The position statement of the World Hypertension League on short‐term urine sodium measurements,1 which reads “Low quality research on dietary sodium/salt should not be funded, conducted or published,” cannot be acceptable by the scientific community. We must always know the guidelines and the recommendations of international societies, but we must always consider that the patient in question is the best guideline. Almost all the discoveries at the outset have been criticized by the scientific community. The best way to do and judge research was recommended by Roger Bacon in 13th Century: he wrote that we must not adhere to everything we hear or read, but we must carefully examine what has been written and published in order to add what the previous authors had not discovered and to correct any errors. The role of a reviewer is not to judge based on statements, but to accurately examine a scientific contribution and to decide to reject or accept or ask for a revision.
Based on these premises, we completely agree that the measurement of urinary sodium excretion derived by single spot or 24‐hour urine collection cannot be the most reliable marker of sodium intake and in our recent commentary, we have reported all the factors that can regulate the sodium excretion.2 The novelty of the manuscript of Mann and Gerber is the consideration of many individual factors involved in the excretion of creatinine and in the evaluation of 24‐hour sodium excretion.3 The accurate history and general visit, the evaluation about eating and drinking, the urinary excretion of liquids, the related blood or morphological examinations are fundamental to make a correct diagnosis and consider a possible treatment. In our commentary, we reported that the gold standard to examine the sodium intake is “considered” the urine collection, but we have proved that too many hormonal and non‐hormonal factors can disturb the interpretation of the sodium excretion.
The letter of Elijovich is important, reporting that the best way to evaluate the sodium metabolism is always to consider the single patient in a holistic manner.4 We agree that we even cannot consider the sodium excretion of 6 days and that the best way to consider the problem after a careful examination of the patient is simply to prescribe if necessary a diet, a limitation of added salt, a correction of increased blood pressure, and the individual medical treatments. We also agree that the evaluation of sodium metabolism and the decision to reduce the sodium intake must consider the single patient with his genetic and epigenetic features, the presence of hypertension, cardiovascular, and kidney dysfunction. At this regard, a correct diagnostic evaluation should consider the measurement of serum sodium and potassium and of renin and aldosterone levels in untreated hypertensive patients or with electrolyte abnormalities not linked to factitious causes.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
REFERENCES
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