Salt Intake in Chronic Kidney Disease Patients| Hypertension

Salt Intake in Chronic Kidney Disease Patients typically has higher blood pressure (BP) hypertension than persons who have normal renal function. Sodium, or salt, is not only a crucial element for maintaining bodily fluid equilibrium, but it has also played an integral role in the history of mankind due to its economic, religious, and symbolic significance.

These people are especially vulnerable to increased salt intake, which may have a higher influence on blood pressure in CKD patients than in non-CKD patients. This finding might be explained by the fact that individuals with poor renal function have a reduced ability to eliminate the salt burden in the urine. Salt reduction strategies have the potential to reduce blood pressure hypertension in a simple, cost-efficient, and effective way, while also lowering the risk of cardiovascular disease (CVD) and CKD development.

The Ideal Amount of Salt to Consume| Hypertension

• It is recommended that healthy adults should consume 1,500 mg (1.5 grams) of sodium per day
• For people with CKD, Hypertension the current recommendation is to limit salt consumption to 2000 mg per day. 
• One of several various advantages of following a low-sodium diet is that it lowers blood pressure and reduces proteinuria.
• High sodium consumption has been demonstrated to reduce the effectiveness of drugs routinely used to treat HTN in CKD, and Hypertension even a slight reduction in sodium intake can help reverse these effects.
• Sodium restrictions, rather than additional drugs, appear to be more successful with Hypertension and CKD management.
• Adding salt to food accounts for around 15% of total salt consumption. Preservatives, canned goods, sauces, sweets, deli meats, and other hidden sources account for the remaining 85% of the total.

Measure Salt Intake| Hypertension

Urinary Sodium | Hypertension  

• Since almost all salt consumed is eliminated in the urine, the world health organization considers repeated 24-hour urine tests to be the gold standard.
• However, because sodium consumption varies greatly from day to day, the ability of 24-hour urine excretion to accurately reflect sodium intake over a period of time is directly proportional to the number of collections taken. 
• When looking at the influence of day-to-day fluctuation in sodium intake on outcomes in research trials, found that using a single measurement of 24-hour urine sodium excretion decreased the association between sodium and an outcome variable (e.g., blood pressure) by half.
• Spot urine sodium, often known as the sodium to creatinine ratio (Na: Cr), is an absolute assessment of dietary sodium consumption that is less time-consuming than 24-hour collection. 
• The usefulness of this test to indicate salt consumption is debatable, especially in CKD, where solute excretion may be abnormal.

Dietary Assessment Methods | Hypertension  

• Diet history, in which information about what is eaten over a while is obtained using open-ended questions, is seen to be a helpful tool for capturing typical consumption and is the most similar to dietary assessment methods used in clinical practice.
• When compared to other dietary assessment methods such as food records or 24-hour recall, this method has done well, and it has been thoroughly examined in terms of nutrients other than salt.

Measure Salt Intake in a Teaspoon  | Hypertension  

• It is recommended that individuals should not consume more than 2,300 milligrams (mg) of salt per day, with an ideal limit of no more than 1,500 mg per day.
• The estimated levels of sodium in a particular amount of table salt are measured as follows:
• 575 mg  = 1/4 teaspoon salt. 
• 1,150 mg = 1/2 teaspoon salt 
• 1 725 mg = 3/4 teaspoon salt 
• 2300 mg = 1 teaspoon salt 

Types of salt Available in the Market for Cooking | Hypertension  

Table salt | kidney disease

• This is the most common type of salt, and it’s also the most widely available. It receives extensive polishing in addition to being finely powdered with no evidence of contaminants. An anti-caking ingredient is added to the salt during processing to keep it from crumbling.
• Furthermore, today’s table salts contain iodine fortification, which protects against thyroid issues that are typically caused by iodine shortage. It has also been shown to be necessary for a child’s brain to develop properly.

Black salt (kala namak)| kidney disease

• In layman’s terms, Himalayan salt is also known as Indian black salt. 
• This salt is preserved using a combination of spices, charcoal, seeds, and tree bark.
• It’s also held for a whole day in a hot oven until it’s cooled, processed, and matured appropriately. This is how Kala namak gets its reddish black color.
• Bloating, constipation, heartburn, and stomach cramps and spasms are all believed to be treated with it.

Himalayan pink salt (sendha namak)

• Sendha namak, also known as Himalayan rose or pink salt, is one of the finest types of salt extracted on Pakistan’s Himalayan side. It is made up of 84 natural minerals and nutrients that are necessary for human health.
• It is available in various colors, ranging from white to deep pink. 
• Pink salt has been shown to aid in a range of biological processes, including blood sugar control, blood cell pH improvement, and the decrease of muscle cramps, making it the healthiest salt to take.

