Short-term plasma chloride supplementation increases plasma potassium in patients with CKD
Click Here to Manage Email Alerts
According to this study, increasing dietary potassium intake among patients with stage 3 to 4 chronic kidney disease to the recommended levels with potassium chloride supplementation increases plasma potassium on a short-term basis.
Further, researchers identified higher baseline plasma potassium and older age as risk factors for developing hyperkalemia after supplementation.
“Observational studies suggest that adequate dietary potassium intake (90 [mmol/day] -120 mmol/day) may be renoprotective, but the effects of increasing dietary potassium and the risk of hyperkalemia are unknown,” Martin Gritter, MD, from the department of internal medicine in the division of nephrology and transplantation at Erasmus Medical Center in The Netherlands, and colleagues wrote. They added, “To address this, we initiated a randomized clinical trial in patients with CKD to study the long-term effects of potassium supplementation on kidney function.”
In a pre-specified analysis of a 2-week run-in phase of an ongoing placebo-controlled randomized trial, researcher examined 191 patients (average age was 68 ± 11 years; 74% were men; 83% were on renin-angiotensin inhibitors; 38% had diabetes) with stage 3 to 4 CKD. All patients were treated with 40-mmol potassium chloride supplementation (KCI) a day for 2 weeks in attempt to achieve the recommended levels.
During the supplementation period, patients maintained their regular diet. Baseline measurements were taken before and after the 2-week phase.
Researchers conducted multivariable linear regression analyses to determine baseline characteristics correlated with the change in plasma potassium after KCI supplementation. Similarly, researchers used logistic regression to identify which characteristics independently correlated with hyperkalemia development.
Among the 240 patients who started the run-in phase, 191 qualified for the final analysis. Following the KCI supplementation, 11% of patients developed hyperkalemia, all of which were older and had higher baseline plasma potassium. The remaining 89% of patients who were normokalemic continued onto the 2-year randomized phase of the study.
Researchers found KCI supplementation increased urinary potassium excretion (72 ± 24 mmol/day to 107 ± 29 mmol/day), plasma potassium (4.3 ± 0.5 mmol/L to 4.7 ± 0.6 mmol/L) and plasma aldosterone (281 ng/L [198 ng/L - 431 ng/L ] to 351 [241 ng/L - 494 ng/L] ng/L). However, there were no significant impacts on urinary sodium excretion, plasma renin, blood pressure, EGFR or albuminuria.
“In conclusion, in patients with CKD stage G3b [to] 4 who were mostly on renin-angiotensin inhibitors, increasing dietary potassium intake to recommended levels with potassium chloride supplementation raises plasma potassium by 0.4 mmol/L. Although the majority of patients remained normokalemic, hyperkalemia may develop especially in older patients or those with higher baseline plasma potassium,” Gritter and colleagues wrote. They added, “The [2]-year randomized phase of our study, which also includes potassium citrate and placebo, should inform whether the proposed cardiorenal benefits of increasing potassium intake outweigh the risks of hyperkalemia.”
Collapse
Read more about
Click Here to Manage Email Alerts