Abstract
Dietary potassium intake is a dilemma in patients with chronic kidney disease (CKD). We investigated the association of urine potassium excretion, a surrogate for dietary potassium intake, with blood pressure variability (BPV) and cardiovascular (CV) outcomes in patients with pre-dialysis CKD. A total of 1860 participants from a cohort of pre-dialysis CKD (KNOW-CKD) patients were divided into the quartiles by spot urine potassium-to-creatinine ratio. The first quartile (26.423 ± 5.731 mmol/gCr) was defined as low urine potassium excretion. Multivariate linear regression analyses revealed an independent association of low urine potassium excretion with high BPV (adjusted β coefficient 1.163, 95% confidence interval 0.424 to 1.901). Cox regression analyses demonstrated that, compared to high urine potassium excretion, low urine potassium excretion is associated with increased risk of CV events (adjusted hazard ratio 2.502, 95% confidence interval 1.162 to 5.387) but not with all-cause mortality. In conclusion, low urine potassium excretion is associated with high BPV and increased risk of CV events in patients with pre-dialysis CKD. The restriction of dietary potassium intake should be individualized in patients with pre-dialysis CKD.
Highlights
Blood pressure (BP) variability (BPV) is an emerging mediator of clinical outcomes [1,2,3].The association between long-term blood pressure variability (BPV) and the risk of incident chronic kidney disease (CKD) has been repeatedly reported in the general population [4,5,6]
We demonstrated that low urine potassium excretion is independently associated with high BPV in patients with pre-dialysis CKD
We proved that low urine potassium excretion is significantly associated with increased risk of extended major cardiovascular events (eMACEs)
Summary
Blood pressure (BP) variability (BPV) is an emerging mediator of clinical outcomes [1,2,3]. The association between long-term BPV and the risk of incident chronic kidney disease (CKD) has been repeatedly reported in the general population [4,5,6]. CKD, higher long-term BPV is associated with more rapid progression of CKD [7], poor cardiovascular (CV) outcomes and increased all-cause mortality [8]. A close relationship between BPV and the amount of dietary sodium has been reported both in normotensive [9]. The association between dietary potassium intake and BPV has not been elucidated in CKD patients
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