A majority of patients with chronic kidney disease (CKD) stage 3b to 4 can tolerate potassium supplementation despite use of renin-angiotensin-system (RAS) inhibitors, according to investigators presenting at the American Society of Nephrology’s Kidney Week 2020 Reimagined virtual conference.

“Recent studies have shown an association between higher potassium intake and better kidney outcomes in patients with chronic kidney disease,” Martin Gritter, MD, of Erasmus MC, Rotterdam in Zuid-Holland, Netherlands, noted in a slide presentation.

Dr Gritter’s team examined tolerance to potassium supplementation in 151 patients during the 2-week screening phase of a randomized clinical trial. A total of 83% were taking RAS inhibitors.

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Patients received 40 mEq potassium supplements daily. Over 2 weeks, supplementation significantly increased whole blood potassium from 4.3 to 4.7 mEq/L, urinary potassium excretion from 73 to 106 mEq/d, and plasma aldosterone from 294 to 366 pg/mL. But 138 patients (91%) remained normokalemic, Dr Gritter Hyperkalemia developed in 13 patients (9%). Supplementation had no significant effects on urinary sodium excretion, systolic blood pressure, or estimated glomerular filtration rate (eGFR).

In multivariable linear regression, age, female sex, RAS inhibitor use, diuretic use, baseline whole blood potassium, and baseline bicarbonate was independently associated with a change in whole blood potassium after 2 weeks of supplementation.

Compared with the normokalemia group, the patients with hyperkalemia were significantly older (74 vs 66 years) and were significantly more likely to have diabetes (69% vs 36%), lower eGFR (26 vs 33 mL/min/1.73 m2), lower baseline bicarbonate (22.5 vs 24.8 mEq/L), and higher baseline whole blood potassium (4.8 vs 4.2 mEq/L).

“This [short-term study] illustrates the feasibility of investigating the renoprotective potential of potassium supplementation in patients with chronic kidney diseases and provides the characteristics of those in whom this is safe,” Dr Gritter told attendees.

Patients with ventricular arrhythmia or users of dual RAS blockade, mineralocorticoid receptor antagonists, or epithelial sodium channel blockers were excluded from the trial.


Gritter M, Yeung SMH, Wouda RD, et al. Tolerance for potassium supplementation in patients with CKD. Presented at: Kidney Week 2020 Reimagined, October 19-25, 2020. Poster PO0563.