scholarly journals Randomized Trial on the Effects of Dietary Potassium on Blood Pressure and Serum Potassium Levels in Adults with Chronic Kidney Disease

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2678
Author(s):  
Sharon Turban ◽  
Stephen P. Juraschek ◽  
Edgar R. Miller ◽  
Cheryl A. M. Anderson ◽  
Karen White ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Population ◽  
Serum Potassium ◽  
Primary Outcome ◽  
Statistical Significance ◽  
Crossover Design ◽  
Feeding Trial ◽  
Dietary Potassium

In the general population, an increased potassium (K) intake lowers blood pressure (BP). The effects of K have not been well-studied in individuals with chronic kidney disease (CKD). This randomized feeding trial with a 2-period crossover design compared the effects of diets containing 100 and 40 mmol K/day on BP in 29 adults with stage 3 CKD and treated or untreated systolic BP (SBP) 120–159 mmHg and diastolic BP (DBP) <100 mmHg. The primary outcome was 24 hour ambulatory systolic BP. The higher- versus lower-K diet had no significant effect on 24 hour SBP (−2.12 mm Hg; p = 0.16) and DBP (−0.70 mm Hg; p = 0.44). Corresponding differences in clinic BP were −4.21 mm Hg for SBP (p = 0.054) and −0.08 mm Hg for DBP (p = 0.94). On the higher-K diet, mean serum K increased by 0.21 mmol/L (p = 0.003) compared to the lower-K diet; two participants had confirmed hyperkalemia (serum K ≥ 5.5 mmol/L). In conclusion, a higher dietary intake of K did not lower 24 hour SBP, while clinic SBP reduction was of borderline statistical significance. Additional trials are warranted to understand the health effects of increased K intake in individuals with CKD.

Association Between Longitudinal Blood Pressure Trajectory and the Progression of Chronic Kidney Disease: Results From the KNOW-CKD

Hypertension ◽  
2021 ◽  
Author(s):  
Young Su Joo ◽  
Hyung Woo Kim ◽  
Ki Heon Nam ◽  
Jee Young Lee ◽  
Tae Ik Chang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Primary Outcome ◽  
Latent Class ◽  
Mixed Model ◽  
Hazards Model ◽  
Trajectory Group ◽  
End Stage

Studies on the longitudinal temporal trend of blood pressure (BP) and its impact on kidney function are scarce. Here, we evaluated the association of dynamic changes in systolic blood pressure (SBP) over time with adverse kidney outcomes. We analyzed 1837 participants from the KNOW-CKD (Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease). The main exposure was 3 distinct SBP trajectories determined by the latent class mixed model (decreasing, stable, and increasing) using 3 SBP measurements at 0, 6, and 12 months. The primary outcome was CKD progression, defined as a composite of halving estimated glomerular filtration rate from baseline value or onset of end-stage kidney disease. SBP declined from 144 to 120 mm Hg in the decreasing SBP trajectory group and rose from 114 to 136 mm Hg in the increasing trajectory group within 1 year. During 6576 person-years of follow-up (median, 3.7 years), the composite outcome occurred in 521 (28.4%) participants. There were fewer primary outcome events in the decreasing (30.6%) and stable (26.5%) SBP trajectory groups than in the increasing trajectory group (33.0%). In the multivariable-adjusted cause-specific hazards model, increasing SBP trajectory was associated with a 1.28-fold higher risk for adverse kidney outcome compared with stable SBP trajectory. However, the risk for the primary outcome did not differ between the decreasing and stable SBP trajectory groups. In this longitudinal CKD cohort study, compared with stable SBP trajectory, increasing SBP trajectory was associated with higher risk for adverse kidney outcome, whereas decreasing SBP trajectory showed similar risk.

scholarly journals Masked Hypertension Determined by Self-Measured Blood Pressure at Home and Chronic Kidney Disease in the Japanese General Population: The Ohasama Study

2008 ◽  
Vol 31 (12) ◽  
pp. 2129-2135 ◽  
Author(s):  
Hiroyuki TERAWAKI ◽  
Hirohito METOKI ◽  
Masaaki NAKAYAMA ◽  
Takayoshi OHKUBO ◽  
Masahiro KIKUYA ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Population ◽  
Masked Hypertension ◽  
Japanese General Population ◽  
At Home

scholarly journals Lower Diastolic Blood Pressure was Associated with Higher Incidence of Chronic Kidney Disease in the General Population Only in those Using Antihypertensive Medications

