Sodium Metabolism in Chronic Kidney Disease

Mark S. Paller

Research output: Chapter in Book/Report/Conference proceedingChapter

2 Scopus citations


Sodium balance is reasonably well maintained in CKD until renal function is seriously diminished. CKD patients do not usually develop either edema or sodium depletion. The adaptive response to decreasing GFR in the face of a constant (or high) sodium diet is an increase in the fractional excretion of sodium (FENa). This, in turn, requires a reduction in sodium reabsorption per nephron. In most circumstances, this is protective and prevents or limits sodium retention and extracellular fluid volume expansion. However, if dietary sodium is suddenly or greatly reduced, the kidney cannot immediately adjust. Distal nephron tubular function in CKD is not permanently impaired because the kidney can adequately adjust to decreases in sodium intake if the changes occur slowly. Hypertension is very common in CKD. Control of extracellular fluid volume through diet, and dialysis prescription in the case of ESRD, is the most effective means of controlling blood pressure. The KDOQI Clinical Practice Guidelines recommends that dietary sodium intake be limited to no more than 2.4g/day.

Original languageEnglish (US)
Title of host publicationChronic Renal Disease
PublisherElsevier Inc.
Number of pages6
ISBN (Electronic)9780124116160
ISBN (Print)9780124116023
StatePublished - 2015

Bibliographical note

Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.

Copyright 2020 Elsevier B.V., All rights reserved.


  • Adaptation
  • Balance
  • Diet
  • Diuretics
  • Edema
  • Guidelines
  • Sodium
  • Wasting


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