Low Potassium Excretion but Not High Sodium Excretion is Associated with Increased Risk of Developing Chronic Kidney Disease

It is unclear whether sodium and potassium intake is relevant to the development of chronic kidney disease (CKD) in the general population. Our aim was to examine the associations of urinary sodium (UNaV) and potassium excretion (UKV), as estimates of intake, with risk of developing CKD in a population-based cohort. We studied 5315 individuals free of CKD at baseline of the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study, a prospective, population-based cohort of Dutch men and women aged 28 to 75 years. UNaV and UKV were measured in two 24-hour urine specimens at baseline (1997-1998) and midway during follow-up (2001-2003). CKD was defined as de novo development of eGFR under 60 ml/min per 1.73 m(2) or albuminuria over 30 mg/24 hours, or both. Baseline UNaV and UKV were 135 mmol/24 hours (interquartile range: 106-169 mmol/24 hours) and 70 mmol/24 hours (interquartile range, 57-85 mmol/24 hours), respectively. During a median follow-up of 10.3 years, 872 patients developed CKD. After multivariable adjustment for important covariables, no association was observed between UNaV and risk of CKD (hazard ratio per 50 mmol/24 hours [1 SD] increment, 0.97; 95% confidence interval, 0.89-1.06). Each 21 mmol/24 hours (1 SD) decrement in UKV was significantly associated with a 16% higher risk of developing CKD (multivariable-adjusted hazard ratio, 1.16; 95% confidence interval, 1.06-1.28). Thus, low UKV, and not high UNaV, was associated with an increased risk of developing CKD in a population-based cohort with normal kidney function.