2019 ◽  
Vol 44 (5) ◽  
pp. 973-983
Author(s):  
Daisuke Uchida ◽  
Ryo Kido ◽  
Hiroo Kawarazaki ◽  
Masaru Murasawa ◽  
Ayami Ando ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Population ◽  
Diastolic Blood Pressure ◽  
Estimated Glomerular Filtration Rate ◽  
Antihypertensive Medications ◽  
Adjusted Risk ◽  
General Japanese Population ◽  
Incidence Of Ckd

Background/Aims: The association of diastolic blood pressure (DBP) with incidence of chronic kidney disease (CKD) in the general population is not well examined. Methods: Using national health check-up database from 2008 to 2011 in the general Japanese population aged 39–74 years, we evaluated the association between DBP and incidence of CKD 2 years later in 127,954 participants without CKD. DBP was categorized by every 5 mm Hg from the lowest (<60 mm Hg) to the highest category (>100 mm Hg) and was further stratified into those with and without antihypertensive medications (BP meds). We calculated the OR for estimating adjusted risk of incident CKD using logistic regression model. Results: Participants were 62% female and 25.9% with BP meds, mean age of 76 years with estimated glomerular filtration rate of 78.2 ± 13.4 and DBP of 76 ± 11 mm Hg. Two years later, 12,379 (9.7%) developed CKD. Compared to DBP 60–64 mm Hg without BP meds as reference, multivariate analysis showed no difference in CKD risk at any DBP category among those without BP meds. However, in those with BP meds, risk increased according to lower DBP from 95 to 60 mm Hg (p for trend 0.05) with OR 1.51 (95% CI 1.14–1.99) in DBP <60 mm Hg. In subgroup analysis within those with or without BP meds, CKD risk was lower at higher DBP (p for trend 0.02) only in those without BP meds. Conclusion: Lower DBP was associated with higher risk of incident CKD only in the general population taking antihypertensive medication.

Night-time blood pressure is associated with the development of chronic kidney disease in a general population

2013 ◽  
Vol 31 (12) ◽  
pp. 2410-2417 ◽  
Author(s):  
Atsuhiro Kanno ◽  
Masahiro Kikuya ◽  
Kei Asayama ◽  
Michihiro Satoh ◽  
Ryusuke Inoue ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Population ◽  
Night Time

Does dietary potassium intake associate with hyperkalemia in patients with chronic kidney disease?

2020 ◽  
Author(s):  
Christiane I Ramos ◽  
Ailema González-Ortiz ◽  
Angeles Espinosa-Cuevas ◽  
Carla M Avesani ◽  
Juan Jesus Carrero ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Serum Potassium ◽  
Multivariable Analysis ◽  
Food Groups ◽  
Cross Sectional ◽  
Potassium Intake ◽  
Dietary Potassium ◽  
Dialysis Vintage

Abstract Background Dietary potassium restriction is a strategy to control hyperkalemia in chronic kidney disease (CKD). However, hyperkalemia may result from a combination of clinical conditions. This study aimed to investigate whether dietary potassium or the intake of certain food groups associate with serum potassium in the face of other risk factors. Methods We performed a cross-sectional analysis including a nondialysis-dependent CKD (NDD-CKD) cohort and a hemodialysis (HD) cohort. Dietary potassium intake was assessed by 3-day food records. Underreporters with energy intake lower than resting energy expenditure were excluded. Hyperkalemia was defined as serum potassium &gt;5.0 mEq/L. Results The NDD-CKD cohort included 95 patients {median age 67 [interquartile range (IQR) 55–73] years, 32% with diabetes mellitus (DM), median estimated glomerular filtration rate 23 [IQR 18–29] mL/min/1.73 m2} and the HD cohort included 117 patients [median age 39 (IQR 18–67) years, 50% with DM]. In NDD-CKD, patients with hyperkalemia (36.8%) exhibited lower serum bicarbonate and a tendency for higher serum creatinine, a higher proportion of DM and the use of renin–angiotensin–aldosterone system blockers, but lower use of sodium bicarbonate supplements. No association was found between serum and dietary potassium (r = 0.01; P = 0.98) or selected food groups. Conditions associated with hyperkalemia in multivariable analysis were DM {odds ratio [OR] 3.55 [95% confidence interval (CI) 1.07–11.72]} and metabolic acidosis [OR 4.35 (95% CI 1.37–13.78)]. In HD, patients with hyperkalemia (50.5%) exhibited higher serum creatinine and blood urea nitrogen and lower malnutrition inflammation score and a tendency for higher dialysis vintage and body mass index. No association was found between serum and potassium intake (r = −0.06, P = 0.46) or food groups. DM [OR 4.22 (95% CI 1.31–13.6)] and serum creatinine [OR 1.50 (95% CI 1.24–1.81)] were predictors of hyperkalemia in multivariable analyses. Conclusions Dietary potassium was not associated with serum potassium or hyperkalemia in either NDD-CKD or HD patients. Before restricting dietary potassium, the patient’s intake of potassium should be carefully evaluated and other potential clinical factors related to serum potassium balance should be considered in the management of hyperkalemia in CKD.

