Yoko Narasaki1, Yusuke Okuda2, Sara S Kalantar3, Amy S You2, Alejandra Novoa2, Theresa Nguyen2, Elani Streja4, Tracy Nakata2, Sara Colman5, Kamyar Kalantar-Zadeh4, Danh V Nguyen6, Connie M Rhee7. 1. Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California; Department of Clinical Nutrition and Food Management, Tokushima University Graduate School of Nutrition and Biosciences, Tokushima, Japan; Japan Society for the Promotion of Science, Tokyo, Japan; Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan. 2. Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California. 3. Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California; University of California, Berkeley, Berkeley, California. 4. Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California; Tibor Rubin Veterans Affairs Medical Center, Long Beach, California. 5. DaVita Inc., El Segundo, California. 6. Division of General Internal Medicine, University of California, Irvine, Orange, California. 7. Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California. Electronic address: crhee1@uci.edu.
Abstract
OBJECTIVES: Among hemodialysis patients, clinical practice guidelines recommend dietary potassium restriction given concerns about potential hyperkalemia leading to malignant arrhythmias and mortality. However, there are sparse data informing recommendations for dietary potassium intake in this population. We thus sought to examine the relationship between dietary potassium intake and death risk in a prospective cohort of hemodialysis patients. DESIGN AND METHODS: Among 415 hemodialysis patients from the prospective "Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease" cohort recruited across 16 outpatient dialysis clinics, information regarding dietary potassium intake was obtained using Food Frequency Questionnaires administered over October 2011 to March 2015. We first examined associations of baseline dietary potassium intake categorized as tertiles with mortality risk using Cox regression. We then examined clinical characteristics associated with low dietary potassium intake (defined as the lowest tertile) using logistic regression. RESULTS: In expanded case-mix Cox analyses, patients whose dietary potassium intake was in the lowest tertile had higher mortality (ref: highest tertile) (adjusted hazard ratio 1.74, 95% confidence interval 1.14-2.66). These associations had even greater magnitude of risk following adjustment for laboratory and nutritional covariates (adjusted hazard ratio 2.65, 95% confidence interval 1.40-5.04). In expanded case-mix restricted cubic spline analyses, there was a monotonic increase in mortality risk with incrementally lower dietary potassium intake. In expanded case-mix logistic regression models, female sex; higher serum bicarbonate; and lower dietary energy, protein, and fiber intake were associated with low dietary potassium intake. CONCLUSIONS: In a prospective cohort of hemodialysis patients, lower dietary potassium intake was associated with higher mortality risk. These findings suggest that excessive dietary potassium restriction may be deleterious in hemodialysis patients, and further studies are needed to determine the optimal dietary potassium intake in this population.
OBJECTIVES: Among hemodialysis patients, clinical practice guidelines recommend dietary potassium restriction given concerns about potential hyperkalemia leading to malignant arrhythmias and mortality. However, there are sparse data informing recommendations for dietary potassium intake in this population. We thus sought to examine the relationship between dietary potassium intake and death risk in a prospective cohort of hemodialysis patients. DESIGN AND METHODS: Among 415 hemodialysis patients from the prospective "Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease" cohort recruited across 16 outpatient dialysis clinics, information regarding dietary potassium intake was obtained using Food Frequency Questionnaires administered over October 2011 to March 2015. We first examined associations of baseline dietary potassium intake categorized as tertiles with mortality risk using Cox regression. We then examined clinical characteristics associated with low dietary potassium intake (defined as the lowest tertile) using logistic regression. RESULTS: In expanded case-mix Cox analyses, patients whose dietary potassium intake was in the lowest tertile had higher mortality (ref: highest tertile) (adjusted hazard ratio 1.74, 95% confidence interval 1.14-2.66). These associations had even greater magnitude of risk following adjustment for laboratory and nutritional covariates (adjusted hazard ratio 2.65, 95% confidence interval 1.40-5.04). In expanded case-mix restricted cubic spline analyses, there was a monotonic increase in mortality risk with incrementally lower dietary potassium intake. In expanded case-mix logistic regression models, female sex; higher serum bicarbonate; and lower dietary energy, protein, and fiber intake were associated with low dietary potassium intake. CONCLUSIONS: In a prospective cohort of hemodialysis patients, lower dietary potassium intake was associated with higher mortality risk. These findings suggest that excessive dietary potassium restriction may be deleterious in hemodialysis patients, and further studies are needed to determine the optimal dietary potassium intake in this population.
Authors: Antoney Ferrey; Amy S You; Csaba P Kovesdy; Tracy Nakata; Mary Veliz; Danh V Nguyen; Kamyar Kalantar-Zadeh; Connie M Rhee Journal: Am J Nephrol Date: 2018-06-07 Impact factor: 3.754
Authors: L J Appel; T J Moore; E Obarzanek; W M Vollmer; L P Svetkey; F M Sacks; G A Bray; T M Vogt; J A Cutler; M M Windhauser; P H Lin; N Karanja Journal: N Engl J Med Date: 1997-04-17 Impact factor: 91.245
Authors: Valeria M Saglimbene; Germaine Wong; Marinella Ruospo; Suetonia C Palmer; Vanessa Garcia-Larsen; Patrizia Natale; Armando Teixeira-Pinto; Katrina L Campbell; Juan-Jesus Carrero; Peter Stenvinkel; Letizia Gargano; Angelo M Murgo; David W Johnson; Marcello Tonelli; Rubén Gelfman; Eduardo Celia; Tevfik Ecder; Amparo G Bernat; Domingo Del Castillo; Delia Timofte; Marietta Török; Anna Bednarek-Skublewska; Jan Duława; Paul Stroumza; Susanne Hoischen; Martin Hansis; Elisabeth Fabricius; Paolo Felaco; Charlotta Wollheim; Jörgen Hegbrant; Jonathan C Craig; Giovanni F M Strippoli Journal: Clin J Am Soc Nephrol Date: 2019-01-31 Impact factor: 8.237
Authors: Amelie Bernier-Jean; Germaine Wong; Valeria Saglimbene; Marinella Ruospo; Suetonia C Palmer; Patrizia Natale; Vanessa Garcia-Larsen; David W Johnson; Marcello Tonelli; Jörgen Hegbrant; Jonathan C Craig; Armando Teixeira-Pinto; Giovanni F M Strippoli Journal: Clin J Am Soc Nephrol Date: 2021-12-01 Impact factor: 8.237