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

Mun, Kwang Ho; Yu, Gyeong Im; Choi, Bo Youl; Kim, Mi Kyung; Shin, Min Ho; Shin, Dong Hoon

doi:10.12659/msm.913504

Cited by 21 publications

(14 citation statements)

References 32 publications

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“…Contrary to sodium, potassium intake is emphasized in the DASH diet. A prospective cohort study in South Korean adults with impaired kidney function found that a higher potassium intake was associated with a decreased risk of CKD development and less estimated glomerular filtration rate (eGFR) decline, but only in participants with hypertension [ 60 ]. These findings are corroborated by a cross-sectional study from South Korea, which found that low potassium intake was associated with increased odds of advanced stage CKD, though only in participants with hypertension [ 61 ].…”

Section: The Dash Diet and Chronic Kidney Diseasementioning

confidence: 99%

The DASH Diet and Cardiometabolic Health and Chronic Kidney Disease: A Narrative Review of the Evidence in East Asian Countries

Lobene

Wang

et al. 2021

Nutrients

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The rising incidence of cardiometabolic diseases and chronic kidney disease (CKD) is a leading public health problem in East Asia. Diet is an important modifiable risk factor; thus, adopting a healthy diet such as the Dietary Approaches to Stop Hypertension (DASH) diet may help combat these chronic diseases. The DASH diet was originally developed in a U.S. population, and East Asia is demographically and culturally different from the U.S. Therefore, it is important to examine the evidence regarding the DASH diet and chronic disease in this unique population. This narrative review summarizes the evidence on the DASH diet and cardiometabolic health and CKD in East Asia. Culturally-modified DASH diets have been developed in some East Asian countries. Studies suggest the DASH diet is effective at lowering blood pressure in this population, though the long-term benefits remain unclear. Evidence also suggests the DASH diet may reduce the risk of type 2 diabetes and metabolic syndrome. Further research indicates the DASH diet and its components may reduce CKD risk. However, recommending the DASH diet in those who already have CKD is controversial, as it conflicts with current CKD dietary guidelines, especially in advanced CKD. Notably, current intakes in the general population differ from the DASH dietary pattern, suggesting public health efforts would be needed to encourage adoption of the DASH diet.

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Section: The Dash Diet and Chronic Kidney Diseasementioning

confidence: 99%

The DASH Diet and Cardiometabolic Health and Chronic Kidney Disease: A Narrative Review of the Evidence in East Asian Countries

Lobene

Wang

et al. 2021

Nutrients

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“…Two other studies also showed that higher K + intake is associated with better kidney outcomes [ 159 , 165 ], while another study showed no association [ 164 ]. Taken together, the majority of these observational studies demonstrate that diets rich in K + were associated with better kidney outcomes in the overall population or patients with early-stage CKD ( Figure 6 ) [ 151 , 152 , 154 , 155 , 165 , 166 ].…”

Section: Dietary Potassium and Ckdmentioning

confidence: 97%

“…Some cohort studies used food frequency questionnaire to evaluate the association between dietary K + intake and kidney outcomes [ 164–166 ]. For example, Mun et al recently studied the association of dietary K + with eGFR <60 mL/min/1.73 m 2 and >15% decline in eGFR in Korean rural populations with CKD Stage 2 (involving a total of 5064 patients) [ 166 ]. Compared with the subjects in the lowest quartile of dietary K + intake (<1236 mg/day), patients in the highest quartile of dietary K + intake (>2323 mg/day) had a 40% lower risk of CKD development and patients in all quartiles had a 28–46% lower risk of eGFR decline during the follow-up period of 47 months.…”

Section: Dietary Potassium and Ckdmentioning

confidence: 99%

Dietary potassium and the kidney: lifesaving physiology

Wei

Gritter

Vogt³

et al. 2020

Clinical Kidney Journal

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Potassium often has a negative connotation in Nephrology as patients with chronic kidney disease (CKD) are prone to develop hyperkalaemia. Approaches to the management of chronic hyperkalaemia include a low potassium diet or potassium binders. Yet, emerging data indicate that dietary potassium may be beneficial for patients with CKD. Epidemiological studies have shown that a higher urinary potassium excretion (as proxy for higher dietary potassium intake) is associated with lower blood pressure (BP) and lower cardiovascular risk, as well as better kidney outcomes. Considering that the composition of our current diet is characterized by a high sodium and low potassium content, increasing dietary potassium may be equally important as reducing sodium. Recent studies have revealed that dietary potassium modulates the activity of the thiazide-sensitive sodium-chloride cotransporter in the distal convoluted tubule (DCT). The DCT acts as a potassium sensor to control the delivery of sodium to the collecting duct, the potassium-secreting portion of the kidney. Physiologically, this allows immediate kaliuresis after a potassium load, and conservation of potassium during potassium deficiency. Clinically, it provides a novel explanation for the inverse relationship between dietary potassium and BP. Moreover, increasing dietary potassium intake can exert BP-independent effects on the kidney by relieving the deleterious effects of a low potassium diet (inflammation, oxidative stress and fibrosis). The aim of this comprehensive review is to link physiology with clinical medicine by proposing that the same mechanisms that allow us to excrete an acute potassium load also protect us from hypertension, cardiovascular disease and CKD.

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“…Several studies have measured urine potassium excretion as a proxy for dietary potassium intake to assess its effect on clinical outcomes [49,[54][55][56]. Nevertheless, limwww.kjim.org https://doi.org/10.3904/kjim.2020.408 ited data are available supporting the idea that dietary potassium restriction improves the outcomes of patients with CKD [57][58][59], and most recommendations are based on opinions. The 2015 American Dietary Guidelines Advisory Committee report recommends a daily potassium intake of 4,700 mg (121 mmol) for healthy adults [60].…”

Section: Potassiummentioning

confidence: 99%

Nutritional management in patients with chronic kidney disease

Kim

Jung

2020

Korean J Intern Med

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The global prevalence of chronic kidney disease (CKD) is increasing with the aging of populations worldwide. As kidney function declines, the accumulation of metabolic waste products and excessive electrolytes can significantly impair the health of patients with CKD. As nutritional management of patients with CKD is thought to control uremic symptoms and provide beneficial effects on the progression of kidney dysfunction, the diet of patients with CKD should be an important consideration in their care. Many guidelines recommend limiting protein intake in these patients, as high-protein diets aggravate kidney dysfunction. Excess sodium may be associated with CKD progression and all-cause mortality and, therefore, limiting salt intake is generally recommended. Low potassium is associated with muscle weakness and hypertension, whereas high potassium is associated with cardiac arrhythmia. Therefore, recent guidelines recommend adjusting dietary potassium intake on an individual basis to maintain serum potassium levels within the normal range. Appropriate dietary calcium intake is recommended to maintain calcium balance in patients with CKD G3, G4. Given the many dietary considerations for patients with CKD, effective nutritional management is challenging. Individualized strategies are needed to ensure the best outcome for patients with CKD.

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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

Cited by 21 publications

References 32 publications

The DASH Diet and Cardiometabolic Health and Chronic Kidney Disease: A Narrative Review of the Evidence in East Asian Countries

The DASH Diet and Cardiometabolic Health and Chronic Kidney Disease: A Narrative Review of the Evidence in East Asian Countries

Dietary potassium and the kidney: lifesaving physiology

Nutritional management in patients with chronic kidney disease

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