Morris, Andrew J., Krishnan, Nithya S., Kimani, Peter K. and Lycett, Deborah (2019) 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 . doi:10.1053/j.jrn.2019.09.009 (In Press)

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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
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology Faculty of Medicine > Warwick Medical School
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:	14 November 2019
Dates:	Date Event 14 November 2019 Available 15 September 2019 Accepted
Date of first compliant deposit:	12 December 2019
DOI:	10.1053/j.jrn.2019.09.009
Status:	Peer Reviewed
Publication Status:	In Press
Access rights to Published version:	Restricted or Subscription Access
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED [NIHR] National Institute for Health Research http://dx.doi.org/10.13039/501100000272

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