salt reduction policy affect its salt iodisation programme? A cross-sectional analysis from the WHO-SAGE Wave 2 Salt & Tobacco study","volume":"8","author":"Charlton","year":"2018","journal-title":"BMJ Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e011168","DOI":"10.1136\/bmjopen-2016-011168","article-title":"Effect of salt reduction on iodine status assessed by 24 hour urinary iodine excretion in children and their families in northern China: a substudy of a cluster randomised controlled trial","volume":"6","author":"He","year":"2016","journal-title":"BMJ Open"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Musso, N., Conte, L., Carloni, B., Campana, C., Chiusano, M.C., and Giusti, M. (2018). Low-Salt Intake Suggestions in Hypertensive Patients Do not Jeopardize Urinary Iodine Excretion. Nutrients, 10.","DOI":"10.3390\/nu10101548"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Suckling, R.J., He, F.J., and MacGregor, G.A. (2010). Altered dietary salt intake for preventing and treating diabetic kidney disease. Cochrane Database Syst Rev., CD006763.","DOI":"10.1002\/14651858.CD006763.pub2"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/S2213-8587(14)70030-0","article-title":"Effects of sodium restriction and hydrochlorothiazide on RAAS blockade efficacy in diabetic nephropathy: a randomised clinical trial","volume":"2","author":"Kwakernaak","year":"2014","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1038\/sj.ki.5002011","article-title":"The effect of a shift in sodium intake on renal hemodynamics is determined by body mass index in healthy young men","volume":"71","author":"Krikken","year":"2007","journal-title":"Kidney Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1089\/thy.2009.0094","article-title":"Estimation of iodine intake from various urinary iodine measurements in population studies","volume":"19","author":"Vejbjerg","year":"2009","journal-title":"Thyroid"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/S0002-8223(01)00078-5","article-title":"Dietary Reference Intakes","volume":"101","author":"Trumbo","year":"2001","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A New Equation to Estimate Glomerular Filtration Rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_26","unstructured":"EMA (2019, June 11). Committee for Medicinal Products for Human Use. Guideline on bioanalytical method validation. EMEA\/CHMP\/EWP\/192217\/2009 Rev 1 Corr 2. 2012, 44(July 2011):1-23. Available online: https:\/\/www.ema.europa.eu\/en\/documents\/scientific-guideline\/guideline-bioanalytical-method-validation_en.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1017\/S1368980013001481","article-title":"Monitoring salt and iodine intakes in Dutch adults between 2006 and 2010 using 24 h urinary sodium and iodine excretions","volume":"17","author":"Hendriksen","year":"2014","journal-title":"Public Health Nutr."},{"key":"ref_28","unstructured":"Hendriksen, M., Etemad, Z., van den Bogaard, C.H., and van der, A.D.L. (2019, June 11). Zout-, jodium- en kaliuminname 2015. Rijksinst voor Volksgezond en Milieu. Available online: https:\/\/www.rivm.nl\/bibliotheek\/rapporten\/2016-0081.pdf."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/S0041-008X(73)80015-8","article-title":"Effect of diuretics on renal iodide excretion by humans","volume":"25","author":"Fregly","year":"1973","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1148\/radiology.187.3.8497641","article-title":"Diuretic-enhanced I-131 clearance after ablation therapy for differentiated thyroid cancer","volume":"187","author":"Seabold","year":"1993","journal-title":"Radiology"},{"key":"ref_31","first-page":"294","article-title":"Effect of diuretics on renal iodide excretion by rats and dogs","volume":"158","author":"McCarthy","year":"1967","journal-title":"J. Pharmacol. Exp. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1002\/j.1552-4604.1981.tb02549.x","article-title":"Hydrochlorothiazide-induced 131I excretion facilitated by salt and water","volume":"21","author":"Beyer","year":"1981","journal-title":"J. Clin. Pharmacol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1172\/JCI105218","article-title":"The effect of acute iodide depletion on thyroid function in man","volume":"44","author":"Barakat","year":"1965","journal-title":"J. Clin. Invest."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1007\/s00259-003-1251-9","article-title":"Effects of diuretics on iodine uptake in non-toxic goitre: comparison with low-iodine diet","volume":"30","author":"Kapucu","year":"2003","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_35","first-page":"1089","article-title":"Prolonged iodine clearance with a depletion regimen for thyroid carcinoma: concise communication","volume":"25","author":"Maruca","year":"1984","journal-title":"J. Nucl. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1089\/thy.2008.0400","article-title":"Unexpected effect of furosemide on radioiodine urinary excretion in patients with differentiated thyroid carcinomas treated with iodine 131","volume":"19","author":"Matovic","year":"2009","journal-title":"Thyroid"},{"key":"ref_37","unstructured":"Sheffer, M. (2019, June 11). Concise International Chemical Assessment Document 72 iodine and inorganic iodides: Human health aspects. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/43579\/9789241530729_eng.pdf?sequence=1&isAllowed=y."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"F1069","DOI":"10.1152\/ajprenal.90581.2008","article-title":"Role of pendrin in iodide balance: Going with the flow","volume":"297","author":"Kim","year":"2009","journal-title":"Am. J. Physiol. Physiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"F1179","DOI":"10.1152\/ajprenal.00211.2004","article-title":"The Cl\u2212\/HCO3\u2212 exchanger pendrin in the rat kidney is regulated in response to chronic alterations in chloride balance","volume":"287","author":"Quentin","year":"2004","journal-title":"Am. J. Physiol. Physiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2153","DOI":"10.1681\/ASN.2005101054","article-title":"Pendrin Regulation in Mouse Kidney Primarily Is Chloride-Dependent","volume":"17","author":"Vallet","year":"2006","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1172\/JCI105242","article-title":"Renal Tubular Reabsorption of Iodide as Compared with Chloride","volume":"44","author":"Walser","year":"1965","journal-title":"J. Clin. Investig."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Zahedi, K., Barone, S., Xu, J., and Soleimani, M. (2013). Potentiation of the Effect of Thiazide Derivatives by Carbonic Anhydrase Inhibitors: Molecular Mechanisms and Potential Clinical Implications. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0079327"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1681\/ASN.2007060693","article-title":"Effects of Dietary Sodium and Hydrochlorothiazide on the Antiproteinuric Efficacy of Losartan","volume":"19","author":"Vogt","year":"2008","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"d4366","DOI":"10.1136\/bmj.d4366","article-title":"Moderate dietary sodium restriction added to angiotensin converting enzyme inhibition compared with dual blockade in lowering proteinuria and blood pressure: Randomised controlled trial","volume":"343","author":"Slagman","year":"2011","journal-title":"BMJ"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1111\/jch.13551","article-title":"The International Consortium for Quality Research on Dietary Sodium\/Salt (TRUE) position statement on the use of 24-hour, spot, and short duration (<24 hours) timed urine collections to assess dietary sodium intake","volume":"21","author":"Campbell","year":"2019","journal-title":"J. Clin. Hypertens."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/11\/9\/2204\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:19:37Z","timestamp":1760188777000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/11\/9\/2204"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9,12]]},"references-count":45,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2019,9]]}},"alternative-id":["nu11092204"],"URL":"https:\/\/doi.org\/10.3390\/nu11092204","relation":{},"ISSN":["2072-6643"],"issn-type":[{"type":"electronic","value":"2072-6643"}],"subject":[],"published":{"date-parts":[[2019,9,12]]}}}