Low Urinary Potassium Excretion Is Associated with Higher Risk of All-Cause Mortality in Patients with Type 2 Diabetes: Results of the Dutch Diabetes and Lifestyle Cohort Twente (DIALECT)

Stanley M H Yeung; Milou M Oosterwijk; Monique Poelstra; Christina M Gant; Joris I Rotmans; Ewout J Hoorn; Liffert Vogt; Gerjan Navis; Stephan J L Bakker; Martin H de Borst; Gozewijn D Laverman

doi:10.1093/jn/nxac215

Low Urinary Potassium Excretion Is Associated with Higher Risk of All-Cause Mortality in Patients with Type 2 Diabetes: Results of the Dutch Diabetes and Lifestyle Cohort Twente (DIALECT)

J Nutr. 2023 Jan 14;152(12):2856-2864. doi: 10.1093/jn/nxac215.

Affiliations

¹ Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
² Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente Hospital, Almelo and Hengelo, The Netherlands.
³ Department of Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands.
⁴ Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
⁵ Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
⁶ Department of Internal Medicine, Section of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.

PMID: 36130237
DOI: 10.1093/jn/nxac215

Abstract

Background: Low 24-h urinary potassium excretion, reflecting low potassium intake, is associated with premature mortality in the general population.

Objectives: To determine whether urinary potassium excretion is associated with all-cause mortality in patients with type 2 diabetes.

Methods: We performed a prospective cohort study in 654 patients with type 2 diabetes in the Diabetes and Lifestyle Cohort Twente (DIALECT). Sex-specific tertiles of 24-h urinary potassium excretion were analyzed in a multivariable Cox regression model with all-cause mortality. The outpatient program of the hospital uses a continuous surveillance system by the municipal registry of death to ensure up-to-date information on the patient's status (alive or deceased). FFQs were used to study associations between urinary potassium excretion and food products.

Results: Urinary potassium excretion at baseline was 84 ± 25 mmol/d in males and 65 ± 22 mmol/d in females, corresponding to estimated potassium intakes of 4250 ± 1270 mg/d and 3300 ± 875 mg/d. During a median follow-up of 5.2 (IQR: 2.7-7.9] y, 96 participants died. In a fully adjusted model, patients in the lowest sex-specific tertile had a higher risk of all-cause mortality, compared with patients in the highest sex-specific tertile (HR: 2.09; 95% CI: 1.06, 4.10; P = 0.03). Patients in the lowest sex-specific tertile consumed fewer fruits and vegetables, dairy, coffee, and potato products compared with patients in the highest sex-specific tertile (all P < 0.05).

Conclusions: Low potassium intake is associated with a higher risk of all-cause mortality in Dutch patients with type 2 diabetes. Intervention studies are needed to determine whether potassium supplementation improves longevity in patients with type 2 diabetes. This trial was registered in the Dutch Trial Register as NTR trial code 5855.

Keywords: 24-hour urinary potassium excretion; all-cause mortality; diet; food-frequency questionnaire; type 2 diabetes.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Diabetes Mellitus, Type 2* / epidemiology
Female
Humans
Language
Life Style
Male
Potassium
Prospective Studies
Risk Factors
Sodium

Substances

Potassium
Sodium

Associated data

NTR/NTR5855