Dietary Modelling to Explore the Impact of Potassium Chloride Replacement for Sodium in Bread for Adults with Chronic Kidney Disease

Abstract

Food manufacturers are increasingly substituting potassium chloride (KCl) in food products so as to reduce the sodium chloride content. Bread and bread products are common staple foods in many Western households and are a target for recipe reformulation using KCl. Given that chronic kidney disease (CKD) is a medical condition of global importance that requires dietary potassium restriction in the later stages, we sought to evaluate the impact and safety of varying levels of KCl substitution in bread products. We undertook a secondary analysis of dietary data from the National Nutrition and Physical Activity Survey 2011–2012 for 12,152 participants (154 participants with CKD). The sodium chloride content in bread and bread-based products was substituted with 20%, 30%, and 40% of KCl. The contribution of these alterations in the dietary potassium intake to the total daily potassium intake were then examined. The replacement of sodium in bread with varying amounts of KCl (20%, 30%, and 40%) resulted in one third of people with CKD exceeding the safe limits for dietary potassium consumption (31.8%, 32.6%, and 33%, respectively). KCl substitution in staple foods such as bread and bread products have serious and potentially fatal consequences for people who need to restrict dietary potassium. Improved food labelling is required for consumers to avoid excessive consumption.

The “FIFTY SHADOWS” of the RALES Trial: Lessons about the Potential Risk of Dietary Potassium Supplementation in Patients with Chronic Kidney Disease

“…Broadcasting and encouraging global public health policies on the beneficial use of salt substitutes rich in K + without appropriate warnings may not be desirable. In this regard, food manufacturers are increasingly substituting KCl in food products so as to reduce the sodium chloride content [ 71 ], and warnings have indeed been issued about the serious and potentially fatal consequences for people who need to restrict dietary K + [ 71 ], such as those to which this review refers.…”

Strategies to Reduce Salt Content and Its Effect on Food Characteristics and Acceptance: A Review

“…However, substituting KCl in the diet has serious and potentially fatal repercussions for people who need to limit their potassium intake. One third of Australian Chronic Kidney Disease patients exceed the safe limit for dietary potassium consumption when NaCl in bread is replaced by KCl (20-40%) [47]. As a result, improved food labeling is required to help customers avoid excessive consumption.…”

High-throughput characterization of the effect of sodium chloride and potassium chloride on 31 lactic acid bacteria and their co-cultures

“…An alternative to preserve consumer health while ensuring food quality is the partial or total substitution of NaCl with other salts such as potassium chloride (KCl), magnesium chloride (MgCl 2 ), and calcium chloride (CaCl 2 ). Among these candidates, KCl appears to stand out, as it has been shown to play a role in reducing blood pressure (Ekmekcioglu et al, 2016;Bernabe-Ortiz et al, 2020), but this might be an issue for people with chronic kidney disease (Morrison et al, 2021). Furthermore, at high concentrations, KCl imparts a bitter metalic taste to food products, leading to lower consumer acceptability (Khetra et al, 2016).…”