Objective To systematically review the dose-response relationship between dietary potassium intake and risk of mortality, CKD progression in chronic kidney disease patients. Methods PubMed, The Cochrane Library, EM-base, Web of Science, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect studies about dietary potassium intake and risk of mortality, CKD progression in patients with CKD from inception to August 2023. Two reviewers screened literature, extracted data and assessed the quality of included studies independently. Meta-analysis was performed by using R4.2, and the dose-response relationship was analyzed by using restricted cubic spline function and generalized least squares estimation. Results A total of 14 studies involving 53694 patients were included. The results of meta-analysis showed that no significant association between potassium intake and mortality in CKD patients (RR=0.875, 95% CI:0.746～1.027, P=0.100). Dose-response meta-analysis showed an L-shaped association between potassium intake and mortality in CKD patients (non-linear test P=0.010), while there was no significant non-linear trend between potassium intake and CKD progression (non-linear test P=0.226). The linear trend results showed that for every unit increase in potassium intake in CKD patients, the risk of CKD progression was reduced by 21.6% (RR=0.784,95% CI:0.625～0.983, P=0.031). Conclusion Current evidence suggests that potassium intake in CKD patients should not be excessively restricted. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.
FENG Qian
,
ZHU Meng-Xia
,
LI Shu-Xian
,
QI Shi-Kun
,
HAN Xiao-Wei
. Association between dietary potassium intake and risk of mortality，CKD progression in chronic kidney disease patients: A systematic review and dose-response meta-analysis[J]. Chinese Journal of Blood Purification, 2024
, 23(04)
: 261
-266
.
DOI: 10.3969/j.issn.1671-4091.2024.04.005
参考文献
[1] Seliger S L. Hyperkalemia in patients with chronic renal failure[J]. Nephrol Dial Transplant， 2019， 34(Suppl 3): i12-i18.
[2] Belmar V L，Galabia E R，Bada D S J，et al. Epidemiology of hyperkalemia in chronic kidney disease[J]. Nefrologia (Engl Ed)， 2019， 39(3): 277-286.
[3] Morris A，Krishnan N，Kimani P K，et al. CORRECTED ARTICLE: Effect of Dietary Potassium Restriction on Serum Potassium, Disease Progression, and Mortality in Chronic Kidney Disease: A Systematic Review and Meta-Analysis[J]. Journal of Renal Nutrition， 2022， 32(1): e1-e10.
[4] Fishbane S，Charytan D M，Chertow G M，et al. Consensus-Based Recommendations for the Management of Hyperkalemia in the Hemodialysis Setting[J]. Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation， 2022， 32(4): e1-e14.
[5] 中华医学会肾脏病学分会专家组. 中国慢性肾脏病患者血钾管理实践专家共识[J]. 中华肾脏病杂志， 2020， 36(10): 781-792.
[6] Noori N，Kalantar-Zadeh K，Kovesdy C P，et al. Dietary potassium intake and mortality in long-term hemodialysis patients[J]. Am J Kidney Dis， 2010， 56(2): 338-347.
[7] K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease[J]. Am J Kidney Dis， 2004， 43(5 Suppl 1): S1-S290.
[8] Andrassy K M. Comments on 'KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease'[J]. Kidney Int， 2013， 84(3): 622-623.
[9] Ikizler T A，Burrowes J D，Byham-Gray L D，et al. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update[J]. Am J Kidney Dis， 2020， 76(3 Suppl 1): S1-S107.
[10] Cano N，Fiaccadori E，Tesinsky P，et al. ESPEN Guidelines on Enteral Nutrition: Adult renal failure[J]. Clin Nutr， 2006， 25(2): 295-310.
[11] Moher D，Liberati A，Tetzlaff J，et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement[J]. PLoS Med， 2009， 6(7): e1000097.
[12] Bernier-Jean A，Wong G，Saglimbene V，et al. Dietary Potassium Intake and All-Cause Mortality in Adults Treated with Hemodialysis[J]. Clinical Journal of the American Society of Nephrology， 2021， 16(12): 1851-1861.
[13] Eisenga M F，Kieneker L M，Soedamah-Muthu S S，et al. Urinary potassium excretion, renal ammoniagenesis, and risk of graft failure and mortality in renal transplant recipients[J]. Am J Clin Nutr， 2016， 104(6): 1703-1711.
[14] He J，Mills K T，Appel L J，et al. Urinary Sodium and Potassium Excretion and CKD Progression[J]. J Am Soc Nephrol， 2016， 27(4): 1202-1212.
[15] Hellman T，Uusalo P，Jarvisalo M J. Chloride, Sodium and Calcium Intake Are Associated with Mortality and Follow-Up Kidney Function in Critically Ill Patients Receiving Continuous Veno-Venous Hemodialysis-A Retrospective Study[J]. NUTRIENTS， 2023， 15(3).
[16] Hundemer G L，Sood M M，Ramsay T，et al. Urinary Potassium Excretion and Progression From Advanced CKD to Kidney Failure[J]. Can J Kidney Health Dis， 2022， 9: 1025039701.
[17] Kim H W，Park J T，Yoo T H，et al. Urinary Potassium Excretion and Progression of CKD[J]. CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY， 2019， 14(3): 330-340.
