Association of Urinary Potassium Excretion with Blood Pressure Variability and Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease

• Published in: Nutrients 2021-12, Vol.13 (12), p.4443
• Main Authors: Suh, Sang Heon, Song, Su Hyun, Oh, Tae Ryom, Choi, Hong Sang, Kim, Chang Seong, Bae, Eun Hui, Oh, Kook-Hwan, Lee, Joongyub, Han, Seung Hyeok, Kim, Yeong Hoon, Chae, Dong-Wan, Ma, Seong Kwon, Kim, Soo Wan, On Behalf Of The Korean Cohort Study For Outcomes In Patients With Chronic Kidney Disease Know-Ckd Investigators
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antihypertensives; Blood Pressure; Body mass index; Cardiac arrhythmia; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Cholesterol; Cohort Studies; Comorbidity; Confidence intervals; Creatinine; Creatinine - urine; Dialysis; Dialysis - methods; Dietary intake; Diuretics; Excretion; Female; Glucose; Hemodialysis; Hemoglobin; Humans; Hypertension - epidemiology; Kidney diseases; Kidneys; Lipoproteins; Male; Middle Aged; Mortality; Population; Potassium; Potassium - administration & dosage; Potassium - urine; Prospective Studies; Regression analysis; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - physiopathology; Renal Insufficiency, Chronic - urine; Risk Factors; Sodium; Sodium - urine; Standard deviation; Statistical analysis; Urine; Vitamin D
• ISSN: 2072-6643; 2072-6643
• DOI: 10.3390/nu13124443

Dietary potassium intake is a dilemma in patients with chronic kidney disease (CKD). We investigated the association of urine potassium excretion, a surrogate for dietary potassium intake, with blood pressure variability (BPV) and cardiovascular (CV) outcomes in patients with pre-dialysis CKD. A total of 1860 participants from a cohort of pre-dialysis CKD (KNOW-CKD) patients were divided into the quartiles by spot urine potassium-to-creatinine ratio. The first quartile (26.423 ± 5.731 mmol/gCr) was defined as low urine potassium excretion. Multivariate linear regression analyses revealed an independent association of low urine potassium excretion with high BPV (adjusted β coefficient 1.163, 95% confidence interval 0.424 to 1.901). Cox regression analyses demonstrated that, compared to high urine potassium excretion, low urine potassium excretion is associated with increased risk of CV events (adjusted hazard ratio 2.502, 95% confidence interval 1.162 to 5.387) but not with all-cause mortality. In conclusion, low urine potassium excretion is associated with high BPV and increased risk of CV events in patients with pre-dialysis CKD. The restriction of dietary potassium intake should be individualized in patients with pre-dialysis CKD.