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Natriuretic response to an acute oral potassium load in healthy individuals and patients with chronic kidney disease: a randomized controlled trial
Background: The health benefits of dietary potassium have been linked to potassium-induced natriuresis. However, it is unknown whether potassium loading in patients with chronic kidney disease (CKD) induces natriuresis and to what degree it increases plasma potassium. We hypothesize that potassium-induced natriuresis remains intact and that potassium loading is safe in patients with CKD.
Methods: In this placebo-controlled crossover study, 18 healthy individuals and 9 patients with non-diabetic CKD stage G3b-G4 received an acute oral load of potassium chloride (KCl), potassium citrate (K-cit) (40 mmol each) or placebo, either with or without 6 weeks of lisinopril (10 mg/day) pretreatment. Differences in placebo-subtracted plasma potassium and natriuresis between groups during 4-h follow-up were analysed using linear mixed models.
Results: In healthy individuals, but not in patients with CKD, urinary sodium excretion increased 2 h after potassium...
Show moreBackground: The health benefits of dietary potassium have been linked to potassium-induced natriuresis. However, it is unknown whether potassium loading in patients with chronic kidney disease (CKD) induces natriuresis and to what degree it increases plasma potassium. We hypothesize that potassium-induced natriuresis remains intact and that potassium loading is safe in patients with CKD.
Methods: In this placebo-controlled crossover study, 18 healthy individuals and 9 patients with non-diabetic CKD stage G3b-G4 received an acute oral load of potassium chloride (KCl), potassium citrate (K-cit) (40 mmol each) or placebo, either with or without 6 weeks of lisinopril (10 mg/day) pretreatment. Differences in placebo-subtracted plasma potassium and natriuresis between groups during 4-h follow-up were analysed using linear mixed models.
Results: In healthy individuals, but not in patients with CKD, urinary sodium excretion increased 2 h after potassium supplementation, independent of lisinopril pretreatment. Compared with patients with CKD, mean urinary sodium excretion in healthy individuals was 13 mmol [95% confidence interval (CI) 4-22; P = .005] and 13 mmol (95% CI 4-22; P = .006) higher 2 h after KCl and K-cit, respectively. Estimated glomerular filtration rate positively correlated with urinary sodium excretion 2 h after KCl and K-cit, both with and without lisinopril pretreatment. Plasma potassium after potassium supplementation was higher in patients with CKD than in healthy individuals independent of lisinopril pretreatment.
Conclusions: These findings indicate that in CKD, potassium-induced natriuresis does not occur and oral potassium loading is accompanied by an increased risk of hyperkalaemia.
Show less- All authors
- Wouda, R.D.; Karsten, M.; Michels, E.H.A.; Garrelds, I.M.; Danser, A.H.J.; Borst, M.H. de; Hoorn, E.J.; Rotmans, J.; Vogt, L.
- Date
- 2025-12-11
- Volume
- 41
- Issue
- 2
- Pages
- 255 - 264