Kidney Week

Abstract: SA-OR40

Dietary Potassium and Potassium Supplementation Differentially Affect Plasma Potassium in Patients with CKD

Session Information

• Fluid, Electrolyte, and Acid-Base Disorders: Clinical Research
  November 04, 2023 | Location: Room 111, Pennsylvania Convention Center
  Abstract Time: 04:48 PM - 04:57 PM

Category: Fluid, Electrolytes, and Acid-Base Disorders

• 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

• Gritter, Martin, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands

Martin Gritter, MD

• Visser, Wesley, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands

Wesley Visser,

Background

Guidelines advise increased potassium (K⁺) intake to prevent hypertension and cardiovascular disease, but whether patients with chronic kidney disease (CKD) can safely increase K⁺ intake is unknown.

Methods

We performed a systematic review and meta-analyses of intervention studies that assessed the acute or short- to long-term effects of increased K⁺ intake on plasma K⁺ in patients with CKD. Studies were eligible if they studied the effects of specified amounts of dietary K⁺, K⁺ supplementation, or K⁺-enriched salt substitution in patients with CKD and provided plasma K⁺ at baseline and end of study (for pre-post intervention studies) or at end of study in control and intervention groups (for randomized trials).

Results

Fourteen eligible studies were identified (2 randomized, 12 pre-post intervention studies). K⁺ supplementation for five days to two years increased plasma K⁺ by on average 0.7 (95% confidence interval, 0.2-1.1) mmol/L and caused hyperkalemia in 4-33% (3 studies, 370 participants). In contrast, increased dietary K⁺ intake for two weeks to three years did not significantly increase plasma K⁺ (7 studies, 275 participants). One study reported two hyperkalemia occurrences on the high K⁺ diet, another study reported lower hyperkalemia incidence on the high K⁺ than on the low K⁺ diet, and five studies reported that no hyperkalemia occurred. These results suggest that increased dietary K⁺ intake may be safer than K⁺ supplementation (Table). However, they do not rule-out the risk of postprandial hyperkalemia, i.e. hyperkalemia occurring after a K⁺-rich meal. Unfortunately, no studies assessed the acute effects of a K⁺-rich meal on plasma K⁺ in CKD. Acute K⁺ supplementation increased plasma K⁺ by 1.2 (95% confidence interval, 0.9-1.6) mmol/L (4 studies, 35 participants). We found no studies that assessed the safety of K⁺-enriched salt substitution in CKD.

Conclusion

In the short- to long-term, K⁺ supplementation increases plasma K⁺ and the risk of hyperkalemia, although the majority maintains normokalemia. Conversely, increased dietary K⁺ intake does not increase plasma K⁺ in the short- to long-term. Whether a K⁺-rich meal causes postprandial hyperkalemia is unknown.