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Oral Session
Community and Public Health Nutrition
Global Nutrition
Matti Marklund, PhD
Research Fellow
The George Institute for Global Health, Faculty of Medicine, UNSW Sydney
Gitanjali Singh, PhD, MPH
Friedman School of Nutrition Science & Policy, Tufts University
Raquel Greer, MD, MHS
assistant professor
Johns Hopkins University School of Medicine
Frederick Cudhea, PhD
Friedman School of Nutrition Science & Policy, Tufts University
Kunihiro Matsushita, MD, PhD
Associate Professor
Johns Hopkins Bloomberg School of Public Health
Renata Micha, PhD
Friedman School of Nutrition Science & Policy, Tufts University
Tammy Brady, MD, PhD
Associate Professor
Johns Hopkins University School of Medicine
Di Zhao, PhD
Research Associate
Johns Hopkins Bloomberg School of Public Health
Liping Huang, MPhil
PhD Candidate
The George Institute for Global Health, Faculty of Medicine, UNSW Sydney
Maoyi Tian, PhD
Senior Research Fellow
The George Institute for Global Health at Peking University Health Science Center
Laura Cobb, DrPH
Director
Resolve to Save 100 Million Lives
Bruce Neal, MB ChB, PhD
Deputy Executive Director, Professor
The George Institute for Global Health, Faculty of Medicine, UNSW Sydney
Lawrence Appel, MD, MPH
Professor
Johns Hopkins Bloomberg School of Public Health,Welch Center for Epidemiology
Dariush Mozaffarian, MD, DrPH
Dean
Friedman School of Nutrition Science & Policy, Tufts University
Jason Wu, PhD
Program Head
The George Institute for Global Health, Faculty of Medicine, UNSW Sydney
Objectives :
Population-level replacement of discretionary (i.e, table/cooking) salt with potassium-enriched salt substitutes is a promising strategy to reduce blood pressure (BP) and prevent cardiovascular disease (CVD). This may be particularly impactful in countries like China where sodium intake is high, mainly from discretionary salt use, and where potassium intake low. However, hyperkalemia resulting from potassium-enriched substitutes and its adverse CVD consequences are of concern for those with chronic kidney disease (CKD). We aimed to estimate the benefits and risks of nationwide replacement of discretionary salt with potassium-enriched salt substitute on CVD mortality in Chinese CKD patients.
Methods : We used a comparative risk assessment framework and incorporated existing data and corresponding uncertainties from randomized trials, the China National Survey of CKD, the Global Burden of Disease study, and the CKD Prognosis Consortium. We estimated averted CVD mortality from reduced BP subsequent to salt substitution in CKD patients (defined as estimated glomerular filtration rate < 60 mL/min per 1.73 m2) stratified by age and sex. Additional CVD deaths from hyperkalemia due to salt substitution were modelled in CKD patients stratified by kidney function. The robustness of the primary model was evaluated in a series of sensitivity analyses where key model assumptions and inputs were altered.
Results : Nationwide implementation of potassium-enriched salt substitution would prevent an estimated 29,735 (95% uncertainty interval: 13,018-50,403) CVD deaths/year among CKD patients by reducing BP, while the increased potassium intake could potentially produce an estimated 9,791 (6,078-15,941) additional hyperkalemia-related deaths (Table). The net effect would be 19,558 (3,430-37,959) fewer CVD deaths/year, corresponding to 7.4% (1.4-13.4) of annual CVD deaths in Chinese CKD patients. Net benefits were consistent in sensitivity analyses (Table).
Conclusions : Despite the risks of hyperkalemia, nationwide potassium-enriched salt substitution in China would result in significant net benefit among CKD patients.
Funding Sources : This analysis was conducted in collaboration with Resolve to Save Lives, an initiative of Vital Strategies. Resolve to Save Lives is funded by Bloomberg Philanthropies, the Bill & Melinda Gates Foundation, and Gates Philanthropy Partners, which is funded with support from the Chan Zuckerberg Foundation. Funding for this work was also provided by the National Health and Medical Research Council and UNSW Sydney.