Smoked salt 

• Smoked salt is made by slowly smoking it over a wood fire, which usually consists of pine, hickory, apple, or alder wood. As the name implies, this salt enhances meals’ strong smokey flavors.
• Because the duration of the smoking process and the quality of the wood utilized determine the texture and flavor of the salt, it varies from one brand to the next.

Kosher salt 

• Table salt can be readily switched to kosher salt, which has a rough, flaky, and grainy appearance.
• Apart from their thickness and larger grains, the difference between the two salts is that kosher salts are not enriched with iodine and do not contain anti-caking ingredients.
• As it’s coarser, it may be used as a brush to top meats.

Alaea salt 

• Hawaiian red salt also referred to as Alaea salt, is a type of sea salt that has been blended with alaea, a rich volcanic clay iron oxide.
• Hawaiians have always used it to clean and cleanse their homes and temples.
• True Hawaiian red salt, which is estimated to contain at least 80 trace minerals, containing iron oxide, is costly and tough to obtain.

Sea salt| kidney disease

• The evaporation of seawater produces sea salt. It’s a salt that hasn’t been refined very much. In fact, it is said to contain more iodine and to have a unique non-melting quality when steamed.
• This keeps the granular texture of the dish and prevents it from becoming watery. Many people are interested in the reduced salt content these days.

Celery salt (ajmod ka namak)

This salt has a low sodium level when compared to other salts and is made by mixing celery seeds and seawater salt.

Role of Salt Play in Hypertension| Hypertension  

• Sodium is a critical nutrient for maintaining plasma volume, acid-base balance, nerve impulse transmission, and proper cell function.
• Elevated sodium has been related to a variety of negative health effects, including high blood pressure.
• High sodium intake (>2 grams per day, or 5 grams of salt per day) raises blood pressure hypertension and raises the risk of heart disease ,kidney disease and stroke.
• Salt is the most common source of sodium in our diet, but sodium glutamate, a condiment used in many regions of the globe, can also be a source.
• It is advised to consume no more than 2,300 milligrams (mg) of salt per day for most people, especially those with high blood pressure, with an ideal limit of no more than 1,500 mg of salt per day. Even a 1,000 mg reduction each day can help with blood pressure and kidney health.

Can salt intake cause high potassium levels?

• Potassium levels often fluctuate with sodium levels, as a result of increased salt consumption.
• When sodium levels rise, potassium levels fall, resulting in hypokalemia, and when sodium levels fall, potassium levels rise, resulting in hyperkalemia. The adrenal glands produce a hormone called aldosterone, which affects potassium levels.
• Other factors that affect potassium levels include the pace at which the kidneys function, the pH of the blood, the quantity of potassium intake, hormone levels in the body, severe vomiting, and the use of certain medications such as diuretics and potassium supplements.
• A potassium level that is very high or excessively low might be dangerous. Symptoms of abnormal potassium levels include muscle cramps or weakness, nausea, diarrhea, frequent urination, dehydration, low blood pressure, disorientation, irritability, paralysis, and heart rhythm abnormalities.

WHO recommendations for salt reduction |chronic kidney Disease

• Adults should take less than 5 g (slightly under a teaspoon) of salt per day.
• For children, the WHO advises that the recommended maximum salt consumption for adults be lowered for children aged two to fifteen years due to a low energy requirement than adults.
• Iodine is required for proper brain development in the fetus and newborn child, as well as enhancing people’s mental performance in general, hence all salt should be iodized or “enriched” with it.

Salt intake in fluid overload ?kidney disease

• Reduced salt consumption will aid in the reduction of extra fluid in the body.
• When we consume too much salt, our bodies retain additional sodium, increasing the quantity of fluid outside of our cells. This increase in fluid permits the body to maintain sodium and fluid retention while excreting increased sodium levels in the urine. 
• When we eat too much salt, we retain about 1.5 liters of fluid in our bodies, and this continues as long as we ingest more salt.
• Eat less salt if you have heart failure, renal disease, or liver cirrhosis.
• Reduced salt consumption can help those suffering from idiopathic and cyclical edema (major causes of fluid retention).

Tips to reduce salt intake| Chronic Kidney Disease

• Eat a lot of veggies, fruit and choose entire unprocessed meals.
• Before you buy anything, read the labels to help you pick less salty products.
• Remove salt and salty sauces from the table so that younger members of the family do not develop the habit of salting their food.
• To add flavor to your meal during cooking and at the table, use herbs, spices, garlic, and citrus in place of salt.
• Reduce your consumption of processed meats, smoked meats, and salty fast food.
• Be cautious of items like cottage cheese that don’t taste particularly salty yet have a high sodium level.
• If you have high blood pressure, limiting salt in your diet will help, you not only decrease your blood pressure but also improve how well you respond to blood pressure drugs.
• The salt choice is a learned taste that can be undone. It takes around 6-8 weeks to become used to eating foods with considerably lower salt levels, but once you do, items like potato chips are really difficult to consume since they are far too salty.