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Abstract: SA-PO789

Association of Lower Dietary Potassium Intake with Higher Death Risk in a Prospective Hemodialysis Cohort

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Narasaki, Yoko, Tokushima University, Irvine, California, United States
  • Okuda, Yusuke, University of California, Irvine, Irvine, California, United States
  • Kalantar, Sara S., University of California Irvine, Huntington Beach, California, United States
  • You, Amy Seung, University of California, Irvine, Irvine, California, United States
  • Novoa, Alejandra, UC Irvine Health, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Nakata, Tracy, UC Irvine, Orange, California, United States
  • Colman, Sara, DaVita, Huntington Beach, California, United States
  • Nguyen, Danh V., University of California Irvine, Huntington Beach, California, United States
  • Rhee, Connie, University of California Irvine, Huntington Beach, California, United States
Background

Among hemodialysis patients, clinical practice guidelines recommend dietary potassium restriction given concerns about potential hyperkalemia leading to malignant arrhythmias and mortality. Yet there are sparse data informing recommendations for dietary potassium intake in this population. We thus sought to examine the relationship between dietary potassium intake and death risk in a prospective hemodialysis cohort.

Methods

Among 415 hemodialysis patients from the prospective “Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease” cohort recruited across 16 outpatient dialysis clinics, information regarding dietary potassium intake was obtained using Food Frequency Questionnaires (FFQ’s) administered over 2011 to 2015. We first examined associations of baseline dietary potassium intake categorized as tertiles with mortality risk using Cox regression. We then examined clinical characteristics associated with low dietary potassium intake (defined as the lowest tertile) using logistic regression.

Results

In expanded case-mix Cox analyses, patients whose dietary potassium intake was in the lowest tertile had higher mortality (ref: highest tertile): adjusted HR (aHR) (95%CI) 1.74 (1.14, 2.66). These associations had even greater magnitude of risk following adjustment for laboratory and nutritional covariates: aHR (95%CI) 2.65 (1.40, 5.04). In expanded case-mix restricted cubic spline analyses, there was a monotonic increase in mortality risk with incrementally lower dietary potassium intake. In expanded case-mix logistic regression models, female sex; higher serum bicarbonate; and lower dietary energy, protein, and fiber intake were associated with low dietary potassium intake.

Conclusion

In a prospective cohort of hemodialysis patients, lower dietary potassium intake was associated with higher mortality risk. These findings suggest excessive dietary potassium restriction may be deleterious in hemodialysis patients, and further studies are needed to determine the optimal dietary potassium intake in this population.

Funding

  • NIDDK Support