The cardiovascular implications of hypokalemia

Coca, Steven G.; Perazella, Mark A.; Buller, Gregory K.

doi:10.1053/j.ajkd.2004.10.015

Cited by 44 publications

(32 citation statements)

References 128 publications

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“…Thus, event rates in subjects with ESVEA and accompanying hypokalemia were almost 14× greater compared with the event rates seen when no ESVEA or hypokalemia were present. According to this study and previous studies, hypokalemia seems to be independently associated with a worse prognostic outcome in terms of cardiovascular-related events, 6,[17][18][19] and data from the present study suggest that mild hypokalemia interacts with excessive supraventricular ectopy to increase the risk of stroke significantly. Earlier studies has shown ESVEA as a predictor of atrial fibrillation and stroke.…”

Section: Discussionmentioning

confidence: 84%

Mild Hypokalemia and Supraventricular Ectopy Increases the Risk of Stroke in Community-Dwelling Subjects

Mattsson

Kumarathurai

Larsen

et al. 2017

Stroke

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Background and Purpose-Stroke is independently associated with the common conditions of hypokalemia and supraventricular ectopy, and we hypothesize that the combination of excessive supraventricular ectopic activity and hypokalemia has a synergistic impact on the prognosis in terms of stroke in the general population. Methods-Subjects (55-75 years old) from the Copenhagen Holter Study cohort (N=671) with no history of atrial fibrillation or stroke were studied-including baseline values of potassium and ambulatory 48-hour Holter monitoring. Excessive supraventricular ectopic activity is defined as ≥30 premature atrial complexes per hour or any episodes of runs of ≥20. Hypokalemia was defined as plasma-potassium ≤3.6 mmol/L. The primary end point was ischemic stroke. Cox models were used. Results-Hypokalemia was mild (mean, 3.4 mmol/L; range, 2.7-3.6). Hypokalemic subjects were older (67.0±6.94 versus 64.0±6.66 years; P<0.0001) and more hypertensive (165.1±26.1 versus 154.6±23.5 mm Hg; P<0.0001). Median followup time was 14.4 years (Q1-Q3, 9.4-14.7 years). The incidence of stroke was significantly higher in the hypokalemic group (hazard ratio, 1.84; 95% confidence interval, 1.04-3.28) after covariate adjustments, as well as in a competing risk analysis with death (hazard ratio, 1.51; 95% confidence interval, 1.12-2.04). Excessive supraventricular ectopic activity was also associated with stroke (hazard ratio, 2.23; 95% confidence interval, 1.33-3.76). The combination of hypokalemia and excessive supraventricular ectopic activity increased the risk of events synergistically. Stroke rate was 93 per 1000 patient-year (P<0.0001) in this group (n=17) compared with 6.9 (n=480); 11 (n=81), and 13 (n=93) per 1000 patient-year in the groups without the combination. Conclusions-The combination of hypokalemia and excessive supraventricular ectopy carries a poor prognosis in terms of stroke.

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Section: Discussionmentioning

confidence: 84%

Mild Hypokalemia and Supraventricular Ectopy Increases the Risk of Stroke in Community-Dwelling Subjects

Mattsson

Kumarathurai

Larsen

et al. 2017

Stroke

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“…1 The presence of hypokalemia in hypermineralocorticoid states has been shown repeatedly to affect both cardiac structure, leading to myocardial necrosis or fibrosis, and myocardial function, resulting in impaired cardiac contractility and ventricular arrhythmias. 12,13,[23][24][25] However, whether hypokalemia contributes to the development of cardiac hypertrophy independent of BP has not clearly been demonstrated.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] Thus, even mild potassium depletion has been shown to produce a substantial impairment of cardiac function in dogs and healthy human subjects. 8,9 Several studies have also demonstrated that hypokalemia or mineralocorticoids that induce hypokalemia can affect cardiac structure, leading to cardiac necrosis and fibrosis in experimental animals and humans.…”

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confidence: 99%

Potassium Supplementation Reduces Cardiac and Renal Hypertrophy Independent of Blood Pressure in DOCA/Salt Mice

