Clinical InvestigationResults of the CARDIA study suggest that higher dietary potassium may be kidney protective
Graphical abstract
Section snippets
Results
Mean age in the sample was 30 in 1990, with 57% female, 54% black, and a mean of 14 years of education (Table 1). Mean systolic BP was 108 mm Hg, with 6.6% having hypertension and only 1.8% treated for hypertension. Overall, mean sodium and potassium intakes were 4074 mg/d and 2223 mg/d, respectively. Compared to those among the low-sodium tertile (range, 682–3316 mg/d), those in the high-sodium tertile (range, 4502–11,470 mg/d) were more likely to be men, have fewer years of education, have
Discussion
In a sample of young black and white adults, 14% developed either decreased eGFR or albuminuria between 1995 and 2015. Sodium intake in 1990 was not significantly associated with incident CKD or changes in renal function measured using either eGFR or ACR. However, every 1000 mg increment of potassium in 1990 was significantly associated with a 29% lower risk of albuminuria and a less rapid ACR growth rate from 1995 through 2015. Taken together, our results suggest that a diet high in potassium
Study population
CARDIA is an ongoing cohort study that enrolled 5114 participants aged 18 to 30 years in 1985–1986 from 4 centers in: Birmingham, Alabama; Minneapolis, Minnesota; Chicago, Illinois; and Oakland, California. Recruitment was balanced within center by sex, age, and education. Individuals were asked to participate in an examination at study entry and to be re-examined in years 2, 5, 10 (our study baseline), 15, 20, 25, and 30. Going forward, we refer to each CARDIA follow-up visit by the calendar
Disclosure
All the authors declared no competing interests.
Acknowledgments
Funding for this study was provided in part by a grant from the American Heart Association (17POST32490000). TE is currently supported by a grant from the National Institutes of Health/National Institute on Minority Health and Health Disparities (K01MD014158). Funders did not have a role in the study design, analysis, interpretation, writing, or the decision to submit the report for publication.
The Coronary Artery Risk Development in Young Adults (CARDIA) Study is supported by contracts
References (52)
- et al.
Salt: its role in chronic kidney disease
J Ren Nutr
(2008) - et al.
High and low sodium intakes are associated with incident chronic kidney disease in patients with normal renal function and hypertension
Kidney Int
(2018) - et al.
Urinary sodium excretion and kidney failure in nondiabetic chronic kidney disease
Kidney Int
(2014) - et al.
Association of dietary sodium and potassium intakes with albuminuria in normal-weight, overweight, and obese participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Am J Clin Nutr
(2011) - et al.
The relationship between estimated sodium and potassium excretion and subsequent renal outcomes
Kidney Int
(2014) - et al.
Potassium excretion and outcomes in CKD: Is K intake OK?
Am J Kidney Dis
(2017) - et al.
Low potassium excretion but not high sodium excretion is associated with increased risk of developing chronic kidney disease
Kidney Int
(2016) - et al.
Chronic kidney disease as a global public health problem: approaches and initiatives—a position statement from Kidney Disease Improving Global Outcomes
Kidney Int
(2007) - et al.
The effect of a shift in sodium intake on renal hemodynamics is determined by body mass index in healthy young men
Kidney Int
(2007) - et al.
Potassium in hypertension and cardiovascular disease
Semin Nephrol
(2013)
Potassium and fruit and vegetable intakes in relation to social determinants and access to produce in New York City
Am J Clin Nutr
Construct validity of a single-item, self-rated question of diet quality
J Nutr Educ Behav
Diet for the management of patients with chronic kidney disease; it is not the quantity, but the quality that matters
J Ren Nutr
CARDIA: study design, recruitment, and some characteristics of the examined subjects
J Clin Epidemiol
KDOQI US commentary on the 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD
AmJ Kidney Dis
Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD
Am J Kidney Dis
Trajectories of kidney function decline in young black and white adults with preserved GFR: results from the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Am J Kidney Dis
Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention
Circulation
Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization
N Engl J Med
Prevalence of chronic kidney disease in the United States
JAMA
Economic burden of chronic kidney disease
J Eval Clin Pract
Guidelines for the management of chronic kidney disease
CMAJ
Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline
Ann Intern Med
KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease
Kidney Int Suppl
Clinical practice guidelines for nutrition in chronic renal failure
Am J Kidney Dis
2014 Evidence Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC8)
JAMA
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