Evaluation of three prediction formulas of 24-hour urinary sodium excretion in Chinese residents: a systematic review and meta-analysis

Objective: To determine the appropriateness of three widely used formulas estimating 24-hour urinary Na (24hUNa) from spot urine samples in the Chinese population. Design: Systematic review and meta-analysis Setting: Literature review was conducted to identify studies for estimating 24hUNa using the Kawasaki, Tanaka, and INTERSALT formulas simultaneously in PubMed, Embase, and the Cochrane library databases. The mean difference (MD) and correlation coefficients (r) between measures and estimates from different formulas were assessed. Subjects: Information extraction and quality assessment were performed in thirteen studies involving 8369 subjects. Results: Two studies which affected the overall robustness were excluded in the “leave-one-out” sensitivity analyses. Within the final meta-analysis included 11 studies and 7197 participants, 36.07 mmol/day (95%CI: 16.89, 55.25) of MD was observed in the Kawasaki formula, and -19.62 mmol/day (95%CI: -37.37, -1.87) in the Tanaka formula and -35.78 mmol/day (95%CI: -50.76, -20.80) in the INTERSALT formula; a pooled r-Fisher 'Z of 0.39 (95%CI: 0.32, 0.45) in the Kawasaki formula, 0.43 (95%CI: 0.37, 0.49) in the Tanaka formula and 0.36 (95%CI: 0.31, 0.42) in the INTERSALT formula. Subgroup analyses were conducted to explore the possible factors affecting the accuracy of the formula estimation from three mainly aspects: population types, sodium intake levels and urine specimen types. Conclusions: The meta-analysis suggested that the Tanaka formula performed a more accurate estimate in Chinese population. Time of collecting spot urine specimens and sodium intake level of the sample population might be the main factors affecting the accuracy of the formula estimation.