[18] Leonberg-Yoo A K，Tighiouart H，Levey A S，et al. Urine Potassium Excretion, Kidney Failure, and Mortality in CKD[J]. Am J Kidney Dis， 2017， 69(3): 341-349.
[19] Matsukuma Y，Nakayama M，Tsuda S，et al. Association between the urinary sodium-to-potassium ratio and renal outcomes in patients with chronic kidney disease: a prospective cohort study[J]. Hypertens Res， 2021， 44(11): 1492-1504.
[20] Mun K H，Yu G I，Choi B Y，et al. Association of Dietary Potassium Intake with the Development of Chronic Kidney Disease and Renal Function in Patients with Mildly Decreased Kidney Function: The Korean Multi-Rural Communities Cohort Study[J]. Med Sci Monit， 2019， 25: 1061-1070.
[21] Nagata T，Sobajima H，Ohashi N，et al. 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[J]. PLoS One， 2016， 11(5): e152306.
[22] Narasaki Y，Okuda Y，Kalantar S S，et al. Dietary Potassium Intake and Mortality in a Prospective Hemodialysis Cohort[J]. J Ren Nutr， 2021， 31(4): 411-420.
[23] Smyth A，Dunkler D，Gao P，et al. The relationship between estimated sodium and potassium excretion and subsequent renal outcomes[J]. Kidney Int， 2014， 86(6): 1205-1212.
[24] Suh S H，Song S H，Oh T R，et al. Association of Urinary Potassium Excretion with Blood Pressure Variability and Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease[J]. Nutrients， 2021， 13(12).
[25] KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 Update[J]. Am J Kidney Dis， 2012， 60(5): 850-886.
[26] Patient education: Low-potassium diet (Beyond the Basics) - UpToDate [EB/OL]. https://www.uptodate.cn/contents/low-potassium-diet-beyond-the-basics?search=%E4%BD%8E%E9%92%BE%E8%86%B3%E9%A3%9F&source=search_result&selectedTitle=1~38&usage_type=default&display_rank=1，2023/8/30.
[27] 杨丽丽，席波. 中国成年居民2000—2015年膳食钠、钾摄入量变化趋势分析[J]. 中国公共卫生， 2017， 33(08): 1249-1253.
[28] Palmer S C，Hanson C S，Craig J C，et al. Dietary and fluid restrictions in CKD: a thematic synthesis of patient views from qualitative studies[J]. Am J Kidney Dis， 2015， 65(4): 559-573.
[29] Morris A，Love H，van Aar Z，et al. Integrating renal nutrition guidelines into daily family life: a qualitative exploration[J]. J Hum Nutr Diet， 2018， 31(1): 3-11.
[30] Morris A，Love H，van Aar Z，et al. THE PROBLEMATIC WORLD OF FOLLOWING A RENAL DIET OUTSIDE THE HOME[J]. J Ren Care， 2015， 41(4): 253-259.
[31] Hollingdale R，Sutton D，Hart K. Facilitating dietary change in renal disease: investigating patients' perspectives[J]. J Ren Care， 2008， 34(3): 136-142.
[32] Stevenson J，Tong A，Gutman T，et al. Experiences and Perspectives of Dietary Management Among Patients on Hemodialysis: An Interview Study[J]. J Ren Nutr， 2018， 28(6): 411-421.
[33] Wakasugi M，Yokoseki A，Wada M，et al. Vegetable and Fruit Intake Frequency and Mortality in Patients With and Without Chronic Kidney Disease: A Hospital-Based Cohort Study[J]. JOURNAL OF RENAL NUTRITION， 2023， 33(4).
[34] Narasaki Y，You A S，Malik S，et al. Dietary potassium intake, kidney function, and survival in a nationally representative cohort[J]. Am J Clin Nutr， 2022， 116(4): 1123-1134.
[35] St-Jules D E，Woolf K，Pompeii M L，et al. Exploring Problems in Following the Hemodialysis Diet and Their Relation to Energy and Nutrient Intakes: The BalanceWise Study[J]. J Ren Nutr， 2016， 26(2): 118-124.
[36] Hu E A，Coresh J，Anderson C，et al. Adherence to Healthy Dietary Patterns and Risk of CKD Progression and All-Cause Mortality: Findings From the CRIC (Chronic Renal Insufficiency Cohort) Study[J]. AMERICAN JOURNAL OF KIDNEY DISEASES， 2021， 77(2): 235-244.
[37] 美国营养与饮食学会，美国肾脏病基金会. 2020 营养和饮食学会/NKF临床实践指南：慢性肾脏病患者营养[EB/OL]. https://guide.medlive.cn/guideline/21947，2020-11-03 2023/2/25.
[38] Eriguchi R，Obi Y，Soohoo M，et al. Racial and Ethnic Differences in Mortality Associated with Serum Potassium in Incident Peritoneal Dialysis Patients[J]. AMERICAN JOURNAL OF NEPHROLOGY， 2019， 50(5): 361-369.
[39] Kim T，Rhee C M，Streja E，et al. Racial and Ethnic Differences in Mortality Associated with Serum Potassium in a Large Hemodialysis Cohort[J]. Am J Nephrol， 2017， 45(6): 509-521.
