Suenaga Tatsuya, Tanaka Shigeru, Kitamura Hiromasa, Tsuruya Kazuhiko, Nakano Toshiaki, Kitazono Takanari
Department of Medicine and Clinical Science, Kyushu University, Fukuoka, Japan.
Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan.
Nephrol Dial Transplant. 2024 Nov 27. doi: 10.1093/ndt/gfae277.
Lower potassium intake is associated with a higher risk of chronic kidney disease (CKD) in the general population. However, there are no stated recommendations on potassium intake in the CKD population owing to limited evidence of benefits from potassium intake and concerns about the risk of hyperkalaemia. This study aimed to investigate the relationship between potassium intake and CKD progression.
A total of 4314 patients aged 18 years or older in Japan were prospectively followed for 5 years using data from the Fukuoka Kidney Disease Registry study. The patients were divided into quartiles according to estimated potassium intake levels assessed by the Tanaka formula from spot urine samples. The primary outcome was CKD progression, which was defined as a composite of a 1.5-fold increase in creatinine concentrations from baseline and development of end-stage kidney disease. We evaluated the relationship between estimated potassium intake and CKD progression using Cox proportional hazards models.
A total of 1490 patients showed CKD progression during the follow-up with an incidence rate of 90.1/1000 person-years. Patients in the lowest estimated potassium intake quartile had higher hazard ratios for CKD progression than those in the highest quartiles in the multivariable-adjusted Cox models (hazard ratio [95% confidence interval], 1.24 [1.03-1.48]). Similarly, each 1-standard deviation decrease in estimated potassium intake as a continuous variable was associated with a higher risk of CKD progression (hazard ratio [95% confidence interval], 1.10 [1.03-1.19]).
Lower estimated potassium intake is associated with CKD progression in patients with CKD. Therefore, we recommend adequate potassium intake, taking care not to cause serious adverse events.
在一般人群中，低钾摄入与慢性肾脏病（CKD）风险较高相关。然而，由于钾摄入有益的证据有限且担心高钾血症风险，对于CKD人群的钾摄入量尚无明确建议。本研究旨在调查钾摄入与CKD进展之间的关系。
利用福冈肾脏病登记研究的数据，对日本4314名18岁及以上患者进行了为期5年的前瞻性随访。根据通过田中公式从即时尿样评估的估计钾摄入量水平，将患者分为四分位数。主要结局为CKD进展，定义为肌酐浓度较基线升高1.5倍和终末期肾病发生的复合情况。我们使用Cox比例风险模型评估估计钾摄入量与CKD进展之间的关系。
共有1490名患者在随访期间出现CKD进展，发病率为90.1/1000人年。在多变量调整的Cox模型中，估计钾摄入量最低的四分位数患者的CKD进展风险比最高四分位数患者更高（风险比[95%置信区间]，1.24[1.03 - 1.48]）。同样，作为连续变量，估计钾摄入量每降低1个标准差与CKD进展风险较高相关（风险比[95%置信区间]，1.10[1.03 - 1.
