Reducing Dietary Sodium Exposure in Chronic Kidney Disease: Challenges and Opportunities

Over 750 million individuals worldwide experience chronic kidney disease (CKD), which is a major contributor to cardiovascular disease and kidney failure as well as increased morbidity and mortality. Diet is a key lifestyle factor in CKD risk prevention and management. Overall public dietary quality and sodium intake have shown limited improvement despite decades of public health efforts. Excessive sodium consumption is a challenging dietary risk factor because exposure is largely passively embedded within the modern food environment. Furthermore, the consequences of overconsumption of dietary sodium are often delayed, invisible, or difficult for patients to recognize. The complexity of dietary behavior approaches coupled with conventional education approaches also contributes to persistently high sodium intake across the CKD spectrum. In this review, we discuss three major overarching challenges to sodium reduction, which comprise the invisible nature of sodium-related risk, the ubiquity of sodium within commercially prepared and processed foods, and the limitations of knowledge-based interventions alone. We also highlight subsequent opportunities to improve implementation. These include practical, patient-centered, and personalized nutrition strategies; food environment and food supply improvements that make lower-sodium choices the default; and expansion of Food Is Medicine and culinary medicine approaches. Reducing dietary sodium exposure and its consequences requires coordinated efforts that extend beyond individual patients and health care providers to include multidisciplinary collaboration across health care systems, public health, industry, community organizations, professional societies, and policymakers. Such multilevel approaches offer important opportunities to improve kidney health trajectories as well as cardiovascular health. Semin Nephrol 36:x-xx © 20XX Elsevier Inc. All rights reserved.