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Turban S, Juraschek SP, Miller ER, Anderson CAM, White K, Charleston J, Appel LJ. Randomized Trial on the Effects of Dietary Potassium on Blood Pressure and Serum Potassium Levels in Adults with Chronic Kidney Disease. Nutrients 2021; 13:nu13082678. [PMID: 34444838 PMCID: PMC8398615 DOI: 10.3390/nu13082678] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 12/31/2022] Open
Abstract
In the general population, an increased potassium (K) intake lowers blood pressure (BP). The effects of K have not been well-studied in individuals with chronic kidney disease (CKD). This randomized feeding trial with a 2-period crossover design compared the effects of diets containing 100 and 40 mmol K/day on BP in 29 adults with stage 3 CKD and treated or untreated systolic BP (SBP) 120–159 mmHg and diastolic BP (DBP) <100 mmHg. The primary outcome was 24 h ambulatory systolic BP. The higher-versus lower-K diet had no significant effect on 24 h SBP (−2.12 mm Hg; p = 0.16) and DBP (−0.70 mm Hg; p = 0.44). Corresponding differences in clinic BP were −4.21 mm Hg for SBP (p = 0.054) and −0.08 mm Hg for DBP (p = 0.94). On the higher-K diet, mean serum K increased by 0.21 mmol/L (p = 0.003) compared to the lower-K diet; two participants had confirmed hyperkalemia (serum K ≥ 5.5 mmol/L). In conclusion, a higher dietary intake of K did not lower 24 h SBP, while clinic SBP reduction was of borderline statistical significance. Additional trials are warranted to understand the health effects of increased K intake in individuals with CKD.
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Affiliation(s)
- Sharon Turban
- School of Medicine, Johns Hopkins University, Baltimore, MD 21087, USA; (E.R.M.III); (K.W.); (L.J.A.)
- Correspondence: ; Tel.: 410-955-5268
| | | | - Edgar R. Miller
- School of Medicine, Johns Hopkins University, Baltimore, MD 21087, USA; (E.R.M.III); (K.W.); (L.J.A.)
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21087, USA;
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD 21087, USA
| | - Cheryl A. M. Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, San Diego, CA 92093, USA;
| | - Karen White
- School of Medicine, Johns Hopkins University, Baltimore, MD 21087, USA; (E.R.M.III); (K.W.); (L.J.A.)
| | - Jeanne Charleston
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21087, USA;
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD 21087, USA
| | - Lawrence J. Appel
- School of Medicine, Johns Hopkins University, Baltimore, MD 21087, USA; (E.R.M.III); (K.W.); (L.J.A.)
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21087, USA;
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD 21087, USA
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Satirapoj B, Kongthaworn S, Choovichian P, Supasyndh O. Electrolyte disturbances and risk factors of acute kidney injury patients receiving dialysis in exertional heat stroke. BMC Nephrol 2016; 17:55. [PMID: 27267762 PMCID: PMC4895821 DOI: 10.1186/s12882-016-0268-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/01/2016] [Indexed: 02/04/2023] Open
Abstract
Background Exertional heat stroke (EHS) is a life-threatening illness and leads to multi-organ dysfunction including acute kidney injury (AKI). The clinical significance of abnormal electrolytes and renal outcomes in ESH patients has been poorly documented. We aim to exhibit the electrolyte abnormalities, renal outcomes and risk factors of patients with AKI receiving dialysis in EHS. Methods A retrospective cohort study in EHS patients between 2003 and 2014 were conducted. Clinical and laboratory outcomes including serum and urine electrolytes, AKI and dialysis were assessed on admission, during hospitalization and at the time of their discharge from the hospital. A logistic regression analysis was performed for risk factors of acute dialysis. Results All 66 subjects with mean age 22.1 ± 4.3 years were included. On admission, the common electrolyte disturbances were hypokalemia (71.2 %), hypophosphatemia (59.1 %), hyponatremia (53.0 %), hypocalcemia (51.5 %), and hypomagnesemia (34.9 %). Electrolytes depletion was confirmed as renal loss (potassium loss; 54.2 %, phosphate loss; 86.7 %, sodium loss; 64.7 % and magnesium loss; 83.3 %). During hospitalization ranging from 2 to 209 days, 90.9 % patients suffered from AKI with 16.7 % receiving acute dialysis, and 3 % patients died. At discharge, AKI and electrolyte abnormalities had dramatically improved. The prognosis factors for AKI receiving dialysis were identified as neurological status, renal function and serum muscle enzyme at time of admission. Conclusion The study suggests that hypoelectrolytemia and AKI are frequently observed in patients with EHS. Neurological impairment, impaired renal function, and increased serum muscle enzyme should be considered risk factors of acute dialysis.
