Table 4.
Intervention effects on deaths from cardiovascular disease* in total adult population in China estimated by the primary model and one way deterministic sensitivity analyses*
| Analyses | Averted deaths from SBP reduction in total population (95% UI) | Additional deaths from increased serum potassium in patients with CKD (95% UI) | Net averted deaths from CVD (95% UI) | ||||||
|---|---|---|---|---|---|---|---|---|---|
| In 000s | Per 100 000 adults exposed† | In 000s | Per 100 000 adults exposed† | In 000s | Per 100 000 adults exposed† | % of current | |||
| Primary model | 460.7 (196.3 to 704.4) | 45.9 (19.8 to 71.9) | 10.6 (6.4 to 16.6) | 1.1 (0.6 to 1.7) | 449.5 (183.7 to 697.1) | 44.8 (18.8 to 70.8) | 10.7 (4.4 to 16.5) | ||
| Sensitivity analyses | |||||||||
| Coverage: | |||||||||
| Lesser (50% of primary model) | 239.1 (99.6 to 372.1) | 23.8 (10.1 to 37.9) | 5.6 (3.3 to 8.7) | 0.6 (0.3 to 0.9) | 233.3 (93.2 to 368.0) | 23.2 (9.5 to 37.4) | 5.5 (2.2 to 8.7) | ||
| Greater (150% of primary model) | 666.3 (288.2 to 1,003.5) | 66.3 (29.3 to 102.4) | 14.9 (9.2 to 23.5) | 1.5 (0.9 to 2.4) | 651.5 (270.8 to 987.6) | 65.0 (27.7 to 100.9) | 15.5 (6.5 to 23.5) | ||
| Patients aware of having chronic kidney disease avoid salt substitutes | 457.1 (195.0 to 699.5) | 45.5 (19.7 to 71.4) | 8.5 (5.1 to 13.1) | 0.9 (0.5 to 1.4) | 448.5 (185.1 to 693.5) | 44.6 (18.8 to 70.6) | 10.6 (4.4 to 16.5) | ||
| Alternative blood pressure effects of salt substitutes: | |||||||||
| About 75% greater5 | 646.0 (347.7 to 928.2) | 65.0 (36.0 to 95.2) | 10.6 (6.4 to 16.6) | 1.1 (0.6 to 1.7) | 635.0 (335.0 to 920.2) | 63.9 (35.0 to 94.2) | 15.1 (8.0 to 21.8) | ||
| About 100% greater6 | 716.2 (544.9 to 892.6) | 72.1 (54.0 to 92.4) | 10.6 (6.4 to 16.6) | 1.1 (0.6 to 1.7) | 706.2 (536.5 to 883.3) | 71.0 (53.1 to 91.3) | 16.8 (12.7 to 21.1) | ||
| About 180% greater24‡ [ | 961.4 (777.3 to 1,138.4) | 97.1 (76.9 to 118.2) | 10.6 (6.4 to 16.6) | 1.1 (0.6 to 1.7) | 950.9 (769.2 to 1,123.9) | 95.9 (75.8 to 117.2) | 22.6 (18.4 to 26.8) | ||
| Effect only in patients with hypertension | 349.7 (156.2 to 534.0) | 34.8 (15.5 to 55.0) | 10.6 (6.4 to 16.6) | 1.1 (0.6 to 1.7) | 338.3 (141.3 to 524.8) | 33.8 (14.3 to 54.0) | 8.1 (3.4 to 12.5) | ||
| Dose-response relation of serum to dietary potassium intake: | |||||||||
| Stronger§ | 460.7 (196.3 to 704.4) | 45.9 (19.8 to 71.9) | 11.9 (6.9 to 19.1) | 1.2 (0.7 to 1.9) | 448.2 (185.3 to 695.9) | 44.6 (18.6 to 70.6) | 10.7 (4.4 to 16.5) | ||
| Weaker¶ | 460.7 (196.3 to 704.4) | 45.9 (19.8 to 71.9) | 7.5 (4.7 to 11.7) | 0.8 (0.5 to 1.2) | 452.8 (187.3 to 699.3) | 45.0 (19.1 to 71.2) | 10.8 (4.5 to 16.6) | ||
| Equal over chronic kidney disease stages G3a-G5 | 460.7 (196.3 to 704.4) | 45.9 (19.8 to 71.9) | 5.8 (3.6 to 9.0) | 0.6 (0.4 to 0.9) | 454.9 (190.6 to 699.5) | 45.2 (19.2 to 71.3) | 10.8 (4.5 to 16.7) | ||
SBP=systolic blood pressure; UI=uncertainty interval; CVD=cardiovascular disease; CKD=chronic kidney disease.*Include deaths from ischaemic heart disease, stroke (ischaemic and haemorrhagic), and other cardiovascular diseases (aortic aneurysm, hypertensive heart disease, atrial fibrillation, cardiomyopathy, peripheral artery disease, and other cardiovascular and circulatory diseases).
Adults aged ≥25 years were considered exposed.
Hernandez et al conducted meta-analyses to evaluate the effect of salt substitutes on blood pressure and 24 hour potassium excretion.24 Estimates for excretion of potassium in 24 hours (11.5 mmol/day, 95% confidence interval 8.4 to 14.6) were multiplied by a factor of 1.3 to estimate the corresponding increase in potassium intake and changed the assumptions of the effects of blood pressure and potassium intake in the sensitivity analysis.
Increasing exponentially with decreasing kidney function.
Increasing linearly with decreasing kidney function.