How much salt should i recommend to a patient with CKD: the real mechanisms of regulation of sodium metabolism in kidney pathology

Dietary considerations for salt (sodium chloride) in people with chronic kidney disease are based on multiple guidelines and suggest an intake of <90 mmol sodium per day, or <5 g sodium chloride per day. It is assumed that excess sodium intake contributes to the formation/maintenance of hypertension and edema syndrome. However, WHO data and cohort studies show that average salt intake is approximately twice the recommended level. In people with chronic kidney disease, a paradoxical situation often arises when, with recommended, but poorly followed, recommendations, 15-36 % of patients may develop hyponatremia. This is due to both the restriction of salt in the diet and the active use of loop diuretics, and recently SGLT-2is, GLP-1RAs against the background of RAASi and increasing age of the patient, which in itself is a risk factor for hyponatremia. In this regard, the possible clinical complications of hyponatremia increase significantly. The article addresses issues of physiology and pathophysiology of sodium metabolism, examines clinical situations and suggests careful treatment of significant restrictions on sodium chloride in the diet, keeping in mind the dietary cravings that develop during hyponatremia. Attention is drawn to the need to control serum sodium and be attentive to the dietary whims of patients.