{"id":"f07cbef41cd2","type":"article","url":"https://hartvaat.nl/2026/10/09/verhoogde-nachtelijke-natriumexcretie-correleert-met-nachtelijke-hypertensie-bij/","title":"Verhoogde nachtelijke natriumexcretie correleert met nachtelijke hypertensie bij chronisch nierpatiënten","title_en":"Nighttime and daytime urine sodium excretion, nighttime and daytime blood pressure and nocturia frequency in patients with chronic kidney disease.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of hypertension","doi":"10.1097/HJH.0000000000004453","source_url":"https://doi.org/10.1097/HJH.0000000000004453","authors":["Artemios G Karagiannidis","Fotini Iatridi","Marieta P Theodorakopoulou","Eleni Karkamani","Sofia Manti","Areti Georgiou","Amalia Baroutidou","Spyros Gerou","Zoi Athanasiadou","Christodoulos Papadopoulos","Pantelis Sarafidis"],"significance":4,"published":"2026-10-17","source_date":"2026-10-09","image":"https://hartvaat.nl/global/img/6e2cc0469790.webp","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/"],"congress":"","summary_en":"In a cohort of 130 patients with chronic kidney disease, researchers examined the association between the nighttime-to-daytime urine sodium excretion ratio and 24-hour blood pressure patterns. Patients with higher nighttime natriuresis had significantly elevated nighttime systolic (123.8 vs. 117.1 mmHg) and diastolic pressures, alongside a higher prevalence of nocturnal hypertension and nocturia. These findings highlight impaired circadian renal sodium handling as a potential driver of nocturnal hypertension in CKD, suggesting that nighttime sodium profiling could help identify patients who may benefit from targeted antihypertensive strategies or ambulatory monitoring.","created":"2026-10-10T01:29:51Z","updated":"2026-10-10T01:29:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een cohort van 130 chronisch nierpatiënten onderzochten onderzoekers de relatie tussen de verhouding tussen nachtelijke en dagelijkse natriumexcretie en de 24-uurs bloeddruk. Patiënten met een hogere nachtelijke natriumuitscheiding hadden significant hogere nachtelijke systolische (123,8 vs. 117,1 mmHg) en diastolische druk, evenals vaker nachtelijke hypertensie en nocturie. Deze bevindingen suggereren dat een verstoorde circadiane natriumafgifte een rol speelt bij nachtelijke bloeddrukregulatie bij CKD, wat mogelijk helpt bij het identificeren van patiënten die baat hebben bij gerichte therapieën of uitgebreid bloeddrukmonitoring.","abstract_original":"OBJECTIVE: Abnormal circadian blood pressure (BP) regulation is common in chronic kidney disease (CKD) and associated with adverse cardiovascular outcomes. In hypertensive individuals, higher nighttime natriuresis is linked to elevated nighttime BP, but evidence in CKD is limited. We hypothesized that impaired circadian renal sodium handling, characterized by increased nighttime natriuresis, would also be associated with higher nighttime BP and adverse nocturnal BP phenotypes. The primary aim was to examine differences in daytime and nighttime BP, dipping and nocturia frequency between CKD patients classified by nighttime-to-daytime urine sodium excretion ratio; secondary aim was to compare diurnal sodium excretion and nocturia between CKD patients with and without nocturnal hypertension. METHODS: One hundred and thirty patients with CKD stages 1-5 on stable antihypertensive treatment underwent 24-h ambulatory BP monitoring (ABPM) with the ABPMpro device and simultaneous split 24-h urine collection separated into daytime (7 : 00-23 : 00) and nighttime (23 : 00-7 : 00) periods. For analyses, patients were divided by tertiles of nighttime-to-daytime ratio of urine sodium excretion and by presence of nocturnal hypertension. RESULTS: No significant differences were detected in baseline characteristics across groups of nighttime-to-daytime sodium excretion ratio. In contrast to daytime SBP/DBP (T1: 124.8 ± 10.1/70.6 ± 7.9 vs. T2: 128.3 ± 12.2/74.6 ± 8.6 vs. T3: 128.6 ± 12.8/73.6 ± 8.2 mmHg, P = 0.254/P = 0.072 respectively), nighttime SBP and DBP (117.1 ± 12.0/64.8 ± 6.9 vs. 121.7 ± 13.1/68.7 ± 7.6 vs. 123.8 ± 13.1/69.3 ± 8.1 mmHg, P = 0.047/P = 0.014, respectively) showed significant increases across tertiles of nighttime-to-daytime sodium excretion. When patients with and without nocturnal hypertension were compared, those with nocturnal hypertension had similar daytime (83.8 ± 45.9 vs. 87.6 ± 50.6 mEq, P = 0.654), but higher nighttime urine sodium excretion (64.0 ± 34.5 vs. 49.7 ± 23.9 mEq, P = 0.012), higher nighttime-to-daytime sodium excretion ratio (0.73 [0.53] vs. 0.57 [0.63], P = 0.037) and more frequent nocturia (2 [2] vs. 1 [2.0], P = 0.006). Nighttime sodium excretion correlated with nighttime SBP (r = 0.212, P = 0.016) and DBP (r = 0.320, P < 0.001), while daytime sodium excretion did not. CONCLUSION: In CKD, impaired circadian renal sodium handling, characterized by increased nighttime natriuresis, is linked to higher nighttime BP and nocturnal hypertension. Assessment of nighttime urine sodium excretion may help identify sodium-related nocturnal hypertension and guide targeted therapeutic strategies."}