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Swift SL, Drexler Y, Sotres-Alvarez D, Raij L, Llabre MM, Schneiderman N, Horn LV, Lash JP, Mossavar-Rahmani Y, Elfassy T. Associations of sodium and potassium intake with chronic kidney disease in a prospective cohort study: findings from the Hispanic Community Health Study/Study of Latinos, 2008-2017. BMC Nephrol 2022; 23:133. [PMID: 35387601 PMCID: PMC8988326 DOI: 10.1186/s12882-022-02754-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 03/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND According to dietary recommendations, reduction of sodium intake has potential to reduce Chronic Kidney Disease (CKD) risk; however the role of dietary potassium and the sodium -to- potassium ratio in the development of CKD is unclear. METHODS We studied 9778 participants of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) from four US urban communities. Participants were aged 18-74 yrs., free from CKD at baseline in 2008-2011 and re-examined between 2014 and - 2017. Dietary intake of sodium, potassium and the ratio of dietary sodium -to- potassium were measured from two baseline 24-h dietary recalls. Incident CKD was defined as: 1) estimated glomerular filtration rate (eGFR) decline of 1 unit per year and eGFR < 60 ml/min/1.73m2 or 2) albumin to creatinine ratio ≥ 30 mg/g at the follow-up visit. We used multivariable survey weighted Poisson regression to estimate adjusted incident rates of incident CKD. RESULTS At baseline, mean age was 41 years. Average follow up time was 6.2 years. From fully adjusted Poisson regression analyses, self-reported sodium intake was not associated with incident CKD. However, for each 500 mg decrement in potassium intake, there was an 11% increase risk of incident CKD (IRR = 1.11, 95% CI = 1.00, 1.24). Additionally, every 1 M ratio increment of sodium -to -potassium ratio was associated with a 21% increased risk of incident CKD (IRR = 1.21, 95% CI = 1.02, 1.45), p < 0.05). CONCLUSIONS We conclude that diets low in potassium and high in sodium are associated with increased risk of developing chronic kidney disease among healthy US Hispanic/Latino adults.
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Affiliation(s)
- Samuel L Swift
- Center for Healthcare Equity in Kidney Disease, University of New Mexico Health Science Center, Albuquerque, NM, USA
| | - Yelena Drexler
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leopoldo Raij
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Maria M Llabre
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanstown, IL, USA
| | - James P Lash
- Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Tali Elfassy
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA.
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Gorriz JL, D'Marco L, Pastor-González A, Molina P, Gonzalez-Rico M, Puchades MJ, Sanchis I, Escudero V, Estañ N, de la Espriella R, Nuñez E, Pallardó L, Núñez J. LONG-TERM MORTALITY AND TRAJECTORY OF POTASSIUM MEASUREMENTS FOLLOWING AN EPISODE OF ACUTE SEVERE HYPERKALEMIA. Nephrol Dial Transplant 2021; 37:522-530. [PMID: 33508124 PMCID: PMC8875445 DOI: 10.1093/ndt/gfab003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hyperkalemia is a common condition in patients with comorbidities such as chronic kidney disease (CKD) or congestive heart failure. Moreover, severe hyperkalemia is a potentially life-threatening condition that is associated with a higher risk of adverse clinical events such as ventricular arrhythmias and sudden cardiac death. Currently, data regarding the prognostic implications of chronic hyperkalemia are available; however, the information about the long-term clinical consequences after an episode of severe hyperkalemia remains scarce. The objective of the study was to evaluate the association between the trajectory of potassium measurements in patients with acute hyperkalemia and long-term all-cause mortality. METHODS This is a retrospective observational study that included patients with acute severe hyperkalemia (K > 6 mEq/L) without hemolysis in the emergency room of Dr. Peset University Hospital in Valencia, Spain searching the lab database from January 2016 to March 2017. The multivariable-adjusted association of serum potassium with mortality was assessed by using comprehensive state-of-the-art regression methods that can accommodate time-dependent exposure modelling. RESULTS We found 172 episodes of acute hyperkalemia in 160 patients in the emergency room. The mean age of the sample was 77 ± 12 years and 60.5% were males. The most frequent comorbidities were CKD (71.2%), heart failure (35%) and diabetes mellitus (56.9%). Only 11.9% of the patients were on chronic dialysis. A quarter of the patients did not have previous CKD making hyperkalemia as an unpredictable life-threatening complication. During the acute episode, mean potassium and eGFR were 6.6 ± 0.6 (range: 6,1-9,2), and eGFR: 23 ± 16 (r : 2-84). After a median follow-up of 17.3 (IQR: 2.2-23.7) months, 68 patients died (42.5%). Recurrences of hyperkalemia (K > 5.5 mEq/L) were detected in 39.5%% of the patients who were monitored during follow-up. We found that previous potassium levels during an acute severe hyperkalemia episode were not predictors of mortality. Conversely, the post-discharge longitudinal trajectories of potassium were able to predict all-cause mortality (overall p-value = 0.0015). The effect of transitioning from hyperkalemia to normokalaemia (K > 5.5 to K ≤ 5.5 after the acute episode was significant and inversely associated with the risk of mortality. CONCLUSION The potassium levels prior to a severe hyperkalemic event do not predict mortality. Conversely, following an episode of acute severe hyperkalemia, serial kinetic of potassium trajectories predicts the risk of death. Further evidence is needed to confirm these findings and clarify the optimal long-term management of these patients.
