Treatment of Hypernatremia in CKD Patients Not on Dialysis

Specific Treatment Approaches

The American College of Physicians recommends implementing dietary sodium restriction to less than 2 g of sodium per day (or less than 5 g of sodium chloride per day) to manage hypernatremia and hypertension in CKD patients 1
The National Kidney Foundation suggests that sodium restriction helps manage both hypernatremia and hypertension commonly present in CKD patients, and dietary counseling should be provided to help patients achieve sodium restriction goals 1
The Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline advises against combinations of ACE inhibitors, ARBs, and direct renin inhibitors as this increases adverse effects without additional benefit in CKD patients 1
The European Renal Association - European Dialysis and Transplant Association recommends that sodium-wasting nephropathy patients should not receive sodium restriction 2
The Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline suggests that DASH-type diets or potassium-rich salt substitutes should be avoided in advanced CKD due to risk of hyperkalemia 2

The National Institute of Diabetes and Digestive and Kidney Diseases states that in advanced CKD (stages G4-G5), more frequent monitoring of serum sodium and other electrolytes is necessary during treatment 3