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Urinary Sodium-to-Potassium Ratio and Incident Chronic Kidney Disease

Results From the Korean Genome and Epidemiology Study
Published:November 03, 2022DOI:



      To evaluate the association of sodium-potassium intake balance on kidney function.

      Patients and Methods

      Data from the Korean Genome and Epidemiology Study were used. The participants were enrolled between June 1, 2001, and January 31, 2003, and were followed-up until December 31, 2016. The 24-hour excretion levels of sodium and potassium were calculated using the Kawasaki formula with spot urinary potassium and sodium measurements. Participants were categorized into tertiles according to the estimated 24-hour urinary sodium-to-potassium (Na/K) ratio. The primary outcome was incident chronic kidney disease (CKD), defined as an estimated glomerular filtration rate of <60 mL/min per 1.73 m2 in two or more consecutive measurements during the follow-up period.


      This study included 4088 participants with normal kidney function. The mean age was 52.4±8.9 years, and 1747 (42.7%) were men. The median estimated 24-hour urinary sodium excretion level, potassium excretion level, and Na/K ratio (inter quartile range) were 4.9 (4.1-5.8) g/d, 2.1 (1.8-2.5) g/d, and 2.3 (1.9-2.7) g/d, respectively. During 37,950 person-years of follow-up (median, 11.5 years), 532 participants developed CKD, and the corresponding incidence rate was 14.0 (95% CI, 12.9-15.3) per 1000 person-years. Multivariable Cox hazard analysis revealed that the risk of incident CKD was significantly lower in the lowest tertile than in the highest tertile (HR, 0.78; 95% CI, 0.63-0.97). However, no significant association was found with incident CKD risk when urinary excretion levels of sodium or potassium were evaluated individually.


      A low urinary Na/K ratio may relate with lower CKD development risk in adults with preserved kidney function.

      Abbreviations and Acronyms:

      BP (blood pressure), CKD (chronic kidney disease), CVD (cardiovascular disease), eGFR (estimated glomerular filtration ratio), KoGES (Korean Genome and Epidemiology study), Na/K (sodium-to-potassium)
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