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Affiliation(s)
- José Luis Gorriz
- Department of Nephrology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain
| | - Luis D'Marco
- Department of Nephrology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain
| | - Anna Pastor-González
- Department of Nephrology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain
| | - Pablo Molina
- Department of Nephrology, Hospital Universitario Dr Peset. Universitat de València, . Valencia, Spain
| | - Miguel Gonzalez-Rico
- Department of Nephrology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain
| | - María Jesús Puchades
- Department of Nephrology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain
| | - Irina Sanchis
- Department of Nephrology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain
| | - Verónica Escudero
- Department of Nephrology, Hospital Universitario Dr Peset. Universitat de València, . Valencia, Spain
| | - Nuria Estañ
- Clinical Analysis Service, Dr Peset University Hospital
| | - Rafael de la Espriella
- Department of Cardiology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain
| | - Eduardo Nuñez
- Department of Cardiology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain
| | - Luis Pallardó
- Department of Nephrology, Hospital Universitario Dr Peset. Universitat de València, . Valencia, Spain
| | - Julio Núñez
- Department of Cardiology, Clínico University Hospital, INCLIVA. Universitat de València, . Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
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Estimated 24 h Urinary Sodium-to-Potassium Ratio Is Related to Renal Function Decline: A 6-Year Cohort Study of Japanese Urban Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165811. [PMID: 32796692 PMCID: PMC7459630 DOI: 10.3390/ijerph17165811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 11/26/2022]
Abstract
The effect of the sodium-to-potassium ratio (Na/K) on renal function within the clinically normal range of renal function are limited. We investigated the effects of an estimated 24 h urinary Na/K (e24hUNa/K) on a 6-year renal function decline among 927 urban Japanese community dwellers with no history of cardiovascular diseases and medication for hypertension, diabetes, or dyslipidemia. We partitioned the subjects into quartiles according to the e24hUNa/K. The estimated glomerular filtration rate (eGFR) was calculated using the chronic kidney disease epidemiology collaboration (CKD/EPI) formula and renal function decline was defined as an absolute value at or above the third quartile of the eGFR decline rate. A multivariable logistic regression model was used for estimation. Compared with the first quartile of the e24hUNa/K, multivariable-adjusted odds ratios (ORs) for eGFR decline in the second, third, and fourth quartiles were 0.96 (95% confidence interval: 0.61–1.51), 1.06 (0.67–1.66), and 1.65 (1.06–2.57), respectively. These results were similar when the simple spot urine Na/K ratio was used in place of the e24hUNa/K. Apparently healthy urban residents with an almost within normal range mean baseline eGFR and high e24hUNa/K ratios had an increased risk for a future decline in renal function. Reducing the Na/K ratio may be important in the prevention of chronic kidney disease in its early stage.
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Elfassy T, Zhang L, Raij L, Bibbins-Domingo K, Lewis CE, Allen NB, Liu KJ, Peralta CA, Odden MC, Zeki Al Hazzouri A. Results of the CARDIA study suggest that higher dietary potassium may be kidney protective. Kidney Int 2020; 98:187-194. [PMID: 32471640 PMCID: PMC7318054 DOI: 10.1016/j.kint.2020.02.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 02/07/2020] [Accepted: 02/27/2020] [Indexed: 02/07/2023]
Abstract
The association between dietary sodium and potassium intake with the development of kidney disease remains unclear, particularly among younger individuals. Here, we determined whether dietary sodium and potassium intake are associated with incident chronic kidney disease (CKD) using data from 1,030 adults (age 23-35 in 1990-1991) from the Coronary Artery Risk Development In Young Adults study, based on repeated measurements of estimated glomerular filtration rate (eGFR) and urinary albumin to creatinine ratio (ACR) from 1995 through 2015. Urinary sodium and potassium excretion (mg/day), calculated from three 24-hour urine collections in 1990-1991, were averaged to measure sodium and potassium intake. Serum creatinine was used to calculate eGFR using the CKD EPI equation; spot urine albumin and creatinine were used to calculate ACR, each at five visits from 1995-1996 through 2015-2016. CKD was defined as decreased eGFR (under 60 ml/min/1.73m2) or the development of albuminuria (ACR over 30 mg/g). We used log binomial regression models adjusted for socio-demographic, behavioral, and clinical factors to determine whether sodium and potassium intake were associated with incident CKD (decreased eGFR or developed albuminuria) among those free of CKD in 1995. Dietary sodium intake was not significantly associated with incident CKD. However, every 1,000 mg/day increment of potassium intake in 1990 was significantly associated with a 29% lower risk of incident albuminuria (relative risk 0.71, 95% confidence interval 0.53, 0.95), but not eGFR. Thus, higher dietary potassium intake may protect against the development of kidney damage, particularly albuminuria.
