Abstract: SA-PO1140
A K-ritical Review: Safety of Potassium Intake in CKD: A Systematic Review and Synthesis Without Meta-Analysis (SWiM)
Session Information
- CKD: Progression, Drugs, Modalities, and Environmental Factors
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Kotwal, Sradha S., The George Institute for Global Health, Sydney, New South Wales, Australia
- Du, Rui, The George Institute for Global Health, Sydney, Australia
- Shah, Nasir A., The George Institute for Global Health, Sydney, New South Wales, Australia
Group or Team Name
- Renal and Metabolic Program, The George Institute for Global Health.
Background
Dietary potassium management in chronic kidney disease (CKD) is complex. While high potassium intake supports cardiovascular (CV) health in the general population, impaired renal excretion in CKD may predispose to hyperkalemia. Restricting dietary potassium can be difficult for patients and may lead to poor dietary quality. Guidelines currently recommend potassium restriction in CKD, but the safety and long-term impact of these remain unclear. This study aimed to assess the safety of high potassium intake in CKD, with primary outcomes including serum potassium levels and hyperkalemia events. Secondary outcomes inlcuded kidney function decline, CV, and all-cause mortality.
Methods
A systematic review was conducted across PubMed, Embase, and Cochrane databases. Eligible studies included randomized controlled trials and observational studies evaluating high versus low potassium intake in adults with CKD. Study heterogeneity made meta-analysis not feasible. Synthesis without meta-analysis was performed using vote counting of direction of effect and Stouffer’s Z method to combine p values.
Results
A total of 1162 studies were identified, with 25 (n=13,319 participants) included in the final analysis. A positive direction of effect was observed for serum potassium level (9/19 studies, combined p=0.007). A neutral direction of effect was observed for hyperkalemia events (4/6 studies, combined p=0.332), and CV mortality (4/4 studies, combined p=0.128). A negative direction of effect was observed for kidney outcomes (3/6 studies, combined p<0.001), and all-cause mortality (5/10 studies, combined p=0.044).
Conclusion
Higher potassium intake appears safe in many CKD populations, with minimal impact on hyperkalemia or CV mortality. Some studies suggested benefits of high potassium intake in CKD on kidney outcomes and all-cause mortality. These findings challenge blanket dietary restrictions in CKD and support re-evaluation of current guidelines.