scholarly journals SO033PATIROMER TO ENABLE SPIRONOLACTONE IN PATIENTS WITH RESISTANT HYPERTENSION AND CHRONIC KIDNEY DISEASE (AMBER): PRESPECIFIED RESULTS BY BASELINE SERUM POTASSIUM

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Patrick Rossignol ◽  
Susan Arthur ◽  
Ansgar Conrad ◽  
William B White ◽  
Bryan Williams ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Adverse Events ◽  
Serum Potassium ◽  
Resistant Hypertension ◽  
Controlled Trial ◽  
Antihypertensive Medications ◽  
Baseline Serum ◽  
Treatment Groups

Abstract Background and Aims Spironolactone (SPIRO) is effective at reducing blood pressure in patients with resistant hypertension (RHTN); however, its use in patients with advanced chronic kidney disease (CKD) is often limited by hyperkalaemia. In AMBER, patiromer (PAT) enabled more persistent use of SPIRO in patients with RHTN and eGFR 25 to ≤45 mL/min/1.73 m2. Patients were required to be normokalaemic at baseline, with serum potassium (sK+) 4.3 to 5.1 mmol/L. Since higher baseline sK+ may increase the risk for developing hyperkalaemia on SPIRO, we evaluated AMBER results in prespecified subgroups by baseline sK+. Methods This was a randomised, double-blind, placebo (PBO)-controlled trial in adults with eGFR 25 to ≤45 mL/min/1.73 m2, uncontrolled RHTN, and sK+ 4.3 to 5.1 mmol/L. Patients were assigned (1:1) to receive PBO or PAT, and SPIRO 25 mg QD, with dose titrations permitted after 1 week (PAT) and 3 weeks (SPIRO). The primary endpoint was the between-group difference at Week 12 in the percentage of patients on SPIRO. The secondary endpoint was the difference between treatment groups in the change in systolic automated office blood pressure (AOBP) from baseline to Week 12 (or to the last available measurement before the addition of any new antihypertensive medications or increase in any of the baseline antihypertensive medications). The primary and secondary endpoints were assessed in prespecified subgroups by baseline sK+ stratum: 4.3 to &lt;4.7 mmol/L and 4.7 to 5.1 mmol/L. Results 295 patients were randomised, 129 (44%) and 166 (56%) with baseline sK+ 4.3 to &lt;4.7 mmol/L and sK+ 4.7 to 5.1 mmol/L, respectively. Baseline mean (SD) systolic AOBP (mmHg) was 144.0 (7.3) and 144.1 (6.4), and eGFR (mL/min/1.73 m2) was 36.4 (7.6) and 35.2 (7.2), respectively. Significantly more patients treated with PAT than with PBO remained on SPIRO at Week 12 in both subgroups (between treatment difference of 16.2% [P=0.0167] for patients with sK+ 4.3 to &lt;4.7 mmol/L and 22.4% [P=0.0016] for patients with sK+ 4.7 to 5.1 mmol/L) with P=0.45 for interaction between subgroups (Figure). In patients with sK+ 4.3 to &lt;4.7 mmol/L, LS mean (SE) systolic AOBP change from baseline was –10.7 (1.9) mmHg in patients receiving PBO and –13.0 (1.9) mmHg in patients receiving PAT; systolic AOBP change from baseline was –10.5 (1.6) (PBO) and –10.5 (1.6) mmHg (PAT) in patients with sK+ 4.7 to 5.1 mmol/L (P&lt;0.001 for all changes from baseline and P=NS for all differences between treatment groups). LS mean (SE) cumulative SPIRO dose was higher with PAT than PBO by 373.2 (157.0) mg and 392.3 (185.0) mg in patients with sK+ 4.3 to &lt;4.7 mmol/L and sK+ 4.7 to 5.1 mmol/L, respectively. Adverse events occurred in 52% (PBO) and 56% (PAT) of patients with sK+ 4.3 to &lt;4.7 mmol/L and in 55% (PBO) and 56% (PAT) of patients with sK+ 4.7 to 5.1 mmol/L. Adverse events of hyperkalaemia or blood K+ increased occurred in 2 (PBO) and 4 (PAT) patients with sK+ 4.3 to &lt;4.7 mmol/L and in 12 (PBO) and 5 (PAT) patients with sK+ 4.7 to 5.1 mmol/L. One PBO and 2 PAT patients (sK+ 4.3 to &lt;4.7 subgroup) and 1 PAT patient (sK+ 4.7 to 5.1 subgroup) had serum Mg 0.49 to &lt;0.58 mmol/L; none had serum Mg &lt;0.49 mmol/L. Conclusion PAT enabled more patients with advanced CKD and RHTN to continue treatment with SPIRO, regardless of baseline sK+ stratum.

