Kidney Week

Abstract: SA-PO0542

Association of Protein Intake with Serum Potassium Concentration in CKD

Session Information

• CKD: Clinical - Therapies, CKM Health, Special Populations, and More
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Rafaey, Wania, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Wania Rafaey, MD, MBBS

• Khaliq, Muhammad, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Muhammad Khaliq, MD, MBBS

• Jan, Muneeb Ullah, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Muneeb Ullah Jan, MD

• Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy, MD, FASN

• Hussein, Wael F., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Wael F. Hussein, MBBS, MSc, FASN

Background

Both high and low dietary protein intake (DPI) have been associated with unfavorable outcomes in patients with chronic kidney disease (CKD). Hypo- and hyperkalemia are also associated with poor outcomes, and serum potassium levels (SK) are affected by nutrition; however, there is little data on the association of protein intake with serum potassium (SK) in CKD. We examined the association between DPI and SK in patients with non-dialysis dependent CKD.

Methods

We conducted a retrospective longitudinal cohort study in outpatient veterans with eGFR <60ml/min/1.73m² at a single institution. DPI was estimated from urine urea nitrogen (UUN), using spot morning urine samples obtained at each clinic visit to measure the ratio of UUN to urine creatinine (UUNCR). SK was categorized based on physiological cutoffs (≤3.5, 3.5-5.2, and ≥5.3 mmol/L). Associations between UUNCR and SK were analyzed using mixed effect models.

Results

Among 496 patients (mean age 65.4 ± 15.4, 97.8% male) we recorded a total of 712 UUNCR/SK measurements. SK ≤ 3.5, 3.5-5.2, and ≥ 5.3 was present in 6.3%, 89.9%, and 3.8% of patients at baseline. Patients with hyperkalemia had a higher prevalence of CHF and lower eGFR. Mean UUNCR was lower among hypokalemic patients (4.71 ± 1.75) compared to normo- (5.75 ± 1.98) and hyperkalemic patients (5.27 ± 1.35), p=0.01. In mixed effect models adjusting age, sex, race, BMI, blood pressure, comorbidities including liver disease and cancer, eGFR, proteinuria, and medication use, UUNCR was not significantly associated with SK (β=0.010, 95% CI = -0.012 to 0.033, p = 0.37). Categorical models for dyskalemia gave similar results.

Conclusion

Protein intake was not associated with serum potassium in this cohort, suggesting that the effects of DPI on clinical outcomes may not be mediated through changes in SK.