Department of Agricultural, Food, and Nutritional Sciences, Li Ka Shing Centre for Health Innovation, University of Alberta, Edmonton, Alberta, Canada.
Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada.
Adv Nutr. 2020 Jul 1;11(4):1002-1015. doi: 10.1093/advances/nmaa027.
The prevalence of chronic kidney disease (CKD) is increasing and dietary interventions may be a strategy to reduce this burden. In the general population, higher potassium intake is considered protective for cardiovascular health. Due to the risk of hyperkalemia in CKD, limiting potassium intake is often recommended. However, given that poor cardiovascular function can cause kidney damage, following a low-potassium diet may be deleterious for patients with CKD. The aim of this systematic review was to summarize the evidence on dietary potassium intake and CKD progression. Multiple databases were searched on 7 June 2019 and data were managed with Covidence. No intervention trials met the inclusion criteria. Eleven observational studies met the inclusion criteria (10 post hoc analyses, 1 retrospective cohort), representing 49,573 stage 1-5 predialysis patients with CKD from 41 different countries. Of the 11 studies, 6 studies reported exclusively on early CKD (stage 1-2), 4 studies separately reported analyses on both early and late (stage 3-5) CKD, and 2 studies reported exclusively on late CKD. A total of 9 studies reported risk of disease progression in early CKD; in 4 studies high potassium intake was associated with lower risk, while in 2 studies the low intake showed a higher progression of risk, and 3 studies reported no relation. In late CKD, results are mixed: 2 studies suggested benefit of higher potassium intake and 1 suggested benefit of lower potassium intake, whereas 3 studies were neutral. These results should be interpreted with caution, as considerations preventing firm conclusions include 1) the overall low range of dietary potassium intake, with all studies reporting an average intake below the 2004 Kidney Disease Outcomes Quality Initiatives guidelines, and 2) the method used to assess potassium intake in most studies (i.e., urine) in late stages of CKD. Ideally, well-controlled intervention studies are needed to understand how dietary potassium intake is linked to CKD progression.
慢性肾脏病（CKD）的患病率正在上升，饮食干预可能是减轻这一负担的策略。在普通人群中，较高的钾摄入量被认为对心血管健康有保护作用。由于 CKD 患者存在高钾血症的风险，通常建议限制钾的摄入。然而，由于心血管功能不良会导致肾脏损伤，因此对于 CKD 患者来说，低钾饮食可能是有害的。本系统评价的目的是总结饮食钾摄入与 CKD 进展的证据。于 2019 年 6 月 7 日在多个数据库中进行了检索，并使用 Covidence 管理数据。没有干预试验符合纳入标准。符合纳入标准的 11 项观察性研究（10 项事后分析，1 项回顾性队列研究），代表了来自 41 个不同国家的 49573 名 1-5 期透析前 CKD 患者。在 11 项研究中，6 项研究仅报道了早期 CKD（1-2 期），4 项研究分别报道了早期和晚期（3-5 期）CKD 的分析，2 项研究仅报道了晚期 CKD。共有 9 项研究报告了早期 CKD 疾病进展的风险；在 4 项研究中，高钾摄入与较低的风险相关，而在 2 项研究中，低钾摄入显示出较高的风险进展，3 项研究报告无相关关系。在晚期 CKD 中，结果参差不齐：2 项研究表明高钾摄入有益，1 项研究表明低钾摄入有益，而 3 项研究结果为中性。这些结果应谨慎解释，因为存在以下因素，无法得出明确结论：1）饮食中钾的摄入量总体较低，所有研究报告的平均摄入量均低于 2004 年肾脏病预后质量倡议指南，2）大多数研究（即尿液）中评估钾摄入的方法在 CKD 晚期阶段。理想情况下，需要进行精心控制的干预研究，以了解饮食钾摄入与 CKD 进展的关系。
