Miss RUI DU1,2, NASIR A SHAH1,3,4, SRADHA S KOTWAL1,3,4
1The George Institute for Global Health, Sydney, Australia, 2 Tsinghua University, Beijing, China, 3Prince of Wales Hospital, Sydney, Australia, 4UNSW Sydney, Sydney, Australia
Biography:
Rui Du is an MD candidate at Tsinghua University, currently working as a visiting student in the Renal and Metabolic Division at the George Institute for Global Health Australia. Under the mentorship of A/Prof Sradha Kotwal, Rui has actively contributed to clinical research, including the Global Kidney Patient Trials Network (GKPTN) and the Chronic kidney disease Adaptive Platform Trial Investigating Various Agents for Therapeutic Effect (CAPTIVATE) studies, focusing on implementing novel clinical trials and improving outcomes for people with kidney disease.
Aim:
To assess the safety of high potassium intake in chronic kidney disease (CKD), with primary outcomes including changes in serum potassium levels and incidence of hyperkalaemia. Secondary outcomes include worsening kidney function, cardiovascular, and all-cause mortality.
Background:
Dietary potassium management in CKD is complex. High potassium intake supports cardiovascular health in the general population, but with impaired excretion in CKD could predispose to hyperkalaemia. Restricting dietary potassium is challenging for many patients and may lead to poor dietary quality. Clinical guidelines currently recommend potassium restriction in CKD, but the safety and long-term impact of these remain unclear.
Methods:
A systematic review was conducted across PubMed, Embase, and Cochrane databases. Eligible studies include randomised controlled trials and observational studies evaluating high versus low potassium intake in adults with CKD. Study heterogeneity made meta-analysis not feasible. Synthesis without meta-analysis (SWiM) was performed using vote counting of direction of effect as the primary outcome.
Results:
The initial search strategy retrieved 1162 studies. After screening, 25 studies were analysed including a total of 13,319 participants. A positive direction of effect was observed for serum potassium level (9/19 studies). A neutral direction of effect was observed for hyperkalaemia events (4/6 studies), and cardiovascular mortality (4/4 studies). A negative direction of effect was observed for kidney outcomes (3/6 studies), and all-cause mortality (5/10 studies).
Conclusions:
Higher potassium intake appears safe in many CKD populations, with minimal impact on the incidence of hyperkalaemia and cardiovascular mortality. Some studies suggested benefits of high potassium intake in CKD on kidney outcomes and all-cause mortality. These findings challenge blanket dietary restrictions in CKD and support re-evaluation of current guidelines.