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Nutrition in acute and chronic diseases

Estimation of potassium intake: single versus repeated measurements and the associated cardiorenal risk



High potassium intake has been associated with lower blood pressure and a lower incidence of chronic kidney disease and cardiovascular events. In cohort studies, potassium intake is often estimated with a single 24-h urine collection. However, this may not represent actual long-term individual intake. We assessed whether a single baseline versus multiple follow-up measurements of 24-h urine potassium excretion results in different estimates of individual potassium intake and different associations between potassium intake and long-term outcome.


We performed a retrospective cohort study in outpatient subjects with an estimated glomerular filtration rate >60 mL/min/1.73 m2 who had sampled a 24-h urine collection at baseline and had ≥1 collection during a 17-year follow-up. Potassium intake was estimated with a single baseline 24-h urine collection but also during 1-year, 5-year, and 15-year follow-up. We used cox regression analysis to assess the association between cardiorenal outcome and estimated potassium intake.


Average population (n = 541) 24-h potassium excretion was similar at baseline and follow-up but significant individual changes in potassium intake between baseline and follow-up were observed. Forty-four percent of the subjects switched between tertiles of estimated potassium intake when follow-up measurements were used instead of baseline measurements. Hazard ratios for renal and cardiovascular outcomes were 6.9 and 1.7 times higher when follow-up estimates of potassium intake were replaced by baseline estimates.


Estimated potassium intake and its association with long-term outcome change significantly when multiple follow-ups 24-h urine collections are used for estimation of potassium intake instead of a single baseline measurement.

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Fig. 1: Urine K+ excretion: individual versus population data.
Fig. 2: K+ intake tertiles based on baseline or follow-up data.
Fig. 3: Estimated K+ intake and renal outcome.
Fig. 4: Estimated K+ intake and cardiovascular outcome.


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The authors acknowledge the efforts of T.C. van den Hoek and N.D. van Noordenne for their work on the database.


This work was part of the K+onsortium which is supported by a grant from the Dutch Kidney Foundation (CP16.01).

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RHOE, B-JvdB, and LV designed the study. RHOE collected data. RHOE and HP-S analyzed data. All authors interpreted the data. RHOE wrote the first draft of the manuscript. B-JvdB, HP-S, and LV critically revised the manuscript. All authors approved the final version of the manuscript.

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Correspondence to Rik H. Olde Engberink.

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Olde Engberink, R.H., van den Born, BJ.H., Peters-Sengers, H. et al. Estimation of potassium intake: single versus repeated measurements and the associated cardiorenal risk. Eur J Clin Nutr (2021).

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