Sodium Restriction Fluid Management CKD — ESENeph MCQ

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HardElectrolyte DisordersSodium Restriction Fluid Management CKDESENeph

A patient with CKD and heart failure has resistant oedema despite appropriate loop and thiazide-like diuretics. Dietary review shows sodium intake 4 g/day. What non-pharmacological intervention is most important?

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Correct answer: A — Reduce sodium intake below 2 g daily

The best answer is “Reduce sodium intake below 2 g daily”. KDIGO suggests sodium below 2 g daily, equivalent to about 5 g salt, for most people with CKD. Lower sodium reduces thirst, extracellular volume and antihypertensive or diuretic resistance. “Increase sodium intake to improve loop-diuretic delivery” is less appropriate because higher sodium intake drives thirst, fluid retention and diuretic resistance “Stop monitoring daily weight” is less appropriate because weight trends help assess decongestion and safety “Use deliberate dehydration without adjusting sodium” is less appropriate because this risks hypotension and AKI while leaving the dietary driver “Replace all dietary protein with salty processed food” is less appropriate because this worsens sodium and phosphate exposure

Reference: KDIGO 2024 CKD guideline: https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf