Salt substitution — the partial replacement of sodium with potassium in table salt — is emerging as a powerful public health strategy to reduce hypertension and related diseases. Here, we explore whether salt substitution is suitable for people with kidney disease by weighing the potential cardiorenal benefits against the risk of hyperkalaemia.
This is a preview of subscription content, access via your institution
Access options
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$29.99 / 30 days
cancel any time
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Neal, B. et al. Effect of salt substitution on cardiovascular events and death. N. Engl. J. Med. 385, 1067–1077 (2021).
McMahon, E. J., Campbell, K. L., Bauer, J. D., Mudge, D. W. & Kelly, J. T. Altered dietary salt intake for people with chronic kidney disease. Cochrane Database Syst. Rev. 6, CD010070 (2021).
Gritter, M., Rotmans, J. I. & Hoorn, E. J. Role of dietary K+ in natriuresis, blood pressure reduction, cardiovascular protection, and renoprotection. Hypertension 73, 15–23 (2019).
Turban, S. et al. Randomized trial on the effects of dietary potassium on blood pressure and serum potassium levels in adults with chronic kidney disease. Nutrients 13, 2678 (2021).
Gritter, M. et al. Effects of short-term potassium chloride supplementation in patients with chronic kidney disease. J. Am. Soc. Nephrol. https://doi.org/10.1681/ASN.2022020147 (2022).
Cappuccio, F. P., Buchanan, L. A., Ji, C., Siani, A. & Miller, M. A. Systematic review and meta-analysis of randomised controlled trials on the effects of potassium supplements on serum potassium and creatinine. BMJ Open 6, e011716 (2016).
Weir, M. R. & Rolfe, M. Potassium homeostasis and renin-angiotensin-aldosterone system inhibitors. Clin. J. Am. Soc. Nephrol. 5, 531–548 (2010).
Ramos, C. I. et al. Does dietary potassium intake associate with hyperkalemia in patients with chronic kidney disease? Nephrol. Dial. Transplant. 36, 2049–2057 (2021).
El Amouri, A. et al. Potassium and fiber: a controversial couple in the nutritional management of children with chronic kidney disease. Pediatr. Nephrol. Jan 7 (2022).
Marklund, M. et al. Estimated population wide benefits and risks in China of lowering sodium through potassium enriched salt substitution: modelling study. Br. Med. J. 369, m824 (2020).
Acknowledgements
E.J.H.’s work is supported by the Dutch Kidney Foundation (grant 21OK+13).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Rights and permissions
About this article
Cite this article
Hoorn, E.J., Marklund, M. & Wu, J.H.Y. Salt substitution: opportunities and challenges for nephrology. Nat Rev Nephrol 18, 539–540 (2022). https://doi.org/10.1038/s41581-022-00599-4
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41581-022-00599-4