Dietary potassium regulates vascular calcification and arterial stiffness

Sun, Yeqing; Byon, Chang Hyun; Yang, Youfeng; Bradley, Wayne E.; Dell’Italia, Louis J.; Sanders, Paul W.; Agarwal, Anupam; Wu, Hui; Chen, Yabing

doi:10.1172/jci.insight.94920

Cited by 65 publications

(46 citation statements)

References 75 publications

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“…These effects were implied in a population-based study, showing an association between impaired proliferation of vascular smooth muscle cells and reduced monocyte adherence to the vessel walls [ 52 ]. Recently, Sun et al [ 53 ] demonstrated a causal role for dietary K + in the regulation of osteogenic differentiation and calcification of vascular smooth muscle cells, both in vitro and in atherosclerotic animal models. Specifically, lower levels of extracellular fluid K + induce vascular smooth muscle cell osteogenic transformation by elevating intracellular calcium.…”

Section: Maladaptations To the Modern Diet And Health Implicationsmentioning

confidence: 99%

Dietary Influence on Body Fluid Acid-Base and Volume Balance: The Deleterious “Norm” Furthers and Cloaks Subclinical Pathophysiology

Qian

2018

Nutrients

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The popular modern diet, characterized by an excess of animal protein and salt but insufficient in fruits, vegetables and water, is a poor fit for human physiological and homeostatic regulatory systems. Sustained net acid and sodium retention, coupled with an insufficient intake of cardiovascular protective potassium-rich foods and hydration in the modern diet can give rise to debilitating chronic organ dysfunction and ultimately, mortality. This holds true, especially in our aging population who are already facing inevitable decline in organ functional reserve. Importantly, in most cases, despite the mismatch and adverse effects to multiple organ systems, plasma electrolyte and acid-base parameters can, on the surface, be maintained within a “normal” reference range, primarily by activating (often maximally activating) compensatory homeostatic mechanisms. These diet-induced effects can thus be clinically silent for decades. Embodied in the chronic corrective homeostatic processes, however, are real risks for multiorgan damage. According to the Dietary Guideline Advisory Committee (DGAC), half of American adults have one or more chronic diseases that are preventable with dietary modification. Here, homeostasis of body fluid acid-base, sodium, potassium and water is examined. Our current dietary habits and their required regulatory adaptation, maladaptation and relevant physiology and pathophysiology are discussed. A framework of dietary modifications to avoid a propensity for maladaptation and thus lowers the risks of common modern diseases (primary prevention) and minimizes the risk of chronic and age-related disease progression (secondary prevention) is emphasized. Although there are other variables at play, a key to restoring the all-important dietary potassium to sodium ratio is greater consumption of vegetables/fruits and adopting salt temperance. Dietary and nutritional optimization is an under-emphasized area of health care that has an enormous potential to temper the epidemics of prevalent chronic diseases in modern society and improve population health.

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Section: Maladaptations To the Modern Diet And Health Implicationsmentioning

confidence: 99%

Dietary Influence on Body Fluid Acid-Base and Volume Balance: The Deleterious “Norm” Furthers and Cloaks Subclinical Pathophysiology

Qian

2018

Nutrients

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“…For example, dietary K + induces natriuresis by dephosphorylating the sodium chloride cotransporter, providing a novel mechanism for its anti-hypertensive effect [20,21]. In animals, dietary K + also has protective effects in the vasculature and the kidney through inhibition of transforming growth factor β and suppression of reactive oxygen species [22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Rationale and Design of a Randomized Placebo-Controlled Clinical Trial Assessing the Renoprotective Effects of Potassium Supplementation in Chronic Kidney Disease