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Affiliation(s)
- Bancha Satirapoj
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, 315, Bangkok, 10400, Thailand.
| | - Suramanat Kongthaworn
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, 315, Bangkok, 10400, Thailand
| | - Panbubpa Choovichian
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, 315, Bangkok, 10400, Thailand
| | - Ouppatham Supasyndh
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, 315, Bangkok, 10400, Thailand
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Alterations of proteins in MDCK cells during acute potassium deficiency. BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2016; 1864:683-696. [DOI: 10.1016/j.bbapap.2016.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/05/2016] [Accepted: 03/10/2016] [Indexed: 11/18/2022]
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Lee EY, Yoon H, Yi JH, Jung WY, Han SW, Kim HJ. Does hypokalemia contribute to acute kidney injury in chronic laxative abuse? Kidney Res Clin Pract 2015; 34:109-12. [PMID: 26484031 PMCID: PMC4570648 DOI: 10.1016/j.krcp.2014.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/29/2014] [Accepted: 10/17/2014] [Indexed: 11/26/2022] Open
Abstract
Prolonged hypokalemia from chronic laxative abuse is recognized as the cause of chronic tubulointerstitial disease, known as “hypokalemic nephropathy,” but it is not clear whether it contributes to acute kidney injury (AKI). A 42-year-old woman with a history of chronic kidney disease as a result of chronic laxative abuse from a purging type of anorexia nervosa (AN-P), developed an anuric AKI requiring hemodialysis and a mild AKI 2 months later. Both episodes of AKI involved severe to moderate hypokalemia (1.2 and 2.7 mmol/L, respectively), volume depletion, and mild rhabdomyolysis. The histologic findings of the first AKI revealed the remnants of acute tubular necrosis with advanced chronic tubulointerstitial nephritis and ischemic glomerular injury. Along with these observations, the intertwined relationship among precipitants of recurrent AKI in AN-P is discussed, and then we postulate a contributory role of hypokalemia involved in the pathophysiology of the renal ischemia-induced AKI.
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Affiliation(s)
- Eun-Young Lee
- Renal Division, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Hyaejin Yoon
- Renal Division, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Joo-Hark Yi
- Renal Division, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Woon-Yong Jung
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Woong Han
- Renal Division, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Ho-Jung Kim
- Renal Division, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
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Santos MSB, Seguro AC, Andrade L. Hypomagnesemia is a risk factor for nonrecovery of renal function and mortality in AIDS patients with acute kidney injury. Braz J Med Biol Res 2010; 43:316-23. [PMID: 20401440 DOI: 10.1590/s0100-879x2010007500002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 01/07/2010] [Indexed: 11/22/2022] Open
Abstract
The objective of the present study was to determine the prevalence of electrolyte disturbances in AIDS patients developing acute kidney injury in the hospital setting, as well as to determine whether such disturbances constitute a risk factor for nephrotoxic and ischemic injury. A prospective, observational cohort study was carried out. Hospitalized AIDS patients were evaluated for age; gender; coinfection with hepatitis; diabetes mellitus; hypertension; time since HIV seroconversion; CD4 count; HIV viral load; proteinuria; serum levels of creatinine, urea, sodium, potassium and magnesium; antiretroviral use; nephrotoxic drug use; sepsis; intensive care unit (ICU) admission, and the need for dialysis. Each of these characteristics was correlated with the development of acute kidney injury, with recovery of renal function and with survival. Fifty-four patients developed acute kidney injury: 72% were males, 59% had been HIV-infected for >5 years, 72% had CD4 counts <200 cells/mm(3), 87% developed electrolyte disturbances, 33% recovered renal function, and 56% survived. ICU admission, dialysis, sepsis and hypomagnesemia were all significantly associated with nonrecovery of renal function and with mortality. Nonrecovery of renal function was significantly associated with hypomagnesemia, as was mortality in the multivariate analysis. The risks for nonrecovery of renal function and for death were 6.94 and 6.92 times greater, respectively, for patients with hypomagnesemia. In hospitalized AIDS patients, hypomagnesemia is a risk factor for nonrecovery of renal function and for in-hospital mortality. To determine whether hypomagnesemia is a determinant or simply a marker of critical illness, further studies involving magnesium supplementation in AIDS patients are warranted.
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da Silva CA, de Bragança AC, Shimizu MHM, Sanches TR, Fortes MAZ, Giorgi RR, Andrade L, Seguro AC. Rosiglitazone prevents sirolimus-induced hypomagnesemia, hypokalemia, and downregulation of NKCC2 protein expression. Am J Physiol Renal Physiol 2009; 297:F916-22. [PMID: 19656910 DOI: 10.1152/ajprenal.90256.2008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Sirolimus, an antiproliferative immunosuppressant, induces hypomagnesemia and hypokalemia. Rosiglitazone activates renal sodium- and water-reabsorptive pathways. We evaluated whether sirolimus induces renal wasting of magnesium and potassium, attempting to identify the tubule segments in which this occurs. We tested the hypothesis that reduced expression of the cotransporter NKCC2 forms the molecular basis of this effect and evaluated the possible association between increased urinary excretion of magnesium and renal expression of the epithelial Mg2+ channel TRPM6. We then analyzed whether rosiglitazone attenuates these sirolimus-induced tubular effects. Wistar rats were treated for 14 days with sirolimus (3 mg/kg body wt in drinking water), with or without rosiglitazone (92 mg/kg body wt in food). Protein abundance of NKCC2, aquaporin-2 (AQP2), and TRPM6 was assessed using immunoblotting. Sirolimus-treated animals presented no change in glomerular filtration rate, although there were marked decreases in plasma potassium and magnesium. Sirolimus treatment reduced expression of NKCC2, and this was accompanied by greater urinary excretion of sodium, potassium, and magnesium. In sirolimus-treated animals, AQP2 expression was reduced. Expression of TRPM6 was increased, which might represent a direct stimulatory effect of sirolimus or a compensatory response. The finding that rosiglitazone prevented or attenuated all sirolimus-induced renal tubular defects has potential clinical implications.
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Affiliation(s)
- Cristianne Alexandre da Silva
- Laboratório de Pesquisa Básica LIM-12, Faculdade de Medicina da USP, Av. Dr. Arnaldo 455, Sala 3310, CEP 01246-903, São Paulo, Brazil
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de Oliveira RA, Marques IDB, Seguro AC, Andrade L. Electrolyte disturbances and acute kidney injury induced by imatinib therapy. NDT Plus 2008; 2:27-9. [PMID: 25949279 PMCID: PMC4421484 DOI: 10.1093/ndtplus/sfn188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 11/04/2008] [Indexed: 11/15/2022] Open
Abstract
Imatinib mesylate is an anticancer agent that selectively inhibits protein kinases involved in the pathophysiology of cancer. It is now the first-line therapy for patients with chronic myeloid leukaemia (CML) and is generally well tolerated. Here, we describe a case of a patient receiving imatinib for CML. The patient developed renal failure accompanied by severe hypophosphataemia, hypokalaemia and hypomagnesaemia. We discuss the pathophysiological characteristics of imatinib-induced renal injury, and we demonstrate that these electrolyte disturbances were caused by increased urinary excretion of phosphate and potassium. Early diagnosis and correction of imatinib-induced renal injury and electrolyte disorders can improve clinical outcomes.
