Hyperkalemia: An adaptive response in chronic renal insufficiency

Gennari, F. John; Segal, Aaron

doi:10.1046/j.1523-1755.2002.00350.x

Cited by 108 publications

(83 citation statements)

References 61 publications

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“…As renal function declines, potassium balance is usually maintained via increases in potassium excretion per functioning nephron (6). Hyperkalemia stimulates aldosterone secretion, which also increases the fractional potassium excretion (27).…”

Section: Discussionmentioning

confidence: 99%

“…Hyperkalemia has also been associated with increased mortality (up to 17%) in the general hospitalized population (5). Although nephron adaptation occurs in those with progressive renal insufficiency by way of enhanced distal tubular secretion of ingested potassium (6), mildly elevated potassium levels are not uncommon and dietary restriction of potassium is frequently considered prudent for patients with advanced chronic kidney disease (CKD) to avoid dangerous hyperkalemia (7).…”

mentioning

confidence: 99%

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Serum Potassium and Outcomes in CKD

Korgaonkar¹,

Tilea²,

Gillespie³

et al. 2010

Clinical Journal of the American Society of Nephrology

202

159

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Background and objectives:The relationship between serum potassium (S K ) and mortality in chronic kidney disease (CKD) has not been systematically investigated.Design, setting, participants, & measurements: We examined the predictors and mortality association of S K in the Renal Research Institute CKD Study cohort, wherein 820 patients with CKD were prospectively followed at four US centers for an average of 2.6 years. Predictors of S K were investigated using linear and repeated measures regression models. Associations between S K and mortality, the outcomes of ESRD, and cardiovascular events in time-dependent Cox models were examined.Results: The mean age was 60.5 years, 80% were white, 90% had hypertension, 36% had diabetes, the average estimated GFR was 25.4 ml/min per 1.73 m 2 , and mean baseline S K was 4.6 mmol/L. Higher S K was associated with male gender, lower estimated GFR and serum bicarbonate, absence of diuretic and calcium channel blocker use, diabetes, and use of angiotensinconverting enzyme inhibitors and/or statins. A U-shaped relationship between S K and mortality was observed, with mortality risk significantly greater at S K <4.0 mmol/L compared with 4.0 to 5.5 mmol/L. Risk for ESRD was elevated at S K <4 mmol/L in S K categorical models. Only the composite of cardiovascular events or death as an outcome was associated with higher S K (>5.5).Conclusions: Although clinical practice usually emphasizes greater attention to elevated S K in the setting of CKD, our results suggest that patients who have CKD and low or even low-normal S K are at higher risk for dying than those with mild to moderate hyperkalemia.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Serum Potassium and Outcomes in CKD

Korgaonkar¹,

Tilea²,

Gillespie³

et al. 2010

Clinical Journal of the American Society of Nephrology

202

159

View full text Add to dashboard Cite

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“…According to the traditional view, extracellular [K ϩ ] is the major stimulus driving renal K ϩ excretion (10,11). Extracellular [K ϩ ] increases during dietary K ϩ intake, and this increase then stimulates renal K ϩ excretion by increasing K ϩ secretion in the collecting duct directly (11,30) and indirectly by stimulating aldosterone secretion (21,22).…”

mentioning

confidence: 99%

“…Extracellular [K ϩ ] increases during dietary K ϩ intake, and this increase then stimulates renal K ϩ excretion by increasing K ϩ secretion in the collecting duct directly (11,30) and indirectly by stimulating aldosterone secretion (21,22). Increased renal K ϩ excretion then normalizes extracellular [K ϩ ].…”

