Kidney Week

Abstract: FR-PO1100

Dietary Potassium Intake and Serum Potassium in the Chronic Renal Insufficiency Cohort Study

Session Information

• Health Maintenance, Nutrition, and Metabolism
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1500 Health Maintenance, Nutrition, and Metabolism

Authors

• Xu, Heli, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, United States

Heli Xu, PhD

• Sullivan, Valerie, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, United States

Valerie Sullivan, PhD, RDN

• Crews, Deidra C., The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Deidra C. Crews, MD, FASN

• Anderson, Cheryl A., University of California San Diego, San Diego, California, United States

Cheryl A. Anderson, PhD, MPH

• Rincon-Choles, Hernan, Cleveland Clinic, Cleveland, Ohio, United States

Hernan Rincon-Choles, MD, MS, FASN

• Weir, Matthew R., University of Maryland Baltimore School of Medicine, Baltimore, Maryland, United States

Matthew R. Weir, MD

• Brown, Julia, University of Illinois Chicago Department of Medicine, Chicago, Illinois, United States

Julia Brown, MD

• Ricardo, Ana C., University of Illinois Chicago Department of Medicine, Chicago, Illinois, United States

Ana C. Ricardo, MD, MS, MPH, FASN

• Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States

Jonathan J. Taliercio, DO, FASN

• Mills, Katherine T., Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States

Katherine T. Mills

• Hamm, L. Lee, Tulane University School of Medicine, New Orleans, Louisiana, United States

L. Lee Hamm, MD

• Sondheimer, James H., Wayne State University School of Medicine, Detroit, Michigan, United States

James H. Sondheimer, MD, FASN

• Appel, Lawrence J., Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, United States

Lawrence J. Appel, MD, MPH

• Rebholz, Casey, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, United States

Casey Rebholz, MS, PhD, MPH

Background

Dietary potassium restriction is often recommended for patients with advanced chronic kidney disease (CKD) to reduce the risk of hyperkalemia. However, restricting potassium-rich foods is inconsistent with healthy eating patterns; furthermore, few studies have examined the relationship between dietary potassium intake and serum potassium in CKD patients.

Methods

We conducted a prospective analysis of 2957 participants in the Chronic Renal Insufficiency Cohort Study. Total dietary potassium intake (tertiles of mg/1000kcal) and consumption of potassium-rich foods (servings/1000kcal) were derived from Diet History Questionnaire responses. Serum potassium (mmol/L) was analyzed continuously, with hyperkalemia defined as the first occurrence of serum potassium >5.0 mmol/L. Linear mixed-effects regression models were used to examine the association of dietary potassium intake and potassium-rich food groups with serum potassium over time. Analyses were stratified by baseline eGFR levels (<45 and ≥45 mL/min/1.73 m²), diabetes, and congestive heart failure (CHF) status.

Results

The incidence rate of hyperkalemia was 4.1, 4.2, and 4.5 cases per 100 person-years for participants with low, medium, and high potassium intake, respectively. The incidence of hyperkalemia was approximately twice as high in participants with lower vs. higher baseline eGFR, and in those with vs. without baseline diabetes. High dietary potassium intake was not associated with higher serum potassium (β = 0.00 [95% CI: -0.04, 0.03] and 0.01 [95%CI: -0.02, 0.04] for medium vs. low and high vs. low intake levels, respectively). This pattern did not differ by baseline diabetes (p-interaction = 0.98) or CHF status (p-interaction = 0.06). There was no significant association between high vs. low dietary potassium and serum potassium in either eGFR category. In food group analysis, higher consumption of oranges/juice and cantaloupe was associated with lower serum potassium (β = -0.03, [95%CI: -0.06, -0.00]).

Conclusion

Higher total dietary potassium intake and consumption of potassium-rich foods were not associated with elevated serum potassium over time among CKD patients, even in the presence of lower eGFR level, diabetes, or CHF at baseline.

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025y18m9pgv