Abstract

In the general population, an increased potassium (K) intake lowers blood pressure (BP). The effects of K have not been well-studied in individuals with chronic kidney disease (CKD). This randomized feeding trial with a 2-period crossover design compared the effects of diets containing 100 and 40 mmol K/day on BP in 29 adults with stage 3 CKD and treated or untreated systolic BP (SBP) 120–159 mmHg and diastolic BP (DBP) <100 mmHg. The primary outcome was 24 h ambulatory systolic BP. The higher-versus lower-K diet had no significant effect on 24 h SBP (−2.12 mm Hg; p = 0.16) and DBP (−0.70 mm Hg; p = 0.44). Corresponding differences in clinic BP were −4.21 mm Hg for SBP (p = 0.054) and −0.08 mm Hg for DBP (p = 0.94). On the higher-K diet, mean serum K increased by 0.21 mmol/L (p = 0.003) compared to the lower-K diet; two participants had confirmed hyperkalemia (serum K ≥ 5.5 mmol/L). In conclusion, a higher dietary intake of K did not lower 24 h SBP, while clinic SBP reduction was of borderline statistical significance. Additional trials are warranted to understand the health effects of increased K intake in individuals with CKD.

Highlights

  • Chronic kidney disease (CKD) increases the risk of cardiovascular disease (CVD) and premature death

  • While mean levels of all other blood pressure (BP) measures were lower during the higher-K period compared to the lower-K period, none of the between-period differences were statistically significant

  • At weeks 3–4 weeks, whether or not all three BP measurements at each visit or just the last two of three BP measurements were used. In this randomized feeding trial of adults with stage 3 CKD, systolic BP (SBP) 120–159 mmHg, and diastolic BP (DBP) < 100 mmHg, we documented that a higher dietary intake of K did not significantly lower systolic 24 h ABP, the primary outcome of the trial

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Summary

Introduction

Chronic kidney disease (CKD) increases the risk of cardiovascular disease (CVD) and premature death. Evidence from animal studies as well as epidemiological studies in humans demonstrate that diets rich in K might reduce the risk of CVD [2]. These effects may be mediated by BP-dependent and BP-independent mechanisms. The effects of K in individuals with CKD have not been well-studied, but animal and recent human studies have demonstrated that a high-K diet might lower BP and may protect against and/or reverse kidney damage [3,4,5,6,7,8,9].

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