mentioning

confidence: 99%

Gut sensing of dietary K⁺ intake increases renal K⁺ excretion

Kim

et al. 2011

American Journal of Physiology-Regulatory, Integrative and Comp

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Dietary K+ intake may increase renal K+ excretion via increasing plasma [K+] and/or activating a mechanism independent of plasma [K+]. We evaluated these mechanisms during normal dietary K+ intake. After an overnight fast, [K+] and renal K+ excretion were measured in rats fed either 0% K+ or the normal 1% K+ diet. In a third group, rats were fed with the 0% K+ diet, and KCl was infused to match plasma [K+] profile to that of the 1% K+ diet group. The 1% K+ feeding significantly increased renal K+ excretion, associated with slight increases in plasma [K+], whereas the 0% K+ diet decreased K+ excretion, associated with decreases in plasma [K+]. In the KCl-infused 0% K+ diet group, renal K+ excretion was significantly less than that of the 1% K+ group, despite matched plasma [K+] profiles. We also examined whether dietary K+ alters plasma profiles of gut peptides, such as guanylin, uroguanylin, glucagon-like peptide 1, and glucose-dependent insulinotropic polypeptide, pituitary peptides, such as AVP, α-MSH, and γ-MSH, or aldosterone. Our data do not support a role for these hormones in the stimulation of renal K+ excretion during normal K+ intake. In conclusion, postprandial increases in renal K+ excretion cannot be fully accounted for by changes in plasma [K+] and that gut sensing of dietary K+ is an important component of the regulation of renal K+ excretion. Our studies on gut and pituitary peptide hormones suggest that there may be previously unknown humoral factors that stimulate renal K+ excretion during dietary K+ intake.

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“…The dynamic changes in renal function as studied by AKI and severe AKI subsets had a greater role on all-cause mortality compared to static value of admit eGFR. Interestingly ESRD patients had better survival compared to severe AKI, perhaps owing to the effect of physiologic adaptations to repeated episodes of hyperkalemia [23].…”

Section: Archives Of Medicine Issn 1989-5216mentioning

confidence: 99%

Long-term Mortality Outcomes of Hyperkalemic Patients in the Emergency Department Setting: A Case Control Study

Velagapudi¹,

O’Horo²,

Glinskii³

et al. 2017

Arch Med

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Background: The impact of an episode of hyperkalemia on long term mortality is not well studied. Such a study is vital for development of a utilization strategy for new drugs for the treatment of hyperkalemia. To study the long term impact of hyperkalemia on mortality, we conducted a retrospective, observational casecontrol study in a tertiary care emergency department. We compared cases of non-hemolyzed serum potassium >5.3 mEq/L with normokalemic controls. Allcause mortality and causes of death were determined from social security death index, national death index, and medical record review over a follow-up period of 490 patient years. Methods and Findings:A total of 287 consecutive subjects (223 cases, 64 controls) were identified among 14,483 patients. Cox proportional hazard regression showed that for each 1 mEq/L increase in admit potassium, all-cause mortality Hazard Ratio was 1.54, 95% Confidence Interval: 1.22-1.96. Subgroup analyses showed higher mortality in acute kidney injury and heart failure patients. Conclusion:Hyperkalemia predicted all-cause mortality, when adjusted for age, sex, Charlson comorbidity index, and significant covariates (heart failure and end stage renal disease). The deleterious effect of admit hyperkalemia persisted in survivors from index episode throughout the study period. Cardiovascular mortality was statistically more prevalent. Future studies are needed for risk stratification strategies and mortality impact of newer drugs.

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Hyperkalemia: An adaptive response in chronic renal insufficiency

Cited by 108 publications

References 61 publications

Serum Potassium and Outcomes in CKD

Serum Potassium and Outcomes in CKD

Gut sensing of dietary K⁺ intake increases renal K⁺ excretion

Long-term Mortality Outcomes of Hyperkalemic Patients in the Emergency Department Setting: A Case Control Study

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Hyperkalemia: An adaptive response in chronic renal insufficiency

Cited by 108 publications

References 61 publications

Serum Potassium and Outcomes in CKD

Serum Potassium and Outcomes in CKD

Gut sensing of dietary K+ intake increases renal K+ excretion

Long-term Mortality Outcomes of Hyperkalemic Patients in the Emergency Department Setting: A Case Control Study

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Gut sensing of dietary K⁺ intake increases renal K⁺ excretion