ECLIPSE-CKD

ECLIPSE-CKD

Patient / Population Intervention / Exposure Comparison Outcome

In 640 adults with hypertension and stage G2–G3a chronic kidney disease, a potassium-enriched salt substitute reduced systolic blood pressure at 3 months compared with regular salt.

N

640patients

Design

Open-label randomised trial in Chinese counties, 1:1; all household salt replaced by a potassium-enriched salt substitute for cooking, seasoning and preservation vs continued regular salt; 3 months of follow-up, analysis by intention to treat with a linear mixed model

Endpoint

Change in systolic blood pressure from baseline to month 3; secondary — diastolic pressure and serum potassium; safety — hyperkalaemia, hypokalaemia, hospitalisation and death

Relevance

3Supporting — context rather than must-know.

ResultSystolic pressure fell 6.6 vs 2.0 mmHg, a between-group difference of −4.3 mmHg (95% CI −6.4 to −2.2; P < 0.001); diastolic −3.5 vs −1.5 mmHg, difference −1.9 mmHg (−3.1 to −0.8; P = 0.001). Serum potassium rose 0.2 vs 0.0 mmol/L, difference 0.2 (0.2 to 0.3; P < 0.001), with no hyperkalaemia in either group and fewer hypokalaemia events on the substitute (9 vs 23); hospitalisation 16 vs 21, death 1 vs 0. eGFR rose less with the substitute (+1.4 vs +3.2 mL/min/1.73 m², difference −1.8; −2.5 to −1.2; P < 0.001).

Dong S, et al. Presented at ESC Congress 2026, Hot Line 9, 30 August.

Discussion & critique

Salt substitutes have lowered blood pressure in every population except the one where the potassium load is feared, and this is the first randomised look at early chronic kidney disease: 4.3 mmHg, with no hyperkalaemia at all and less hypokalaemia than on ordinary salt. The reassurance stops where the trial does — three months, eGFR 45 to 89, potassium at or below 5.5 mmol/L at entry, so nothing here speaks for G3b or worse, which is where the fear lives. The small extra fall in eGFR is the finding to watch rather than to explain, and the trial is open-label with the substitute donated by the salt industry.