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Affiliation(s)
- Tali Elfassy
- Division of Epidemiology, Department of Public Health Sciences, University of Miami, Miami, Florida, USA.
| | - Lanyu Zhang
- Division of Epidemiology, Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Leopoldo Raij
- Department of Medicine, University of Miami, Miami, Florida, USA
| | - Kirstin Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Norrina Bai Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Kiang J Liu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Carmen A Peralta
- University of California San Francisco, San Francisco, California, USA
| | - Michelle C Odden
- Health Research and Policy, Department of Epidemiology, Stanford University, Stanford, California, USA
| | - Adina Zeki Al Hazzouri
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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Leonberg-Yoo AK, Tighiouart H, Levey AS, Beck GJ, Sarnak MJ. Urine Potassium Excretion, Kidney Failure, and Mortality in CKD. Am J Kidney Dis 2016; 69:341-349. [PMID: 27233381 DOI: 10.1053/j.ajkd.2016.03.431] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/31/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Low urine potassium excretion, as a surrogate for dietary potassium intake, is associated with higher risk for hypertension and cardiovascular disease in a general population. Few studies have investigated the relationship of urine potassium with clinical outcomes in chronic kidney disease (CKD). STUDY DESIGN Longitudinal cohort study. SETTING & PARTICIPANTS The MDRD (Modification of Diet in Renal Disease) Study was a randomized controlled trial (N = 840) conducted in 1989 to 1993 to examine the effects of blood pressure control and dietary protein restriction on kidney disease progression in adults aged 18 to 70 years with CKD stages 2 to 4. This post hoc analysis included 812 participants. PREDICTOR The primary predictor variable was 24-hour urine potassium excretion, measured at baseline and at multiple time points (presented as time-updated average urine potassium excretion). OUTCOMES Kidney failure, defined as initiation of dialysis therapy or transplantation, was determined from US Renal Data System data. All-cause mortality was assessed using the National Death Index. RESULTS Median follow-up for kidney failure was 6.1 (IQR, 3.5-11.7) years, with 9 events/100 patient-years. Median all-cause mortality follow-up was 19.2 (IQR, 10.8-20.6) years, with 3 deaths/100 patient-years. Baseline mean urine potassium excretion was 2.39±0.89 (SD) g/d. Each 1-SD higher baseline urine potassium level was associated with an adjusted HR of 0.95 (95% CI, 0.87-1.04) for kidney failure and 0.83 (95% CI, 0.74-0.94) for all-cause mortality. Results were consistent using time-updated average urine potassium measurements. LIMITATIONS Analyses were performed using urine potassium excretion as a surrogate for dietary potassium intake. Results are obtained from a primarily young, nondiabetic, and advanced CKD population and may not be generalizable to the general CKD population. CONCLUSIONS Higher urine potassium excretion was associated with lower risk for all-cause mortality, but not kidney failure.
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Affiliation(s)
| | - Hocine Tighiouart
- Research Design Center/Biostatistics Research Center, Tufts CTSI and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Andrew S Levey
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Gerald J Beck
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Mark J Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA.
