Effects of Short-Term Potassium Chloride Supplementation in Patients with CKD

摘要

Background Observational studies suggest that adequate dietary potassium intake (90-120 mmol/day) may be renoprotective, but the effects of increasing dietary potassium and the risk of hyperkalemia are unknown. Methods This is a prespecified analysis of the run-in phase of a clinical trial in which 191 patients (age 68±11 years, 74 males, 86 European ancestry, eGFR 31±9 ml/min per 1.73 m2, 83 renin-angiotensin system inhibitors, 38 diabetes) were treated with 40 mmol potassium chloride (KCI) per day for 2 weeks. Results KCI supplementation significantly increased urinary potassium excretion (72±24 to 107±29 mmol/day), plasma potassium (4.3±0.5 to 4.7±0.6 mmol/L), and plasma aldosterone (281 198-431 to 351 241-494 ng/L), but had no significant effect on urinary sodium excretion, plasma renin, BP, eGFR, or albuminuria. Furthermore, KCI supplementation increased plasma chloride (104±3 to 105±4 mmol/L) and reduced plasma bicarbonate (24.5±3.4 to 23.7±3.5 mmol/L) and urine pH (all P<0.001), but did not change urinary ammonium excretion. In total, 21 participants (11) developed hyperkalemia (plasma potassium 5.9±0.4 mmol/L). They were older and had higher baseline plasma potassium. Conclusions In patients with CKD stage G3b-4, increasing dietary potassium intake to recommended levels with potassium chloride supplementation raises plasma potassium by 0.4 mmol/L. This may result in hyperkalemia in older patients or those with higher baseline plasma potassium. Longer-term studies should address whether cardiorenal protection outweighs the risk of hyperkalemia. Clinical trial number: NCT03253172