Gritter

Vogt

Yeung

et al. 2018

Nephron

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Background/Aims: Dietary potassium (K⁺) has beneficial effects on blood pressure and cardiovascular (CV) outcomes. Recently, several epidemiological studies have revealed an association between urinary K⁺ excretion (as proxy for dietary intake) and better renal outcomes in subjects with chronic kidney disease (CKD). To address causality, we designed the “K⁺ in CKD” study. Methods: The K⁺ in CKD study is a multicenter, randomized, double blind, placebo-controlled clinical trial aiming to include 399 patients with hypertension, CKD stage 3b or 4 (estimated glomerular filtration rate [eGFR] 15–44 mL/min/1.73 m²), and an average eGFR decline > 2 mL/min/1.73 m²/year. As safety measure, all included subjects will start with a 2-week open-label phase of 40 mmol potassium chloride daily. Patients who do not subsequently develop hyperkalemia (defined as serum K⁺ >5.5 mmol/L) will be randomized to receive potassium chloride, potassium citrate (both K⁺ 40 mmol/day), or placebo for 2 years. The primary end point is the difference in eGFR after 2 years of treatment. Secondary end points include other renal outcomes (> 30% decrease in eGFR, doubling of serum creatinine, end-stage renal disease, albuminuria), ambulatory blood pressure, CV events, all-cause mortality, and incidence of hyperkalemia. Several measurements will be performed to analyze the effects of potassium supplementation, including body composition monitoring, pulse wave velocity, plasma renin and aldosterone concentrations, urinary ammonium, and intracellular K⁺ concentrations. Conclusion: The K⁺ in CKD study will demonstrate if K⁺ supplementation has a renoprotective effect in progressive CKD, and whether alkali therapy has additional beneficial effects.

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“…16 Vascular smooth muscle cells cultured in the lower limits of physical range of potassium increased intracellular calcium and cell calcification. 17 Serum potassium in the group with AAC > 5.5 (3.8 AE 0.6 meq/L) was actually within normal reference range (3.5-4.8 meg/L), but near the lower normal limit.…”

Section: Discussionmentioning

confidence: 80%

“…In an animal study, high serum potassium diminished balloon‐injury induced carotid artery neointima formation and high dietary potassium inhibited vascular smooth muscle and vascular calcification in rats . Vascular smooth muscle cells cultured in the lower limits of physical range of potassium increased intracellular calcium and cell calcification . Serum potassium in the group with AAC > 5.5 (3.8 ± 0.6 meq/L) was actually within normal reference range (3.5–4.8 meg/L), but near the lower normal limit.…”

Section: Discussionmentioning

confidence: 94%

Abdominal aortic calcification score predicts the occurrence of coronary artery disease in middle‐aged peritoneal dialysis patients

2019

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Aim Abdominal aortic calcification (AAC) score in dialysis patients was associated with coronary artery disease (CAD) in cross‐sectional study, but the use of AAC score in the CAD prediction was not clear. We aimed to use AAC score in the estimation of CAD occurrence in middle‐aged peritoneal dialysis (PD) patients. Methods Middle‐aged (45–65 years old) PD patients were recruited and followed up until CAD occurrence, patient mortality, or PD failure. We quantified AAC score by lateral lumbar radiography, and used receiver operation curve (ROC) analysis to find the cut‐off value for CAD prediction. Results There were 187 patients recruited for study with a mean follow‐up of 1027 ± 427 days. AAC score in patients with CAD during follow‐up period (9.7 ± 7.6, n = 41) was higher than in patients without CAD occurrence (5.5 ± 6.1, n = 146) (P < 0.001). Multivariate hazard ratio of AAC score for CAD was 1.07 (P = 0.044). ROC showed that AAC score of 5.5 had a sensitivity of 0.667 and a specificity of 0.581 in the prediction of CAD occurrence. Patients with AAC score above 5.5 had significantly higher cumulative incidence of CAD than patients with AAC score below 5.5 (Log‐rank test, P = 0.003). Age (P = 0.002), diabetes (P = 0.002), hypertension (P = 0.032), longer dialysis vintage (P < 0.001) and lower serum potassium (P = 0.012) were parameters significantly associated with higher AAC score. Conclusion AAC score can predict CAD occurrence in PD patients. Age, diabetes, hypertension, dialysis vintage and serum potassium level are factors associated with higher AAC score.

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Dietary potassium regulates vascular calcification and arterial stiffness

Cited by 65 publications

References 75 publications

Dietary Influence on Body Fluid Acid-Base and Volume Balance: The Deleterious “Norm” Furthers and Cloaks Subclinical Pathophysiology

Dietary Influence on Body Fluid Acid-Base and Volume Balance: The Deleterious “Norm” Furthers and Cloaks Subclinical Pathophysiology

Rationale and Design of a Randomized Placebo-Controlled Clinical Trial Assessing the Renoprotective Effects of Potassium Supplementation in Chronic Kidney Disease

Abdominal aortic calcification score predicts the occurrence of coronary artery disease in middle‐aged peritoneal dialysis patients

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