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Role of sodium status in the clinical management of diabetic nephropathy: interaction with RAAS-blockade efficacy

Martin H de Borst & Gerjan Navis

Diabetic nephropathy is the leading cause of chronic kidney disease worldwide. The expanding endemic of diabetes, the high risk of premature morbidity and mortality and the incapacity of current therapies to halt progression toward renal failure urges additional treatment modalities. We will review current evidence addressing dietary sodium intake as a key determinant of renin–angiotensin–aldosterone system (RAAS)- blockade efficacy, particularly in diabetic nephropathy. High sodium intake is very common in these patients, and blunts the protective effects of RAAS-blockade on cardiovascular and renal outcomes. Moderate dietary sodium restriction restores the protective effects of RAASblockade. The data warrant monitoring of sodium intake and practical implementation of sodium restriction as a lifestyle-related intervention, mandatory as an addition to RAAS-blockade in diabetic nephropathy.