Correcting for Plasma Aldosterone Improves the Accuracy of Repeated Timed Urine Sampling for Estimation of Dietary Sodium Intake

Abstract

Introduction: Long-term sodium balance studies show that sodium can be temporarily stored and released in tissues, mediated by circaseptan rhythms of aldosterone and cortisol. This complicates the reliability of a single 24-h urine collection to estimate individual sodium intake. We investigated whether repeated timed urine collection with and without correction for plasma aldosterone is a more accurate alternative for estimating daily sodium intake. Methods: We conducted a post hoc analysis of a metabolic ward study in which 16 healthy male adults consumed a diet with a fixed sodium content (50 or 200 mmol/day) for 7 days. Each day, urine was collected in 4 intervals (7:00–13:00 h, 13:00–19:00 h, 19:00–23:00 h, and 23:00–07:00 h). Plasma aldosterone was measured at 6:30 h, 12:30 h, and 18:30 h. Sodium intakes were estimated by various formulas using 3 timed urines of day 5–7. Results: During a 200-mmol daily sodium intake, sodium intake estimates based on three repeated timed urine samples and the Toft equation differed 10 [IQR: 3–14], 8 [6–19], 36 [16–49], and 20 [10–43] mmol from the actual intake for intervals 7:00–13:00 h, 13:00–19:00 h, 19:00–23:00 h, 23:00–7:00 h, respectively. These measurements did not significantly differ from a single 24-h urine (20 [12–55] mmol). During a 50-mmol daily sodium intake, repeated timed urine collection performed worse than a single 24-h urine collection. On both diets, correction for plasma aldosterone increased accuracy and sodium intake estimates were significantly more accurate than a single 24-h urine. Conclusion: In a controlled environment, repeated timed urine collection corrected for plasma aldosterone is more accurate than a single 24-h urine collection.