Wang¹,

Domenighetti²,

Pedrazzini³

et al. 2005

Hypertension

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Abstract-We have demonstrated previously that deoxycorticosterone acetate (DOCA)/salt induces cardiac hypertrophy and left ventricular dysfunction independent of blood pressure (BP) in 1-renin gene mice. Because these mice also develop hypokalemia and metabolic alkalosis caused by mineralocorticoid excess, we investigated whether correcting hypokalemia by dietary potassium supplementation would prevent the DOCA/salt-induced cardiac hypertrophy, cardiac dysfunction, and electrocardiographic changes in normotensive, 1-renin gene and hypertensive, 2-renin gene mice. All mice were studied after 5 weeks of DOCA and salt administration. Potassium was given by adding 0.4 or 0.6% KCl to the drinking water. Our results show that correction of hypokalemia and metabolic alkalosis prevents cardiac hypertrophy and normalizes cardiac function without affecting BP in normotensive, 1-renin gene mice. In hypertensive, 2-renin gene mice, potassium supplementation induces a significant decrease in BP. The decrease in BP and correction of kalemia are associated with a significant but partial correction of cardiac hypertrophy. In both group of mice, electrocardiographic alterations were measured after administration of DOCA/salt, which could be corrected by potassium supplementation. Thus, these results show that correction of hypokalemia and metabolic alkalosis does prevent the development of cardiac hypertrophy and normalizes cardiac function independent of BP in normotensive, 1-renin gene mice that receive excess mineralocorticoid and salt. In 2-renin gene, hypertensive mice, potassium supplementation also prevents the development of cardiac hypertrophy, but the effect cannot be separated from the decrease in BP. Key Words: hypokalemia Ⅲ metabolism Ⅲ hypertrophy Ⅲ heart failure Ⅲ deoxycorticosterone Ⅲ mouse T here is substantial clinical and experimental evidence that potassium depletion, or hypokalemia, has a negative impact on the cardiovascular system as well as on the kidney and contributes to the pathogenesis of hypertension, stroke, ventricular arrhythmias, and renal injury. 1-7 Thus, even mild potassium depletion has been shown to produce a substantial impairment of cardiac function in dogs and healthy human subjects. 8,9 Several studies have also demonstrated that hypokalemia or mineralocorticoids that induce hypokalemia can affect cardiac structure, leading to cardiac necrosis and fibrosis in experimental animals and humans. 8,10 -13 Conversely, potassium supplementation appears to be rather cardioprotective and nephroprotective. Indeed, a high potassium intake and prevention of hypokalemia have been associated with a decrease in blood pressure (BP) in hypertensive animals and humans. 14 -19 Potassium supplementation has also been shown to prevent stroke; to reduce mortality in stroke-prone spontaneously hypertensive and Dahl saltsensitive rats; and to prevent renal glomerular, tubular, and vascular lesions in rats. 14,17,20,21 Together with systemic hypertension and metabolic alkalosis, hypokalemia is the clinical hallm...

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“…This observation suggests that triuret may be able to deplete potassium under certain pathophysiological conditions and should therefore be considered as a potential hypokalemic agent. Hypokalemia is an electrolyte disorder that has been associated with a plethora of pathologic conditions: cardiovascular, neuromuscular, renal, and metabolic [106–109]. A hypokalemic state results from either an increased K + shift into cells and/or excessive net loss of K + .…”

Section: Discussionmentioning

confidence: 99%

Triuret as a potential hypokalemic agent: Structure characterization of triuret and triuret–alkali metal adducts by mass spectrometric techniques

Palii

Contreras

Steill

et al. 2010

Archives of Biochemistry and Biophysics

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Triuret (also known as carbonyldiurea, dicarbamylurea, or 2,4-diimidotricarbonic diamide) is a byproduct of purine degradation in living organisms. An abundant triuret precursor is uric acid, whose level is altered in multiple metabolic pathologies. Triuret can be generated via urate oxidation by peroxynitrite, the latter being produced by the reaction of nitric oxide radical with superoxide radical anion. From this standpoint, an excess production of superoxide radical anions could indirectly favor triuret formation; however very little is known about the potential in vivo roles of this metabolite. Triuret’s structure is suggestive of its ability to adopt various conformations and act as a flexible ligand for metal ions. In the current study, HPLC-MS/MS, energy-resolved mass spectrometry, selected ion monitoring, collision-induced dissociation, IRMPD spectroscopy, Fourier transform-ion cyclotron resonance mass spectrometry and computational methods were employed to characterize the structure of triuret and its metal complexes, to determine the triuret-alkali metal binding motif, and to evaluate triuret affinity toward alkali metal ions, as well as its affinity for Na+ and K+ relative to other organic ligands. The most favored binding motif was determined to be a bidentate chelation of triuret with the alkali metal cation involving two carbonyl oxygens. Using the complexation selectivity method, it was observed that in solution triuret has an increased affinity for potassium ions, compared to sodium and other alkali metal ions. We propose that triuret may act as a potential hypokalemic agent under pathophysiological conditions conducive to its excessive formation and thus contribute to electrolyte disorders. The collision- or photo-induced fragmentation channels of deprotonated and protonated triuret, as well as its alkali metal adducts, are likely to mimic the triuret degradation pathways in vivo.

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The cardiovascular implications of hypokalemia

Cited by 44 publications

References 128 publications

Mild Hypokalemia and Supraventricular Ectopy Increases the Risk of Stroke in Community-Dwelling Subjects

Mild Hypokalemia and Supraventricular Ectopy Increases the Risk of Stroke in Community-Dwelling Subjects

Potassium Supplementation Reduces Cardiac and Renal Hypertrophy Independent of Blood Pressure in DOCA/Salt Mice

Triuret as a potential hypokalemic agent: Structure characterization of triuret and triuret–alkali metal adducts by mass spectrometric techniques

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