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Dietary Potassium Intake and Mortality in a Prospective Hemodialysis Cohort

  • Yoko Narasaki
    Affiliations
    Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California

    Department of Clinical Nutrition and Food Management, Tokushima University Graduate School of Nutrition and Biosciences, Tokushima, Japan

    Japan Society for the Promotion of Science, Tokyo, Japan

    Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
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  • Yusuke Okuda
    Affiliations
    Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California
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  • Sara S. Kalantar
    Affiliations
    Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California

    University of California, Berkeley, Berkeley, California
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  • Amy S. You
    Affiliations
    Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California
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  • Alejandra Novoa
    Affiliations
    Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California
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  • Theresa Nguyen
    Affiliations
    Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California
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  • Elani Streja
    Affiliations
    Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California

    Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
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  • Tracy Nakata
    Affiliations
    Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California
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  • Sara Colman
    Affiliations
    DaVita Inc., El Segundo, California
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  • Kamyar Kalantar-Zadeh
    Affiliations
    Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California

    Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
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  • Danh V. Nguyen
    Affiliations
    Division of General Internal Medicine, University of California, Irvine, Orange, California
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  • Connie M. Rhee
    Correspondence
    Address correspondence to Connie M. Rhee, MD, MSc, Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California, Irvine, 101 The City Drive South, City Tower, Orange, CA 92868-3217.
    Affiliations
    Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California, Irvine, Orange, California
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Published:October 27, 2020DOI:https://doi.org/10.1053/j.jrn.2020.05.008

      Objectives

      Among hemodialysis patients, clinical practice guidelines recommend dietary potassium restriction given concerns about potential hyperkalemia leading to malignant arrhythmias and mortality. However, there are sparse data informing recommendations for dietary potassium intake in this population. We thus sought to examine the relationship between dietary potassium intake and death risk in a prospective cohort of hemodialysis patients.

      Design and Methods

      Among 415 hemodialysis patients from the prospective “Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease” cohort recruited across 16 outpatient dialysis clinics, information regarding dietary potassium intake was obtained using Food Frequency Questionnaires administered over October 2011 to March 2015. We first examined associations of baseline dietary potassium intake categorized as tertiles with mortality risk using Cox regression. We then examined clinical characteristics associated with low dietary potassium intake (defined as the lowest tertile) using logistic regression.

      Results

      In expanded case-mix Cox analyses, patients whose dietary potassium intake was in the lowest tertile had higher mortality (ref: highest tertile) (adjusted hazard ratio 1.74, 95% confidence interval 1.14-2.66). These associations had even greater magnitude of risk following adjustment for laboratory and nutritional covariates (adjusted hazard ratio 2.65, 95% confidence interval 1.40-5.04). In expanded case-mix restricted cubic spline analyses, there was a monotonic increase in mortality risk with incrementally lower dietary potassium intake. In expanded case-mix logistic regression models, female sex; higher serum bicarbonate; and lower dietary energy, protein, and fiber intake were associated with low dietary potassium intake.

      Conclusions

      In a prospective cohort of hemodialysis patients, lower dietary potassium intake was associated with higher mortality risk. These findings suggest that excessive dietary potassium restriction may be deleterious in hemodialysis patients, and further studies are needed to determine the optimal dietary potassium intake in this population.
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