Potassium-enriched salt: 2.96M deaths a year prevented, model

Researchers at The George Institute for Global Health modelled the effect of replacing regular salt with potassium-enriched salt in 193 countries; the study is published at doi.org. In the scenario where all added salt is replaced worldwide, the model estimates 2.96 million deaths (95% uncertainty interval 2.81–3.12), 10.17 million new cases (9.59–10.70) and 69.43 million disability-adjusted life years (DALYs) prevented each year from cardiovascular disease (CVD) and chronic kidney disease (CKD) doi.org. This corresponds to 14.6% of deaths, 13.1% of new cases and 16.5% of DALYs attributable to these conditions annually doi.org.

The result comes from a model, not from a trial of a whole population. The authors used comparative risk assessment and a composition of 75% sodium chloride and 25% potassium chloride for the substitute doi.org.

Five replacement scenarios

The study compared five scenarios. Replacing only discretionary salt, used in home cooking and seasoning, would prevent 1.85 million deaths (1.74–1.97) and 6.19 million cases, according to the release. Replacing only non-discretionary salt, found in processed and restaurant foods, would prevent 1.56 million deaths (1.46–1.67) and 5.46 million cases doi.org.

Two narrower scenarios covered discretionary salt among people with hypertension. For diagnosed hypertensives, the model gives 0.59 million deaths prevented (0.55–0.63); for treated hypertensives, 0.48 million (0.45–0.52) doi.org. These scenarios assume that 80% of the 659 million diagnosed and 524 million treated people switch.

Model structure and hyperkalaemia risk

The model converts changes in sodium and potassium intake into changes in systolic blood pressure, and then into changes in CVD and CKD risk. Average global sodium intake is 4.3 g per day against a WHO recommendation of 2.0 g, and potassium intake is 2.3 g against a recommended minimum of 3.5 g doi.org.

Increased potassium intake can cause hyperkalaemia in people with CKD. For people with advanced CKD, the model estimates that replacing all salt might cause 0.10 million deaths (0.09–0.11) from hyperkalaemia, while preventing 0.75 million deaths (0.71–0.80) through lower blood pressure doi.org. Net deaths averted are calculated as the difference between the two; net effects on cases and DALYs include only the blood-pressure pathway doi.org.

The authors note that most trials asked participants at elevated hyperkalaemia risk to exclude themselves, and that no study or overview has shown clinical harm. One trial in elderly care facilities, which enrolled residents regardless of kidney function, showed more biochemical hyperkalaemia but no increase in adverse clinical outcomes doi.org.

Potassium-enriched salt could prevent 2.96 million deaths a year, a 193-country model estimates

Five replacement scenarios

Model structure and hyperkalaemia risk

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