scholarly journals Tubular Biomarkers and Chronic Kidney Disease Progression in SPRINT Participants

2020 ◽  
Vol 51 (10) ◽  
pp. 797-805
Author(s):  
Vasantha Jotwani ◽  
Pranav S. Garimella ◽  
Ronit Katz ◽  
Rakesh Malhotra ◽  
Jeffrey Bates ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Strong Predictor ◽  
Statistical Significance ◽  
Pressure Treatment ◽  
Tubular Atrophy ◽  
Blood Pressure Treatment ◽  
Egfr Decline ◽  
Intensive Blood Pressure

<b><i>Background:</i></b> Kidney tubular atrophy on biopsy is a strong predictor of chronic kidney disease (CKD) progression, but tubular health is poorly quantified by traditional measures including estimated glomerular filtration rate (eGFR) and albuminuria. We hypothesized that urinary biomarkers of impaired tubule function would be associated with faster eGFR declines in persons with CKD. <b><i>Methods:</i></b> We measured baseline urine concentrations of uromodulin, β2-microglobulin (β2m), and α1-microglobulin (α1m) among 2,428 participants of the Systolic Blood Pressure Intervention Trial with an eGFR &#x3c;60 mL/min/1.73 m<sup>2</sup>. We used linear mixed models to evaluate biomarker associations with annualized relative change in eGFR, stratified by randomization arm. <b><i>Results:</i></b> At baseline, the mean age was 73 ± 9 years and eGFR was 46 ± 11 mL/min/1.73 m<sup>2</sup>. In the standard blood pressure treatment arm, each 2-fold higher urinary uromodulin was associated with slower % annual eGFR decline (0.34 [95% CI: 0.08, 0.60]), whereas higher urinary β2m was associated with faster % annual eGFR decline (−0.10 [95% CI: −0.18, −0.02]) in multivariable-adjusted models including baseline eGFR and albuminuria. Associations were weaker and did not reach statistical significance in the intensive blood pressure treatment arm for either uromodulin (0.11 [−0.13, 0.35], <i>p</i> value for interaction by treatment arm = 0.045) or β2m (−0.01 [−0.08, 0.08], <i>p</i> value for interaction = 0.001). Urinary α1m was not independently associated with eGFR decline in the standard (0.01 [−0.22, 0.23]) or intensive (0.03 [−0.20, 0.25]) arm. <b><i>Conclusions:</i></b> Among trial participants with hypertension and CKD, baseline measures of tubular function were associated with subsequent declines in kidney function, although these associations were diminished by intensive blood pressure control.

scholarly journals Association of Urinary Potassium Excretion with Blood Pressure Variability and Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease

Nutrients ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 4443
Author(s):  
Sang Heon Suh ◽  
Su Hyun Song ◽  
Tae Ryom Oh ◽  
Hong Sang Choi ◽  
Chang Seong Kim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Blood Pressure Variability ◽  
Potassium Excretion ◽  
Regression Analyses ◽  
Potassium Intake ◽  
Increased Risk ◽  
Dietary Potassium ◽  
Urine Potassium

Dietary potassium intake is a dilemma in patients with chronic kidney disease (CKD). We investigated the association of urine potassium excretion, a surrogate for dietary potassium intake, with blood pressure variability (BPV) and cardiovascular (CV) outcomes in patients with pre-dialysis CKD. A total of 1860 participants from a cohort of pre-dialysis CKD (KNOW-CKD) patients were divided into the quartiles by spot urine potassium-to-creatinine ratio. The first quartile (26.423 ± 5.731 mmol/gCr) was defined as low urine potassium excretion. Multivariate linear regression analyses revealed an independent association of low urine potassium excretion with high BPV (adjusted β coefficient 1.163, 95% confidence interval 0.424 to 1.901). Cox regression analyses demonstrated that, compared to high urine potassium excretion, low urine potassium excretion is associated with increased risk of CV events (adjusted hazard ratio 2.502, 95% confidence interval 1.162 to 5.387) but not with all-cause mortality. In conclusion, low urine potassium excretion is associated with high BPV and increased risk of CV events in patients with pre-dialysis CKD. The restriction of dietary potassium intake should be individualized in patients with pre-dialysis CKD.

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