What are the indications for sodium restriction?

From the Guidelines

Sodium restriction is indicated for patients with hypertension, heart failure, chronic kidney disease, and certain other cardiovascular conditions, with a general recommendation to limit sodium intake to less than 2,300 mg per day, and further restriction to 1,500 mg per day for some patients, as supported by the American Heart Association 1. To implement salt restriction:

• Avoid adding salt during cooking or at the table
• Choose fresh, unprocessed foods over packaged or prepared meals
• Read food labels and select low-sodium options
• Use herbs, spices, and salt-free seasonings for flavor When eating out, request meals be prepared without added salt and avoid high-sodium condiments like soy sauce or ketchup. Salt restriction helps lower blood pressure and reduces fluid retention, which can ease the workload on the heart and kidneys, as evidenced by studies showing that reducing sodium intake by 80–100 mmol per day can reduce blood pressure by 4–6 mmHg 1. Additionally, sodium restriction has been associated with lower diuretic requirement, faster resolution of ascites, and shorter hospitalization in patients with cirrhosis 1, and has been shown to have beneficial effects on blood pressure in individuals with diabetes 1. It is essential to individualize sodium intake recommendations, taking into account palatability, availability, and the difficulty of achieving both low-sodium recommendations and a nutritionally adequate diet, as some studies have warranted caution for universal sodium restriction to 1,500 mg in certain populations 1.

From the Research

Indications for Sodium Restriction

The indications for sodium restriction are varied and include:

• Hypertension: Sodium restriction is recommended for the management of hypertension, as it can help to reduce blood pressure and cardiovascular risk 2, 3, 4
• Chronic Kidney Disease (CKD): Sodium restriction is beneficial for CKD patients, as it can help to control extracellular fluid expansion, hypertension, and cardiovascular risk, and may also slow down the progression of CKD 2, 5
• Heart Failure: While a low-sodium diet is often recommended for heart failure patients, the evidence suggests that it may not be beneficial for all patients, and individualized approaches may be necessary 6
• Cardiovascular Disease: Sodium restriction can help to reduce the risk of cardiovascular disease, particularly in individuals with high blood pressure or other risk factors 3, 4

Key Considerations

When considering sodium restriction, the following key considerations should be taken into account:

• The level of sodium restriction: The optimal level of sodium restriction is not well established, but aiming for 2-3 g/day in the general population and 2 g/day in individuals with hypertension or CKD may be reasonable 3
• Individualized approaches: Sodium restriction may not be beneficial for all individuals, and individualized approaches may be necessary, particularly in certain patient populations such as those with heart failure 6
• Potential risks: Excessive sodium restriction may be associated with increased cardiovascular risk, and careful consideration should be given to the potential risks and benefits of sodium restriction in different patient populations 3