Abstract P294: Estimated Benefits and Risks of Lowering Sodium Intake With Potassium-based Salt Substitutes in China: a Modelling Study

Abstract

Introduction: Replacement of regular salt (NaCl) with potassium-based salt substitutes is a promising strategy to reduce blood pressure (BP) and prevent cardiovascular disease (CVD), especially in countries like China with high discretionary salt intake and low potassium intake. However, benefits of this strategy remain uncertain, and the risks of hyperkalemia and increased CVD mortality in persons with chronic kidney disease (CKD) are a concern. Hypothesis: In China, the estimated benefits of nationwide potassium-based salt substitution on CVD mortality will exceed potential risks. Methods: We used a comparative risk assessment framework to estimate potential benefits and risks of nationwide replacement of discretionary salt with potassium-based salt substitute (30±10% KCl) on CVD mortality in China. We incorporated existing data and corresponding uncertainties from randomized trials, the China National Survey of CKD, the Global Burden of Disease, and the CKD Prognosis Consortium ( Table ). We estimated averted CVD deaths from reduced BP subsequent to salt substitution in the adult population (benefits), and CVD deaths attributed to hyperkalemia from salt substitution in CKD patients (risks). Results: A nationwide implementation of potassium-based salt substitution in China, could prevent ~400,000 CVD deaths/year through BP lowering in the adult population, and increase ~10,000 CVD deaths/year through hyperkalemia among CKD patients (Table). For each additional death in CKD patients, around 40 CVD deaths could be averted in the adult population. Overall, the intervention could result in 369,258 (95% uncertainty interval: 160,702-576,680) net fewer deaths each year, corresponding to 9.4% (4.1-14.7) of annual CVD deaths in China. Conclusions: A nationwide potassium-based salt substitution in China could result in significant net benefits, preventing about 1 in 10 CVD deaths. Strategies to avoid potential hyperkalemic deaths among CKD patients could further improve the benefit:risk ratio.