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Abstract: SA-OR40

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

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

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

Authors

  • Gritter, Martin, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
  • Visser, Wesley, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
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.

 K+ supplementationDietary K+K+-enriched salt
Short- to long-term effects
on plasma K+
+ 0.7 mmol/LNo change?
Acute effects
on plasma K+
+ 1.2 mmol/L??