Lesson of the week: Danger of salt substitutes that contain potassium in patients with renal failure

Doorenbos, C. J.; Vermeij, C. G.

doi:10.1136/bmj.326.7379.35

Cited by 29 publications

(17 citation statements)

References 3 publications

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“…2 12-17 Generally, these warnings, while applied to the general population, are based on case reports referring to either sick patients with end-stage kidney disease ignoring medical advice on K intake restrictions or excessive intakes leading to increases in serum K levels of several millimoles per litre with severe hyperkalaemia. [25][26][27][28][29][30][31] In 5 cases, 30 31 individuals suffered serious hyperkalaemia and in 2 cases fatal hyperkalaemia (serum K 8.9 and 10.8 mmol/L) following K overdoses of up to 723 mmol (28 200 mg) in a day. In other reports, 25 26 28 29 individuals with severe renal impairment and, in some cases, already of haemodialysis 28 abused K-containing salt substitutes.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Systematic review and meta-analysis of randomised controlled trials on the effects of potassium supplements on serum potassium and creatinine

Cappuccio

Buchanan

et al. 2016

BMJ Open

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ObjectivesHigh potassium intake could prevent stroke, but supplementation is considered hazardous. We assessed the effect of oral potassium supplementation on serum or plasma potassium levels and renal function.SettingWe updated a systematic review of the effects of potassium supplementation in randomised clinical trials carried out worldwide, published in 2013, extending it to July 2015. We followed the PRISMA guidelines.ParticipantsAny individual taking part in a potassium supplementation randomised clinical trial. Studies included met the following criteria: randomised clinical trials, potassium supplement given and circulating potassium levels reported.InterventionOral potassium supplementation.Primary outcome measuresSerum or plasma potassium and serum or plasma creatinine.ResultsA total of 20 trials (21 independent groups) were included (1216 participants from 12 different countries). All but 2 were controlled (placebo n=16, control n=2). Of these trials, 15 were crossover, 4 had a parallel group and 1 was sequential. The duration of supplementation varied from 2 to 24 weeks and the amount of potassium given from 22 to 140 mmol/day. In the pooled analysis, potassium supplementation caused a small but significant increase in circulating potassium levels (weighted mean difference (WMD) 0.14 mmol/L, 95% CI 0.09 to 0.19, p<1×10−5), not associated with dose or duration of treatment. The average increase in urinary potassium excretion was 45.75 mmol/24 hours, 95% CI 38.81 to 53.69, p<1×10−5. Potassium supplementation did not cause any change in circulating creatinine levels (WMD 0.30 µmol/L, 95% CI −1.19 to 1.78, p=0.70).ConclusionsIn short-term studies of relatively healthy persons, a moderate oral potassium supplement resulted in a small increase in circulating potassium levels and no change in renal function.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Systematic review and meta-analysis of randomised controlled trials on the effects of potassium supplements on serum potassium and creatinine

Cappuccio

Buchanan

et al. 2016

BMJ Open

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“…6 However, it will be difficult to quantify or even recognize any adverse effects from an increase in the potassium content of processed foods, according to Sherman. 6 However, it will be difficult to quantify or even recognize any adverse effects from an increase in the potassium content of processed foods, according to Sherman.…”

Section: Study Of Enhanced Meatsmentioning

confidence: 99%

Fruits and Vegetables

Lomangino¹

2010

Clinical Nutrition INSIGHT

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Balance, moderation, variety, and appropriate exercise are fundamental to good health. During the same period, basic research and clinical investigations have increased, and our understanding of the nuances associated with diet and health has contributed to improved and often more detailed dietary recommendations.As the volunteer 2010 USDA Advisory Panel of 13 experts began its deliberations in October 2008, it was clear that the focus needed to be directed to an unhealthy American population. The high prevalence of diet-related diseases, such as obesity, cardiovascular disease (CVD), and diabetes, compelled the Advisory Panel to examine the most recent evidence in an effort to provide dietary guidance to reduce the risk of developing these conditions throughout the age spectrum.

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“…As already mentioned above, salt substitutes used either to sprinkle directly on food or as preservatives in low‐sodium meat products, are made with potassium salts; dialysis patients have to be particularly aware of them to avoid hyperkalemia …”

Section: Introduction To the Concept Of An Aspirational Diet For Dialmentioning

confidence: 99%

An aspirational diet for dialysis patients: Evidence and theory

Uribarri

2018

Seminars in Dialysis

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Dialytic renal replacement therapy is now entering into its sixth decade in the United States. Despite major advances in dialysis technology, regimens and protocols, and pharmacological treatments, patients' restricted dietary intake remains the lynchpin to their well-being and success. Herein, we review current guidelines that limit dietary intake of nutrients and minerals in dialysis patients and explore potential ways to use them in designing a daily food intake that is not only healthy, but also easy to implement and therefore patient friendly. The main theme behind this review is attempting to emphasize that dietary restriction guidelines can be used in such a way that dialysis patients can eat things they really enjoy as long as they follow some relatively simple general rules.

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Lesson of the week: Danger of salt substitutes that contain potassium in patients with renal failure

Abstract: Salt substitutes may cause severe hyperkalaemia in patients with impaired renal potassium handling

Cited by 29 publications

References 3 publications

Systematic review and meta-analysis of randomised controlled trials on the effects of potassium supplements on serum potassium and creatinine

Systematic review and meta-analysis of randomised controlled trials on the effects of potassium supplements on serum potassium and creatinine

Fruits and Vegetables

An aspirational diet for dialysis patients: Evidence and theory

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