P90
DIETARY SODIUM INTAKE AS ASSESSED 24 HOUR URINARY SODIUM
EXCRETION 1 YEAR POST RENAL TRANSPLANT DOES NOT PREDICT
SUBSEQUENT GRAFT OUTCOME
Raza H1, Wodeyar H2, Kemp G.J3¸ Howse M4
1
Renal Unit, Royal Liverpool University Hospital, Liverpool, 2Renal Unit, University
Hospital Aintree, Liverpool, 3Department of Musculoskeletal Biology II Institute of Ageing
and Chronic Disease Faculty of Health and Life Sciences University of Liverpool, 4Renal
Unit, Royal Liverpool University Hospital, Liverpool
INTRODUCTION: Kidney Disease Improving Global Outcomes (KDIGO) clinical practice
guidelines recommend dietary sodium intake of less than 2.4 g/d (less than 100 mmol/d) in
adults with CKD and hypertension .
There is evidence in patients with CKD that high sodium intake limits the antihypertensive
and antiproteinuric effects of angiotensin converting enzyme inhibitor (ACE-I) and hence
leads to progression of CKD independent of blood pressure (BP) control.(J Am SocNephrol
23: 165-173, 2012
High Urinary sodium in type 2 Diabetes Mellitus is associated with impaired cardiac diastolic
function. ClinCardiol. 2009 Oct;32(10):569-74
However there has not been any study in patients with renal transplant and the effect of high
sodium intake on renal transplant outcomes.
AIM:To determine whether dietary sodium intake, assessed by urinary sodium excretion, at
one year post transplant, impacts on subsequent transplant outcome.
METHODS:Data was retrospectively collected from the 230 patients who had renal
transplant from 2000 to 2003. All patients performed 24 hour urine collections. We compared
urinary sodium excretion at one year post-transplantation with subsequent transplant outcome
at ten years follow up. To allow for incomplete collections Na excretion was corrected for
urinary creatinine excretion.Death with function graft was counted as graft failure.
RESULTS:Between January 1st 2000 and 31st December 2003 there were 230 kidney alone
transplants performed. Of those 177 patients were included in study due to completeness of
data.There were 111 male recipients and 66 female recipients, mean age 47 years, live donor
transplant 36, deceased donor transplants 141, median HLA mismatch (range) A,B, DR 1,1,0. Mean Urinary sodium excretion was (mmol/day) 204+/-6(SD)
At ten-year post transplantation 138 (78%) of transplant were functioning, 26 patients (15%)
had died with a functioning transplant and 13 patients (7%) had experienced graft failure and
returned to dialysis or been retransplanted.
There was no significant difference in urinary sodium excretion corrected for urinary
creatinine excretion at one year post transplant between patients with a functioning or not
functioning transplant at 10 years follow-up (p value 0.61). There was, however, a statistically
significant relationship between serum creatinine(p value-<0.005) and 24-hour urinary protein
excretion(p value-0.03) between patients with a functioning or non-functioning transplant at
10 years follow-up.
CONCLUSION:
1-Dietary sodium intake, assessed by urinary sodium excretion, one year post renal
transplantation, does not predict subsequent transplant outcome.
2-We therefore hypothesize that dietary sodium restriction is unlikely to have an impact on
graft outcome.
3-As expected increased serum creatinine and proteinuria measured 1 year post transplant has
negative impact on graft survival. This confirms the validity of this data set.