首页|Searching for the Risk-Benefit Profile of Higher Potassium Intake in CKD: Primum Non Nocere
Searching for the Risk-Benefit Profile of Higher Potassium Intake in CKD: Primum Non Nocere
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NSTL
Amer Soc Nephrology
Observational studies indicate that higher dietary potassium intake is associated with improved BP control, lower risk of cardiovascular disease, and slower CKD progression. Similarly, randomized controlled trials (RCTs) of potassium supplementation and potassium-based salt substitutes demonstrate consistent reductions in BP and in hypertension-associated adverse outcomes in populations with a low risk of hyperkalemia. However, the effect of potassium supplementation on clinical outcomes in patients with moderate to advanced CKD is unknown because these patients are typically excluded from such trials due to concerns of hyperkalemia. In fact, the belief that higher potassium intake increases the risk of hyperkalemia in CKD remains poorly investigated. Alternatively, the risk of adverse outcomes resulting from mild or moderate chronic hyperkalemia in advanced CKD is still a matter of debate, notwithstanding the consistent associations between hyperkalemia and poor outcomes in nondialysis CKD.3 Unmet gaps thus ensue—many guidelines recommen-dlow-potassium diets (e.g, 2-4 g/d by the Kidney Disease Outcomes Quality Initiative [KDOQI]) without clear evidence from RCTs; concerns of hyperkalemia blunt plausible interventions, such as salt substitutes or potassium supplementation, in CKD.
Murilo Guedes、Roberto Pecoits-Filho
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School or Medicine, Pontificia Universidade Católica do Paraná, Curitiba, Brazil
NSTL
Amer Soc Nephrology
