Effects of Short-Term Potassium Chloride Supplementation in Patients with Chronic Kidney Disease

Martin Gritter, Rosa Wouda, Stanley Yeung, Michiel Wieers, Frank Geurts, Maria de Ridder, Christian Ramakers, Liffert Vogt, Martin de Borst, Joris Rotmans, Ewout Hoorn

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Abstract

BACKGROUND: Observational studies suggest that adequate dietary potassium intake (90-120 mmol/day) may be renoprotective, but the effects of increasing dietary potassium and the risk of hyperkalemia are unknown.

METHODS: This is a pre-specified analysis of the run-in phase of a clinical trial in which 191 patients (age 68 ± 11 years, 74% males, 86% European ancestry, eGFR 31 ± 9 mL/min/1.73 m2, 83% renin-angiotensin system inhibitors, 38% diabetes) were treated with 40 mmol KCl/day for two weeks.

RESULTS: KCl supplementation significantly increased urinary potassium excretion (72 ± 24 to 107 ± 29 mmol/day), plasma potassium (4.3 ± 0.5 to 4.7 ± 0.6 mmol/L), and plasma aldosterone (281 [198-431] to 351 [241-494] ng/L), but had no significant effect on urinary sodium excretion, plasma renin, blood pressure, eGFR, or albuminuria. Furthermore, KCl supplementation increased plasma chloride (104 ± 3 to 105 ± 4 mmol/L), reduced plasma bicarbonate (24.5 ± 3.4 to 23.7 ± 3.5 mmol/L) and urine pH (all P < 0.001), but did not change urinary ammonium excretion. Twenty-one participants (11%) developed hyperkalemia (plasma potassium 5.9 ± 0.4 mmol/L). They were older and had higher baseline plasma potassium.

CONCLUSIONS: In patients with CKD stage G3b-4, increasing dietary potassium intake to recommended levels with potassium chloride supplementation raises plasma potassium by 0.4 mmol/L. This may result in hyperkalemia in older patients or those with higher baseline plasma potassium. Longer-term studies should address whether cardiorenal protection outweighs the risk of hyperkalemia.

Original languageEnglish
Pages (from-to)1779-1789
Number of pages11
JournalJournal of the American Society of Nephrology
Volume33
Issue number9
Early online date31-Aug-2022
DOIs
Publication statusPublished - 1-Nov-2022

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