What are the guidelines regarding the use of potassium (K) salt?

From the Guidelines

Potassium-enriched salt substitutes with a composition of 75% sodium chloride and 25% potassium chloride should be recommended to all patients with hypertension, unless they have advanced kidney disease, are using a potassium supplement, are using a potassium-sparing diuretic, or have another contraindication. This recommendation is based on recent data from randomized controlled trials showing that potassium-enriched salt substitutes are an effective option for improving consumption levels and reducing blood pressure and the rates of cardiovascular events and deaths 1.

Key Considerations

• The use of potassium-enriched salt substitutes has been shown to be beneficial in reducing blood pressure and cardiovascular events in patients with hypertension 1.
• However, patients with advanced kidney disease, those using potassium supplements, potassium-sparing diuretics, or having other contraindications should not use potassium-enriched salt substitutes without medical supervision.
• Regular monitoring of potassium levels is essential, especially in patients with kidney disease or those taking medications that can affect potassium levels.

Clinical Guidelines

• Clinical guidelines for the management of hypertension or chronic kidney disease have inconsistent recommendations about the use of potassium-enriched salt substitutes 1.
• Updating clinical guidelines to provide consistent advice about the use of potassium-enriched salt for hypertension control is necessary.
• The European Best Practice Guidelines on Nutrition recommend a daily potassium intake of 50 to 70 mmol (1,950 to 2,730 mg) potassium daily or 1 mmol/kg ideal body weight for hyperkalemic predialysis patients 1.

Patient Education

• Patients should be educated on the benefits and risks of using potassium-enriched salt substitutes.
• They should be informed about the importance of regular monitoring of potassium levels and the potential side effects of excessive potassium intake.
• Patients should be advised to consult their healthcare provider before starting or stopping any potassium-enriched salt substitute.

From the FDA Drug Label

In patients with impaired mechanisms for excreting potassium, the administration of potassium salts can produce hyperkalemia and cardiac arrest. The use of potassium salts in patients with chronic renal disease, or any other condition which impairs potassium excretion, requires particularly careful monitoring of the serum potassium concentration and appropriate dosage adjustment Interaction with Potassium-Sparing Diuretics Hypokalemia should not be treated by the concomitant administration of potassium salts and a potassium-sparing diuretic (e.g., spironolactone, triamterene, or amiloride) since the simultaneous administration of these agents can produce severe hyperkalemia Interaction with Renin- Angiotensin Aldosterone System Inhibitors Drugs that inhibit the renin-angiotensin-aldosterone system (RAAS) including angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), spironolactone, eplerenone, or aliskiren produce potassium retention by inhibiting aldosterone production Closely monitor potassium in patients receiving concomitant RAAS therapy. Interaction with Nonsteroidal Anti-Inflammatory Drugs: Nonsteroidal anti-inflammatory drugs (NSAIDs) may produce potassium retention by reducing renal synthesis of prostaglandin E and impairing the renin-angiotensin system. Closely monitor potassium in patients receiving concomitant NSAID therapy

The guidelines regarding the use of potassium (K) salt are:

• Monitor serum potassium concentration and adjust dosage accordingly, especially in patients with impaired potassium excretion mechanisms.
• Avoid concomitant administration of potassium salts and potassium-sparing diuretics.
• Closely monitor potassium in patients receiving renin-angiotensin-aldosterone system (RAAS) inhibitors or nonsteroidal anti-inflammatory drugs (NSAIDs).
• Use with caution in patients with chronic renal disease or other conditions that impair potassium excretion. 2

From the Research

Guidelines for Potassium (K) Salt Use

• The use of potassium supplements or potassium-sparing diuretics is not recommended in healthy people with normal serum potassium levels 3.
• Increasing dietary potassium intake in the elderly and in patients with renal impairment must be considered with caution 3.
• Treating all patients whose serum potassium level decreases below 3 mmol/L is recommended, although for certain patients at particular risk of hypokalaemia, levels may need to be maintained above 3.5 mmol/L 3.
• In overt hypokalemia, several therapeutic options are available, including increased consumption of potassium-rich foods, the use of salt substitutes, medicinal potassium supplementation, or distal tubular (potassium-sparing) diuretics 3.

Potassium Supplementation

• Potassium repletion requires substantial and prolonged supplementation, as small potassium deficits in serum represent large body losses 4.
• For patients with known risk factors for hypokalemia (e.g. hypertension, heart failure, or diabetes), careful monitoring is crucial to avoid the adverse sequelae associated with potassium deficits and to ensure that adequate and timely preventive measures can be taken 4.
• The efficacy of enteral potassium supplementation is equivalent to that of supplementation with high intravenous potassium concentrations in elderly patients with chronic heart failure and moderate to severe hypokalemia 5.

Treatment of Hypokalemia

• Hypokalemia is treated with oral or intravenous potassium 6.
• To prevent cardiac conduction disturbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes 6.
• Insulin, usually with concomitant glucose, and albuterol are preferred to lower serum potassium levels in the acute setting; sodium polystyrene sulfonate is reserved for subacute treatment 6.
• Treatment is aimed at replacing potassium intravenously or orally or preventing further potassium loss (spironolactone, triamterene); when associated with a metabolic alkalosis (chloride deficiency), the replacement should be potassium chloride 7.