For a study, researchers sought to calculate the total health impact of national salt substitution in India (i.e., replacement of regular salt used at home for cooking or at the table with potassium-enriched reduced-sodium salt substitute). They used a comparative risk assessment framework to estimate the number of cardiovascular disease (CVD) deaths averted in all adults due to blood pressure reductions, the potential number of hyperkalemia deaths from increased potassium intake in people with advanced chronic kidney disease (CKD, estimated glomerular filtration rate <60 mL/min per 1.73 m2), and 3) the net averted deaths (calculated as the difference between 1 and 2) from nationwide salt substitution. They compared two scenarios: a cautious one based on major model inputs and assumptions derived from a large, long-term pragmatic study just completed in a rural area, and an optimistic one based on data from our recent salt replacement trial. The models used data and uncertainties from randomized trials, national surveys, the Global Burden of Disease Study, and the CKD Prognosis Consortium to create the models. Sensitivity analyses were used to test the findings’ resistance to changes in model inputs and assumptions. 

In the most cautious scenario, salt replacement would result in a net reduction of ~191,000 (95% CI: 69,683; 329,147) CVD deaths per year in the general population, and a reduction of ~30,000 (1,052; 58,409) fatalities among 28 million people with advanced CKD. The comparable figures in the optimistic scenario were ~343,000 (120,035; 537,134) and ~57,000. (14,253; 96,606). In deterministic sensitivity assessments, net benefits were consistent. A nationwide salt replacement has regularly been expected to result in significant net benefits, avoiding 8-14% of yearly CVD fatalities. Even when hyperkalemia concerns were taken into account, net advantages for people with CKD were predicted.