Effects of Sodium Intake and Diet on Racial Differences in Urinary Potassium Excretion: Results From the Dietary Approaches to Stop Hypertension (DASH)-Sodium Trial
Abstract
Background We previously showed that African Americans excreted less urinary potassium than whites, even while consuming similar diets in the Dietary Approaches to Stop Hypertension (DASH) trial. We hypothesized that a low-sodium diet may eliminate these differences.Study design Data from the DASH-Sodium randomized controlled feeding trial were analyzed.Setting & participants 412 adults with prehypertension or stage 1 hypertension.Intervention Random assignment to either a typical American "control" diet (1.7 g [43 mEq] potassium/2,100 kcal/d) or the DASH diet (4.1 g [105 mEq] potassium/2,100 kcal/d). Within each diet, participants received 3 levels of sodium intake in random order for 30 days.Outcomes & measurements 24-hour urine samples were analyzed at the end of each period. The primary outcome was urinary potassium excretion.Results On the DASH diet, African Americans consistently excreted significantly less urinary potassium (mean 24-hour urinary potassium excretion, 2,594 ± 961 mg [66 ± 25 mEq]) than whites (3,412 ± 1,016 mg [87 ± 26 mEq]) at the highest sodium level; adjusted (P < 0.001); this difference was not altered by sodium level (P = 0.6 comparing white to African American difference in urinary potassium excretion on high- vs low-sodium diet). In contrast, there was a smaller but significant white-African American difference in mean daily urinary potassium excretion in participants fed the control/high-sodium diet that was not present in the control/low-sodium diet (adjusted differences of 281 mg [7 mEq]/d vs 20 mg [0.5 mEq]/d, respectively; P = 0.007). Significant interactions were found between race and diet (P < 0.001) and between race and sodium (P = 0.02).Limitations Single rather than multiple urine collections were available at each time. Lack of stool potassium and sweat potassium values.Conclusions Racial differences in urinary potassium excretion depend on sodium intake and diet. Our results may help explain the previously documented large variability in urinary potassium excretion.
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Chronically high dietary sodium may induce other, blood-pressure-independent effects, such as increasing myocardial, arterial, and renal fibrosis and dysfunction.
“and also induce other, BP-independent effects, for example increasing myocardial, arterial, and renal fibrosis and dysfunction.29,30”
From Global Sodium Consumption and Death from Cardiovascular Causes (2014) · cites this paper as [29]
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Self-citation
- Authors
- Turban, S., Thompson, C. B., Parekh, R. S., & Appel, L. J.
- Affiliations
- Johns Hopkins University (US)
- University Health Network (CA)
- Corresponding author
- Turban, Sharon
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2013-01
- Volume
- 61
- Issue
- 1
- Pages
- 88-95
- ISSN
- 0272-6386 (ISSN-L)
- OpenAlex
- W2023654762
- Cited by
- 39
- References
- 34
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 5 · 2020: 1 · 2019: 2 · 2018: 4 · 2017: 4 · 2016: 6 · 2015: 3 · 2014: 4 · 2013: 1
- FWCI
- 2.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Research Resources (KL2RR025006)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Potassium and Related Disorders
- Keywords
- potassium excretion, sodium intake, racial differences, African Americans, DASH diet, sodium restriction, hypertension, prehypertension, potassium intake, 24-hour urine, potassium balance, sodium-potassium balance, dietary sodium reduction, potassium supplementation, blood pressure control
- MeSH terms
- Black or African American, Blood Pressure, Diet, Female, Humans, Hypertension, Male, Middle Aged, Potassium, Sodium, Dietary, Treatment Outcome, Potassium, Dietary, White People, Racial Groups
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