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Effect of dietary potassium restriction on serum potassium, disease progression, and mortality in chronic kidney disease : a systematic review and meta-analysis
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Morris, Andrew J., Krishnan, Nithya S., Kimani, Peter K. and Lycett, Deborah (2020) Effect of dietary potassium restriction on serum potassium, disease progression, and mortality in chronic kidney disease : a systematic review and meta-analysis. Journal of Renal Nutrition, 30 (4). pp. 276-285. doi:10.1053/j.jrn.2019.09.009
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WRAP-effect-dietary-potassium-restriction-serum-disease-progression-chronic-Kimani-2019.pdf - Accepted Version - Requires a PDF viewer. Available under License Creative Commons Attribution Non-commercial No Derivatives 4.0. Download (1158Kb) | Preview |
Official URL: http://dx.doi.org/10.1053/j.jrn.2019.09.009
Abstract
Low-potassium diets are recommended to reduce serum potassium (Sk) and prevent complications of chronic kidney disease (CKD), but evidence underpinning this recommendation has not been systematically reviewed and synthesized. We conducted a systematic review comparing change in Sk, CKD progression, and mortality between those on a low-potassium versus unrestricted potassium diet. We searched Medline, AMED, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, and Clinicaltrials.org from inception to 3 April 2018. We included randomized and observational studies that compared these outcomes in adults with CKD who ate a restricted versus unrestricted amount of dietary potassium. We pooled mean change in Sk and adjusted hazard ratios of disease progression and mortality using random-effects meta-analyses. We identified 5,563 articles, of which seven studies (3,489 participants) met our inclusion criteria. We found very low-quality evidence that restricted (1,295 mg/d) versus unrestricted (1,570 mg/d) dietary potassium lowered Sk by -0.22 mEq/L (95% confidence interval [CI]: -0.33, -0.10; I = 0%). Lower (1,725 mg/d) versus higher (4,558 mg/d) dietary potassium was not significantly associated with disease progression (hazard ratio [HR]: 1.14; 95% CI: 0.77, 1.70; I = 57%). Lower (1,670 mg/d), compared with higher (4,414 mg/d) dietary potassium intake was associated with a 40% reduction in mortality hazard (HR: 0.60; 95% CI: 0.40, 0.89; I = 56%). Very-low-quality evidence supports consensus that dietary potassium restriction reduces Sk in normokalemia and is associated with a reduced risk of death in those with CKD. High-quality randomized controlled trials are needed. [Abstract copyright: Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.]
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RC Internal medicine | ||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| SWORD Depositor: | Library Publications Router | ||||||||
| Library of Congress Subject Headings (LCSH): | Chronic renal failure -- Treatment -- Research, Hypokalemia -- Complications, Potassium -- Physiological effect, Chronic renal failure -- Diet therapy | ||||||||
| Journal or Publication Title: | Journal of Renal Nutrition | ||||||||
| Publisher: | W.B. Saunders Co. | ||||||||
| ISSN: | 1051-2276 | ||||||||
| Official Date: | 1 July 2020 | ||||||||
| Dates: |
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| Volume: | 30 | ||||||||
| Number: | 4 | ||||||||
| Page Range: | pp. 276-285 | ||||||||
| DOI: | 10.1053/j.jrn.2019.09.009 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access | ||||||||
| RIOXX Funder/Project Grant: |
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