Long-term safety of dietary salt: A 5-year ProspEctive rAndomized bliNded and controlled stUdy in healThy aged cats (PEANUT study)

Background: High-salt diets promote urine dilution and decrease urolithiasis risk.Objective: Prospectively evaluate the safety of chronic high dietary salt intake (randomized controlled trial).Animals: Twenty research colony neutered, healthy aged cats (11.5 years [10.0-11.6], median [interquartile range]).Methods: Healthy cats were randomized to control or high-salt dry diets (sodium: 1.02 +/- 0.16 [mean, SD] and 3.26 +/- 0.30 g/Mcal metabolizable energy [ME], respectively; chloride: 2.26 +/- 0.33 and 5.71 +/- 0.28 g/Mcal ME, respectively), fed for up to 60 months. Assessments included CBC, plasma biochemistry, urinalysis, glomerular filtration rate (GFR), blood pressure, renal and cardiac (conventional Doppler and 2-dimensional color tissue Doppler) imaging, annually. Cats that died or were euthanized underwent necropsy. Diet effects over time were evaluated with linear mixed models.Results: Follow-up duration (median [Interquartile range]) was similar between the control (38.7 months [28.6-48.2]) and high-salt group (51.4 months [45.7-59.0]). Diet had no significant effect on changes in GFR, blood pressure, plasma creatinine concentration, end-diastolic left ventricular (LV) wall thicknesses, LV internal diameters, LV systolic function, left atrial size, or systolic and diastolic Doppler variables. One control cat developed hypertension. One high-salt group cat developed persistent azotemia. Serial plasma biochemistry and urine specific gravity suggested early chronic kidney disease in 4 nonazotemic cats (2 per group), consistent with necropsy findings.Conclusions and Clinical Importance: In healthy aged cats, a commercial veterinary diet containing 3.26 +/- 0.30 g/Mcal ME sodium was safe with regard to renal and cardiac function for up to 5 years.