Evidence map›Paper›PMID 32321724›Full record

ArticleBMJ (Clinical research ed.)2020

Estimated population wide benefits and risks in China of lowering sodium through potassium enriched salt substitution: modelling study.

Matti Marklund, Gitanjali Singh, Raquel Greer, Frederick Cudhea, Kunihiro Matsushita, Renata Micha, Tammy Brady, Di Zhao, Liping Huang, Maoyi Tian and 5 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 68 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
68citing papers in PubMed, 5 pooled it
8.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

68 citing papers in PubMed, 5 syntheses or guidelines pooled it, 120 citations in OpenAlex.

  1. Pooled it
  2. The Japanese Society of Hypertension Guidelines for the management of elevated blood pressure and hypertension 2025 (JSH2025).Hypertension research : official journal of the Japanese Society of Hypertension · 2026
    Guideline
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  8. Article
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  12. Potassium and the kidney.Nature reviews. Nephrology · 2026
    Review
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  14. Multidimensional Evaluation of Fruit Color Differentiation inInternational journal of food science · 2026
    Article
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8 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 4 institutions in 4 countries.

Matti MarklundGeorge Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, PO Box M201, Missenden Road, NSW 2050, Australia mmarklund@georgeinstitute.org.au.ORCID 0000-0002-3320-796X
Gitanjali SinghFriedman School of Nutrition Science and Policy at Tufts University, Boston, MA, USA.
Raquel GreerJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Frederick CudheaFriedman School of Nutrition Science and Policy at Tufts University, Boston, MA, USA.
Kunihiro MatsushitaJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Renata MichaFriedman School of Nutrition Science and Policy at Tufts University, Boston, MA, USA.
Tammy BradyJohns Hopkins University School of Medicine, Baltimore, MD, USA.
Di ZhaoJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Liping HuangGeorge Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, PO Box M201, Missenden Road, NSW 2050, Australia.
Maoyi TianGeorge Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, PO Box M201, Missenden Road, NSW 2050, Australia.
Laura CobbResolve to Save Lives, New York City, NY, USA.
Bruce NealGeorge Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, PO Box M201, Missenden Road, NSW 2050, Australia.
Lawrence J AppelJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Dariush MozaffarianFriedman School of Nutrition Science and Policy at Tufts University, Boston, MA, USA.
Jason H Y WuGeorge Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, PO Box M201, Missenden Road, NSW 2050, Australia.
Johns Hopkins University · USTufts University · USUNSW Sydney · AUPeking University · CN

Funding

Research BaseP30DK072488 · NIDDK · UNIVERSITY OF MARYLAND BALTIMORE · PI MITCHELL, BRAXTON D, TAYLOR, SIMEON I. · 2005 to 2019
$17.3M
Medical Research CouncilNIDDK NIH HHS P30 DK072488
6 · The paper itself

Abstract

objectivesTo estimate the effects of nationwide replacement of discretionary salt (used at table or during cooking) with potassium enriched salt substitute on morbidity and death from cardiovascular disease in China.

designModelling study.

settingChina. POPULATION: Adult population in China, and specifically individuals with chronic kidney disease (about 17 million people).

interventionsComparative risk assessment models were used to estimate the effects of a nationwide intervention to replace discretionary dietary salt with potassium enriched salt substitutes (20-30% potassium chloride). The models incorporated existing data and corresponding uncertainties from randomised trials, the China National Survey of Chronic Kidney Disease, the Global Burden of Disease Study, and the Chronic Kidney Disease Prognosis Consortium.

main outcome measuresAverted deaths from cardiovascular disease, non-fatal events, and disability adjusted life years from a reduction in blood pressure were estimated after implementation of potassium enriched salt substitution. In individuals with chronic kidney disease, additional deaths from cardiovascular disease related to hyperkalaemia from increased intake of potassium were calculated. The net effects on deaths from cardiovascular disease were estimated as the difference and ratio of averted and additional deaths from cardiovascular disease.

resultsNationwide implementation of potassium enriched salt substitution could prevent about 461 000 (95% uncertainty interval 196 339 to 704 438) deaths annually from cardiovascular disease, corresponding to 11.0% (4.7% to 16.8%) of annual deaths from cardiovascular disease in China; 743 000 (305 803 to 1 273 098) non-fatal cardiovascular events annually; and 7.9 (3.3 to 12.9) million disability adjusted life years related to cardiovascular disease annually. The intervention could potentially produce an estimated 11 000 (6422 to 16 562) additional deaths related to hyperkalaemia in individuals with chronic kidney disease. The net effect would be about 450 000 (183 699 to 697 084) fewer deaths annually from cardiovascular disease in the overall population and 21 000 (1928 to 42 926) fewer deaths in individuals with chronic kidney disease. In deterministic sensitivity analyses, with changes to key model inputs and assumptions, net benefits were consistent in the total population and in individuals with chronic kidney disease, with averted deaths outweighing additional deaths.

conclusionsNationwide potassium enriched salt substitution in China was estimated to result in a substantial net benefit, preventing around one in nine deaths from cardiovascular disease overall. Taking account of the risks of hyperkalaemia, a substantial net benefit was also estimated for individuals with chronic kidney disease.

Indexed as

Blood PressureDiet, Sodium-RestrictedPotassium ChlorideSodium Chloride, DietaryAdultAgedCardiovascular DiseasesChinaFemaleHumansHyperkalemiaHypertensionMaleMiddle AgedMyocardial IschemiaQuality-Adjusted Life YearsPotassium ChlorideSodium Chloride, Dietary

Identifiers

PMID32321724
PMCPMC7190075
OpenAlexW3018500475

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.