George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, PO Box M201, Missenden Road, NSW 2050, Australia
Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA, USA.
BMJ. 2020 Apr 22;369:m824. doi: 10.1136/bmj.m824.
To estimate the effects of nationwide replacement of discretionary salt (used at table or during cooking) with potassium enriched salt substitute on morbidity and death from cardiovascular disease in China.
Modelling study.
China.
Adult population in China, and specifically individuals with chronic kidney disease (about 17 million people).
Comparative risk assessment models were used to estimate the effects of a nationwide intervention to replace discretionary dietary salt with potassium enriched salt substitutes (20-30% potassium chloride). The models incorporated existing data and corresponding uncertainties from randomised trials, the China National Survey of Chronic Kidney Disease, the Global Burden of Disease Study, and the Chronic Kidney Disease Prognosis Consortium.
Averted deaths from cardiovascular disease, non-fatal events, and disability adjusted life years from a reduction in blood pressure were estimated after implementation of potassium enriched salt substitution. In individuals with chronic kidney disease, additional deaths from cardiovascular disease related to hyperkalaemia from increased intake of potassium were calculated. The net effects on deaths from cardiovascular disease were estimated as the difference and ratio of averted and additional deaths from cardiovascular disease.
Nationwide implementation of potassium enriched salt substitution could prevent about 461 000 (95% uncertainty interval 196 339 to 704 438) deaths annually from cardiovascular disease, corresponding to 11.0% (4.7% to 16.8%) of annual deaths from cardiovascular disease in China; 743 000 (305 803 to 1 273 098) non-fatal cardiovascular events annually; and 7.9 (3.3 to 12.9) million disability adjusted life years related to cardiovascular disease annually. The intervention could potentially produce an estimated 11 000 (6422 to 16 562) additional deaths related to hyperkalaemia in individuals with chronic kidney disease. The net effect would be about 450 000 (183 699 to 697 084) fewer deaths annually from cardiovascular disease in the overall population and 21 000 (1928 to 42 926) fewer deaths in individuals with chronic kidney disease. In deterministic sensitivity analyses, with changes to key model inputs and assumptions, net benefits were consistent in the total population and in individuals with chronic kidney disease, with averted deaths outweighing additional deaths.
Nationwide potassium enriched salt substitution in China was estimated to result in a substantial net benefit, preventing around one in nine deaths from cardiovascular disease overall. Taking account of the risks of hyperkalaemia, a substantial net benefit was also estimated for individuals with chronic kidney disease.
估计在中国用富含钾的盐替代可随意添加的盐（用于餐桌或烹饪中）对心血管疾病发病率和死亡率的影响。
模型研究。
中国。
中国的成年人群体，特别是患有慢性肾病的个体（约 1700 万人）。
使用比较风险评估模型来估计在全国范围内用富含钾的盐替代剂（20-30%氯化钾）的干预效果。该模型结合了随机试验、中国慢性肾脏病全国调查、全球疾病负担研究和慢性肾脏病预后联盟现有的数据及其相应的不确定性。
估计实施钾盐替代后，血压降低可减少多少心血管疾病导致的死亡、非致死性事件和因心血管疾病导致的伤残调整生命年。在患有慢性肾病的个体中，计算了因钾摄入增加而导致的与高钾血症相关的心血管疾病额外死亡人数。通过比较心血管疾病减少的死亡人数与增加的心血管疾病死亡人数来估计心血管疾病死亡人数的净效应。
在全国范围内实施富含钾的盐替代，每年可预防约 46.1 万人（95%不确定区间 19.6339 万至 70.4438 万）死于心血管疾病，相当于中国每年心血管疾病死亡人数的 11.0%（4.7%至 16.8%）；每年可预防 74.3 万例非致死性心血管事件；每年与心血管疾病相关的伤残调整生命年减少 790 万（33 万至 1290 万）。该干预措施可能会导致患有慢性肾病的个体每年额外增加约 1.1 万例（6422 例至 16562 例）与高钾血症相关的死亡。净效应是总人口中每年死于心血管疾病的人数减少约 45 万（18.3699 万至 69.7084 万），而慢性肾病患者的死亡人数减少 2.1 万（1928 例至 42926 例）。在确定性敏感性分析中，改变关键模型输入和假设，总人群和慢性肾病患者的净效益仍然一致，避免的死亡人数超过了额外的死亡人数。
在中国，全国范围内用富含钾的盐替代估计会带来显著的净效益，整体上可预防约九分之一的心血管疾病死亡。考虑到高钾血症的风险，该干预措施对慢性肾病患者也有显著的净效益。
