Should we liberalize potassium intake in CKD? No, we should not

Abstract

Although a high dietary sodium (Na) intake has dominated our understanding of pathophysiology of hypertension, the moderating effects of a dietary potassium (K) intake on blood pressure (BP) are less appreciated. K depletion in normotensive men can increase BP,1 supplementation of K among normotensive women can modestly lower 24-hour ambulatory BP,2 and in those with untreated hypertension3 or among those with hypertension and hypokalemia provoked by diuretics, K supplementation can lower BP.4 A cluster randomized trial from 600 villages in China in people with a history of previous stroke (72.6%) or a history of hypertension (88.4%) showed that compared with villages assigned regular salt (100% NaCl), villages assigned a K-containing salt substitute (75% NaCl, 25% KCl) had a 14% lower rate of strokes, a 13% lower rate of major cardiovascular events, and a 12% lower rate of all-cause mortality.