(OR27-02-26) Estimated Health Impact of Potassium-Enriched Salt Substitution in the United States

Objectives: To estimate the potential health impact of replacing regular salt with potassium-enriched salt on cardiovascular disease (CVD) and chronic kidney disease (CKD) outcomes in the United States.

Methods: We applied a comparative risk assessment framework to estimate the impact of replacing regular salt (100% sodium chloride) with potassium-enriched salt containing 25% potassium chloride and 75% sodium chloride. Baseline sodium intake, blood pressure distributions, disease burdens, and relative risks linking systolic blood pressure (SBP) with CVD and CKD were derived from the Global Burden of Disease study. We modeled salt replacement overall and by source (i.e., discretionary salt, such as salt used for seasoning or cooking vs non-discretionary sources, such as packaged foods). Effects on SBP were estimated using established dose-response relationships for sodium reduction and potassium increase. Health outcomes included new CVD and CKD cases, deaths, and disability-adjusted life years (DALYs) averted. Potential harms (i.e., hyperkalemia-related deaths from increased potassium intake) were incorporated for individuals with advanced CKD (i.e., stages G3-G5). Monte Carlo simulations generated 95% uncertainty intervals (UI).

Results: In the United States, replacing all salt with potassium-enriched salt was estimated to avert 293 (95% UI: 238-343) thousand incident CVD events, 177 (95% UI: 141-209) thousand new CKD cases, 105 (95% UI: 87-121) thousand deaths, and 2.3 (95% UI: 1.9-2.6) million DALYs annually. Most benefits (~90%) were attributable to salt replacement in dietary sources other than discretionary salt (e.g., packaged foods). Among individuals with advanced CKD, deaths prevented through SBP reduction greatly outnumbered potential hyperkalemia-related deaths (~43 vs ~5.6 thousand annually), resulting in a considerable net health gain (~37 thousand deaths prevented per year).

Conclusions: Replacing regular salt with potassium-enriched salt in the United States could substantially reduce CVD and CKD burden in the population, with a net survival benefit even among high-risk groups such as individuals with advanced CKD. Salt substitution, particularly in pre-packaged foods, represents a promising complementary strategy to existing sodium reduction policies.

Funding Sources: None