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Nagata T, Sobajima H, Ohashi N, Hirakawa A, Katsuno T, Yasuda Y, Matsuo S, Tsuboi N, Maruyama S. Association between 24h Urinary Sodium and Potassium Excretion and Estimated Glomerular Filtration Rate (eGFR) Decline or Death in Patients with Diabetes Mellitus and eGFR More than 30 ml/min/1.73m2. PLoS One 2016; 11:e0152306. [PMID: 27136292 PMCID: PMC4852934 DOI: 10.1371/journal.pone.0152306] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/12/2016] [Indexed: 12/31/2022] Open
Abstract
Background Data regarding the association between 24h urinary sodium and potassium excretion with kidney outcomes in patients with diabetes mellitus is currently scarce. Methods We conducted a single-center, retrospective cohort study in which 1230 patients with diabetes who had undergone a 24h urinary sodium and potassium excretion test were analyzed. Patients with incomplete urine collection were excluded based on 24h urinary creatinine excretion. Outcomes were the composite of a 30% decline in eGFR or death. Multivariate cox regression analysis was used to investigate the association between urinary sodium and potassium excretion and outcomes. Results With a mean follow up period of 5.47 years, 130 patients reached the outcomes (30% decline in eGFR: 124, death: 6). Mean (SD) eGFR and 24h urinary sodium and potassium excretion at baseline were 78.6 (19.5) ml/min/1.73m2, 4.50 (1.64) g/day, and 2.14 (0.77) g/day. Compared with sodium excretion < 3.0 g/day, no significant change in risk of outcomes was observed with increased increments of 1.0 g/day. Compared with potassium excretion of < 1.5 g/day, 2.0–2.5 g/day, and 2.5–3.0 g/day were significantly associated with a lower risk of outcomes (hazard ratio [HR], 0.49 and 0.44; 95% confidence interval [CI], 0.28 to 0.84 and 0.22 to 0.87). Conclusions 24h urinary sodium excretion was not significantly associated with a risk of 30% decline in eGFR or death in patients with diabetes. However, an increased risk of 30% decline in eGFR or death was significantly associated with 24h urinary potassium excretion < 1.5 g/day than with 2.0–2.5 g/day and 2.5–3.0 g/day.
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Affiliation(s)
- Takanobu Nagata
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Diabetology and Nephrology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hiroshi Sobajima
- Department of Diabetology and Nephrology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Norimi Ohashi
- Department of Diabetology and Nephrology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Akihiro Hirakawa
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Takayuki Katsuno
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinari Yasuda
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Seiichi Matsuo
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naotake Tsuboi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Abstract
Smyth et al. examined the association between urinary sodium and potassium excretion and adverse renal outcomes in adults at high cardiovascular risk. They found no association between urinary sodium excretion and adverse renal outcomes, but a reduced odds of adverse renal outcomes with higher urinary potassium excretion. This finding is quite interesting and a major advancement from this study. It will be important to ascertain whether this finding holds true in individuals free from vascular disease and diabetes, as well as in patients with chronic kidney disease.
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Manger WM, Simchon S, Stier CT, Loscalzo J, Jan KM, Jan R, Haddy F. Protective effects of dietary potassium chloride on hemodynamics of Dahl salt-sensitive rats in response to chronic administration of sodium chloride. J Hypertens 2003; 21:2305-13. [PMID: 14654751 DOI: 10.1097/00004872-200312000-00019] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dietary potassium supplementation decreases blood pressure and prevents strokes in humans, and prevents strokes and renal damage in Dahl salt-sensitive (DSS) rats. OBJECTIVE To study the effects of various concentrations of dietary potassium chloride (KCl) on the hemodynamics of Dahl salt-resistant (DSR) and DSS rats receiving a 1% sodium chloride (NaCl) diet for 8 months, to determine whether there is an optimal dietary concentration of KCl that minimizes increases in blood pressure and causes least impairment of blood flow in the brain and kidneys. METHODS AND RESULTS We found a biphasic effect on hemodynamic parameters as a function of dietary KCl in DSS rats of the Rapp strain fed 1% NaCl with increasing dietary KCl (0.7, 2.6, 4 and 8%). After 8 months receiving a diet containing 1% NaCl and 0.7% KCl, DSS rats had mean arterial pressures (MAP), plasma volumes, cardiac outputs and renal and cerebral vascular resistances that were significantly increased compared with those of DSR rats receiving the same diet. With a 2.6% KCl diet, all these parameters were significantly reduced compared with those in DSS rats fed the 0.7% KCl diet and were similar to those in DSR rats fed 2.6% KCl. Total peripheral resistance in DSR and DSS rats was similar on all diets. When KCl was increased to 4 and 8%, MAP, plasma volume, cardiac output and renal vascular resistance progressively increased in DSR and DSS rats, without changing total peripheral resistance. These changes paralleled increases in plasma aldosterone, which resulted from adrenocortical stimulation by the increasing dietary KCl; however, cerebral vascular resistance of DSR and DSS rats decreased significantly with a 4% KCl diet, despite increased aldosterone and sodium retention. Only DSS rats fed a 2.6% KCl diet had hemodynamics similar to those of DSR control rats fed the same diet, and hyperaldosteronism, sodium retention and increased plasma volume did not occur. CONCLUSION 'Optimal' dietary KCl (2.6%) prevents hypertension and preserves cerebral and renal hemodynamics in DSS rats fed a diet containing 1% NaCl for 8 months, which causes hypertension when dietary KCl is limited or excessive.
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