Twenty‐four‐Hour Urinary Potassium Excretion, But Not Sodium Excretion, Is Associated With All‐Cause Mortality in a General Population
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- Published on May 16, 2018RE: Inapropriate adjustment?
- Chris Kypridemos, Epidemiologist, Univeristy of Liverpool
This is a very interesting study. I am wondering why the authors adjusted for blood pressure in their Cox regression model. It is now well established that increased sodium consumption mediates the risk for cardiovascular disease through an increase in blood pressure. Therefore, it is expected given the small number of deaths in their study, that the authors found no effect of sodium on mortality as their model estimates the remaining effect of sodium on mortality not mediated through blood pressure.
I encourage the author to publish a Cox regression model without adjusting for blood pressure or if their data allows, to consider using other mediation analysis approaches. Until then, their claim that urinary sodium is nor associated with all-cause mortality is not appropriately supported by their analysis.
All the best
Chris KypridemosCompeting Interests: None declared.