Posted from: https://www.everydayhealth.com/kidney-diseases/are-salt-alternatives-dangerous-for-people-with-kidney-disease/
The U.S. Food and Drug Administration (FDA) announced a proposed rule earlier this month that would allow food manufacturers to use salt substitutes in place of the real thing. The public health measure is aimed at reducing the amount of added sodium in foods. About 90 percent of Americans ages 2 and up consume too much salt, according to the Centers for Disease Control and Prevention (CDC) , which contributes to the high burden of chronic disease seen across the nation. One of the proposed substitutes is potassium chloride, also known as potassium salt. The natural alternative to sodium provides a similar flavor without the negative effects of sodium. But advocates for people with kidney disease warn the move to add potassium to food could be dangerous — and even fatal — for people with chronic kidney disease . The American Association of Kidney Patients (AAKP), the Academy of Nutrition and Dietetics (the Academy), and the National Kidney Foundation (NKF) issued a statement August 8 , soon after the FDA made its announcement, stating their concerns and pushing against the proposed rule. While they applauded the FDA’s effort to reduce sodium in packaged foods, “We must balance population health goals and the acute needs of an already medically complex population,” the organizations wrote. Kidney Disease Prevents the Body From Excreting Potassium An estimated 37 million American adults, or about 15 percent of the population, live with chronic kidney disease, a condition that disproportionately impacts people of color, according to the CDC . Black Americans make up roughly 13 percent of the U.S. population, but account for 35 percent of people with kidney failure. Hispanic Americans are also nearly 1.3 times more likely to develop kidney failure than non-Hispanic Americans, and the rate of kidney failure among this population has gone up by 70 percent since 2000, the National Institutes of Health (NIH) reports . Many people with chronic kidney disease, including those with kidney failure, cannot excrete potassium normally. If these people eat high amounts of potassium, the mineral can accumulate in their blood. Elevated levels of potassium in the blood, a condition called hyperkalemia , can cause abnormal heart rhythms and even sudden cardiac death. “Given the very high estimates of those who are unaware they have compromised kidney function and the clinical consequences of hyperkalemia, adding ‘hidden potassium’ in the form of potassium chloride substitutes to the American diet is a risk that should not be taken,” the AAKP statement said. But David Goldfarb, MD , the clinical chief of nephrology at NYU Langone Health in New York City, says the proposed changes likely will only affect people who are being treated for severe kidney disease, and even then, the effects will likely be modest. People who have decreased kidney function and are taking angiotensin-converting enzyme (ACE) inhibitors, angiotensin 2 receptor blockers (ARBs), or another drug called spironolactone, could be affected by increased potassium in foods, since they make it more difficult for a person’s body to excrete potassium — but there are medications that can prevent this. These secondary drugs work by binding to potassium in the intestines, which reduces potassium in the blood. According to Dr. Goldfarb, these medications are already commonly prescribed to people with chronic kidney disease who are on medications that can make too much potassium a dangerous issue. “These people also would have their potassium checked on a regular basis regardless of this FDA change,” he says. Population Benefits Could Outweigh Small Risk of Harm — but People With Kidney Disease Should Be Monitored Goldfarb argued the change would likely do more good than harm. “People recognize that sodium is adverse and that people have to limit their salt intake, and that’s true especially for people with conditions such as chronic kidney disease, bone disease, and high blood pressure,” he says. Too much salt can actually be a contributing factor that causes kidney disease, according to the National Kidney Foundation . It also causes high blood pressure, stroke, and heart disease, the No. 1 killer worldwide. Salt Substitutes May Lower the Risk of Cardiovascular Disease and Death A randomized clinical trial published in the New England Journal of Medicine in 2021 tested the effects of salt versus a potassium-based salt substitute in 600 villages in rural China. The study included nearly 21,000 people who were all ages 60 or older, and nearly all had a history of stroke, hypertension, or both. Half the participants used a salt substitute that was 75 percent sodium chloride (table salt) and 25 percent potassium chloride. The other half used regular salt. The researchers followed up after about five years and found that people in the salt substitute group had lower rates of stroke, major cardiovascular events, and death from any cause. A major caveat of the study, though, was that it excluded people who had kidney disease and were on medications that made them more susceptible to hyperkalemia — so the study doesn’t give insights on whether or not the extra potassium would impact this population. Although he’s in support of the rule, Goldfarb does not dismiss its potential impact, and stresses that it’s important for people with chronic kidney disease who are on medications that make them more susceptible to hyperkalemia to be monitored. “There’s a possibility that a modest amount of potassium would be safe for people with kidney disease, but there’s a border to that,” he said, noting that it’s likely potassium levels would stay relatively low in foods that contain salt alternatives, since it typically replaces some, but not all, of the salt. “The amount of potassium that could be used as a salt substitute is relatively small and not necessarily dangerous even to people with kidney disease.”
