Validation and Assessment of Three Methods to Estimate 24-h Urinary Sodium Excretion from Spot Urine Samples in High-Risk Elder Patients of Stroke from the Rural Areas of Shaanxi Province

Wenxia Ma, Xuejun Yin, Ruijuan Zhang, Furong Liu, Danrong Yang, Yameng Fan, Jie Rong, Maoyi Tian and Yan Yu
Additional contact information
Wenxia Ma: Xi’an Jiaotong University Health Science Center, School of Public Health, No. 76 West Yanta Road, Xi’an 710061, Shaanxi, China
Xuejun Yin: The George Institute for Global Health at Peking University Health Science Center, No. 6 Zhichun Road Haidian District, Beijing 100088, China
Ruijuan Zhang: Xi’an Jiaotong University Health Science Center, School of Public Health, No. 76 West Yanta Road, Xi’an 710061, Shaanxi, China
Furong Liu: Xi’an Jiaotong University Health Science Center, School of Public Health, No. 76 West Yanta Road, Xi’an 710061, Shaanxi, China
Danrong Yang: Xi’an Jiaotong University Health Science Center, School of Public Health, No. 76 West Yanta Road, Xi’an 710061, Shaanxi, China
Yameng Fan: Xi’an Jiaotong University Health Science Center, School of Public Health, No. 76 West Yanta Road, Xi’an 710061, Shaanxi, China
Jie Rong: Xi’an Jiaotong University Health Science Center, School of Public Health, No. 76 West Yanta Road, Xi’an 710061, Shaanxi, China
Maoyi Tian: The George Institute for Global Health at Peking University Health Science Center, No. 6 Zhichun Road Haidian District, Beijing 100088, China
Yan Yu: Xi’an Jiaotong University Health Science Center, School of Public Health, No. 76 West Yanta Road, Xi’an 710061, Shaanxi, China

IJERPH, 2017, vol. 14, issue 10, 1-15

Abstract: Background : 24-h urine collection is regarded as the “gold standard” for monitoring sodium intake at the population level, but ensuring high quality urine samples is difficult to achieve. The Kawasaki, International Study of Sodium, Potassium, and Blood Pressure (INTERSALT) and Tanaka methods have been used to estimate 24-h urinary sodium excretion from spot urine samples in some countries, but few studies have been performed to compare and validate these methods in the Chinese population. Objective : To compare and validate the Kawasaki, INTERSALT and Tanaka formulas in predicting 24-h urinary sodium excretion using spot urine samples in 365 high-risk elder patients of strokefrom the rural areas of Shaanxi province. Methods : Data were collected from a sub-sample of theSalt Substitute and Stroke Study. 365 high-risk elder patients of stroke from the rural areas of Shaanxi province participated and their spot and 24-h urine specimens were collected. The concentrations of sodium, potassium and creatinine in spot and 24-h urine samples wereanalysed. Estimated 24-h sodium excretion was predicted from spot urine concentration using the Kawasaki, INTERSALT, and Tanaka formulas. Pearson correlation coefficients and agreement by Bland-Altman method were computed for estimated and measured 24-h urinary sodium excretion. Results : The average 24-h urinary sodium excretion was 162.0 mmol/day, which representing a salt intake of 9.5 g/day. Three predictive equations had low correlation with the measured 24-h sodium excretion (r = 0.38, p < 0.01; ICC = 0.38, p < 0.01 for the Kawasaki; r = 0.35, p < 0.01; ICC = 0.31, p < 0.01 for the INTERSALT; r = 0.37, p < 0.01; ICC = 0.34, p < 0.01 for the Tanaka). Significant biases between estimated and measured 24-h sodium excretion were observed (all p < 0.01 for three methods). Among the three methods, the Kawasaki method was the least biased compared with the other two methods (mean bias: 31.90, 95% Cl: 23.84, 39.97). Overestimation occurred when the Kawasaki and Tanaka methods were used while the INTERSALT method underestimated 24-h sodium excretion. Conclusion : The Kawasaki, INTERSALT and Tanaka methods for estimation of 24-h urinary sodium excretion from spot urine specimens were inadequate for the assessment of sodium intake at the population level in high-risk elder patients of stroke from the rural areas of Shaanxi province, although the Kawasaki method was the least biased compared with the other two methods.

Keywords: 24-h urine; spot urine; urinary sodium excretion (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2017
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