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Sex-Specific Cardiovascular Risk of Lower Potassium Intake in Patients with CKD

Tatsuya Suenaga1, Shigeru Tanaka1, Hiromasa Kitamura1

  • 1Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

European Journal of Preventive Cardiology
|April 17, 2026
PubMed

Insights

Low potassium intake increases cardiovascular disease (CVD) risk in chronic kidney disease (CKD) patients. This risk is significantly higher in women, highlighting the importance of sex-specific considerations for dietary potassium in CKD management.

Area of Science:

  • Nephrology
  • Cardiology
  • Nutritional Science

Background:

  • Lower potassium intake is linked to increased cardiovascular disease (CVD) risk in the general population.
  • Sex differences in this association are noted, but poorly understood in chronic kidney disease (CKD) patients.
  • Limited research exists on potassium intake and CVD risk specifically within the CKD population, especially regarding sex-specific effects.

Purpose of the Study:

  • To investigate the association between estimated dietary potassium intake and the risk of CVD events in patients with CKD.
  • To examine potential sex-specific differences in the relationship between potassium intake and CVD risk among CKD patients.

Main Methods:

  • Prospective follow-up of 4,314 adult CKD patients in Japan over 5 years.
  • Estimated potassium intake calculated using the Tanaka formula from spot urine samples, categorized into sex-specific quartiles.
  • Cox proportional hazards models used to assess CVD risk, with analyses stratified by sex.

Main Results:

  • A total of 431 CVD events occurred during the 5-year follow-up.
  • Overall, the lowest quartile of potassium intake showed a trend towards higher CVD risk (HR 1.41 [0.97-2.03]).
  • A significant interaction between sex and potassium intake was observed (p<0.001), with lower potassium intake significantly increasing CVD risk in women (HR 2.97 [1.44-6.10]) but not in men (HR 0.98 [0.63-1.53]).

Conclusions:

  • Lower estimated potassium intake is associated with an elevated risk of CVD in patients with CKD.
  • This association is particularly pronounced in women, suggesting a critical sex-specific difference in dietary potassium's role in CVD risk for this population.
Abstract

Keywords:
Chronic kidney disease (CKD)cardiovascular disease (CVD)potassium excretionpotassium intakesex-difference

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