Key result
Salt substitution reduces SBP by an additional ~5 mmHg vs regular salt without hyperkalemia.
Why the trial?
Potassium-enriched salt substitutes lower blood pressure and stroke risk in general populations, but patients with chronic kidney disease were excluded from those trials over hyperkalaemia concerns, leaving both safety and efficacy in CKD unknown.
Does a salt substitute (75% sodium chloride and 25% potassium chloride) reduce systolic blood pressure in patients with chronic kidney disease and hypertension?
Population
640 patients with hypertension and CKD (eGFR 45–89 mL/min/1.73 m²)
Comparison
Potassium-enriched salt substitute (75% NaCl / 25% KCl) vs regular salt
Design
Randomized controlled trial; blinding and centres not reported
Follow-up
3 months
Authors
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Supports salt substitution for systolic blood pressure reduction in stage G2–G3a CKD with hypertension; extends prior randomized evidence to this population.
| Outcome | Salt sub | Regular salt |
|---|---|---|
| Systolic BP reduction at 3 months | −6.6 mmHg | −2.0 mmHg |
| Primary · p<0.001; confidence interval not reported | ||
Safety
Serum potassium rose 0.2 vs 0 mmol/L (p<0.001), with no hyperkalaemia episodes observed in either group.
Design limitations
Follow-up was only 3 months and blood pressure is a surrogate endpoint; investigators state long-term cardiovascular, kidney and safety effects remain unestablished.
Representation
Enrolment required eGFR 45–89, so results do not cover more advanced CKD.
Statistical certainty
No confidence intervals or per-arm sample sizes are reported.
Does a salt substitute (75% sodium chloride and 25% potassium chloride) reduce systolic blood pressure in patients with chronic kidney disease and hypertension?
Absolute Event Rate: 6.6% vs 2%
p-value: p=<0.001
In patients with chronic kidney disease and hypertension, a potassium-enriched salt substitute significantly reduced systolic blood pressure at 3 months without causing hyperkalaemia.
Journal, society, and media accounts. Useful signal, not independent expert judgment.
Dong Shui (2026) conducted an RCT in Chronic kidney disease and hypertension (n=640). Salt substitute vs. Regular salt (100% sodium chloride) was evaluated on Decrease in systolic blood pressure (p=<0.001). A salt substitute reduced systolic blood pressure by 6.6 mmHg compared to 2.0 mmHg with regular salt at 3 months (p<0.001), with no episodes of hyperkalaemia.
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