Observational studies suggest that adequate dietary potassium intake (90–120 mmol/day) may be renoprotective, but the effects of increasing dietary potassium and the risk of hyperkalemia are unknown.

This is a prespecified analysis of the run-in phase of a clinical trial in which 191 patients (age 68±11 years, 74% males, 86% European ancestry, eGFR 31±9 ml/min per 1.73 m², 83% renin-angiotensin system inhibitors, 38% diabetes) were treated with 40 mmol potassium chloride (KCl) per day for 2 weeks.

KCl supplementation significantly increased urinary potassium excretion (72±24 to 107±29 mmol/day), plasma potassium (4.3±0.5 to 4.7±0.6 mmol/L), and plasma aldosterone (281 [198–431] to 351 [241–494] ng/L), but had no significant effect on urinary sodium excretion, plasma renin, BP, eGFR, or albuminuria. Furthermore, KCl supplementation increased plasma chloride (104±3 to 105±4 mmol/L) and reduced plasma bicarbonate (24.5±3.4 to 23.7±3.5 mmol/L) and urine pH (all P<0.001), but did not change urinary ammonium excretion. In total, 21 participants (11%) developed hyperkalemia (plasma potassium 5.9±0.4 mmol/L). They were older and had higher baseline plasma potassium.

In patients with CKD stage G3b–4, increasing dietary potassium intake to recommended levels with potassium chloride supplementation raises plasma potassium by 0.4 mmol/L. This may result in hyperkalemia in older patients or those with higher baseline plasma potassium. Longer-term studies should address whether cardiorenal protection outweighs the risk of hyperkalemia.

Clinical trial number: NCT03253172

观察性研究表明，充足的膳食钾摄入量（90-120 mmol/天）可能具有肾脏保护作用，但增加膳食钾的影响和高钾血症的风险尚不清楚。

这是一项临床试验磨合期的预先设定分析，其中 191 名患者（年龄 68±11 岁，74% 男性，86% 欧洲血统，eGFR 31±9 ml/min 每 1.73 m 2 ，83 ^%肾素-血管紧张素系统抑制剂（38% 糖尿病）每天接受 40 mmol 氯化钾 (KCl) 治疗，持续 2 周。

补充 KCl 显着增加尿钾排泄（72±24 至 107±29 mmol/天）、血浆钾（4.3±0.5 至 4.7±0.6 mmol/L）和血浆醛固酮（281 [198–431] 至 351 [241– 494] ng/L），但对尿钠排泄、血浆肾素、血压、eGFR 或白蛋白尿没有显着影响。此外，补充 KCl 会增加血浆氯化物（104±3 至 105±4 mmol/L），降低血浆碳酸氢盐（24.5±3.4 至 23.7±3.5 mmol/L）和尿液 pH 值（均 P <0.001），但不会改变尿酸浓度。铵的排泄。总共有 21 名参与者 (11%) 出现高钾血症（血浆钾 5.9±0.4 mmol/L）。他们年龄较大，基线血浆钾水平较高。

在 CKD G3b-4 期患者中，将膳食钾摄入量增加至推荐水平并补充氯化钾可使血浆钾升高 0.4 mmol/L。这可能会导致老年患者或基线血浆钾较高的患者出现高钾血症。长期研究应解决心肾保护是否超过高钾血症风险的问题。

临床试验号： NCT03253172