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Affiliation(s)
| | | | - Antonio Carlos Seguro
- Department of Nephrology , University of São Paulo School of Medicine , São Paulo , Brazil
| | - Lúcia Andrade
- Department of Nephrology , University of São Paulo School of Medicine , São Paulo , Brazil
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Wang W, Soltero L, Zhang P, Huang XR, Lan HY, Adrogue HJ. Renal inflammation is modulated by potassium in chronic kidney disease: possible role of Smad7. Am J Physiol Renal Physiol 2007; 293:F1123-30. [PMID: 17634402 DOI: 10.1152/ajprenal.00104.2007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
High-potassium diets have been shown to be beneficial in cardiovascular disease partly because of a blood pressure-lowering effect. The effect of potassium on inflammation has not been studied. We investigated the influence of potassium supplementation on the degree of renal inflammation and the intracellular signaling mechanisms that could mediate inflammation in chronic kidney disease (CKD). CKD was created in male Sprague-Dawley rats by subtotal nephrectomy. Two groups of CKD rats were pair fed with diets containing 2.1% potassium (potassium-supplemented diet) or 0.4% potassium (basal diet). Body weight, blood pressure, and blood and urine electrolytes were measured biweekly. The animals were euthanized at week 8, and the remnant kidneys were analyzed by histology, immunohistochemistry, Western blotting, and real-time quantitative PCR. In the CKD pair-fed groups, blood potassium concentration did not differ significantly, but blood pressure was lower in the potassium-supplemented group. Compared with the basal diet, potassium supplementation decreased renal tubulointerstitial injury and suppressed renal inflammation as evidenced by decreased macrophage infiltration, lower expression of inflammatory cytokines, and decreased NF-kappaB activation. These renoprotective effects were associated with downregulation of renal transforming growth facto-beta, upregulation of renal Smad7, and lower blood pressure. Our results show that potassium supplementation can reduce renal inflammation and hence, could modulate the progression of kidney injury in CKD.
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Affiliation(s)
- Wansheng Wang
- Dept. of Medicine-Renal Section, Baylor College of Medicine, Houston, TX 77030, USA.
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de Souza AL, Souza AL, Rodrigues C, Sztajnbok J, Andrade L, Romano CC, Duarte AJS, Seguro AC. Hypoelectrolytemia accompanied by acute renal failure in exertional heatstroke. Am J Emerg Med 2006; 24:888-9. [PMID: 17098121 DOI: 10.1016/j.ajem.2006.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 03/12/2006] [Accepted: 03/14/2006] [Indexed: 11/23/2022] Open
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Chou CL, Chen YH, Chau T, Lin SH. Acquired Bartter-Like Syndrome Associated with Gentamicin Administration. Am J Med Sci 2005; 329:144-9. [PMID: 15767821 DOI: 10.1097/00000441-200503000-00007] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although acute nonoliguric renal failure is a well-known nephrotoxic effect of aminoglycoside antibiotics, less recognized is acquired Bartter-like syndrome. Herein, we describe four female patients who presented with marked paresthesia, muscle weakness, and tetany following gentamicin therapy with total dose ranging from 1.2 g to 2.6 g. All were normotensive. Biochemical abnormalities included hypokalemia (K+ 1.8-2.3 mmol/L), metabolic alkalosis (HCO(3-) 31.9-34.2 mmol/L), hypomagnesemia (Mg2+ 0.9-1.2 mg/dL), hypermagnesiuria (fractional excretion of Mg 3-6%), hypocalcemia (free Ca2+ 2.0-4.1 mg/dL), and hypercalciuria (molar ratio of Ca2+/creatinine 0.23-0.53), all consistent with Bartter-like syndrome. Serum immunoreactive parathyroid hormone concentration was low despite the hypocalcemia. The Bartter-like syndrome lasted for 2 to 6 weeks after cessation of gentamicin, coupled with supplementation of K+, Ca2+, and Mg2+. These biochemical abnormalities resembled those seen in patients with gain-of-function mutations in the calcium-sensing receptor. We hypothesize that gentamicin, a polyvalent cationic molecule, induces the action of calcium-sensing receptor on the thick ascending loop of Henle and distal convoluted tubule to cause renal wasting of Na+, K+, Cl-, Ca2+, and Mg2+.
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Affiliation(s)
- Chu-Lin Chou
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Shetty AK, Rogers NL, Mannick EE, Aviles DH. Syndrome of hypokalemic metabolic alkalosis and hypomagnesemia associated with gentamicin therapy: case reports. Clin Pediatr (Phila) 2000; 39:529-33. [PMID: 11005366 DOI: 10.1177/000992280003900904] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nephrotoxicity, as evidenced by renal insufficiency is a well-known consequence of gentamicin therapy. We report two patients with gentamicin-induced syndrome of hypokalemic metabolic alkalosis and hypomagnesemia. Both had complete recovery of renal tubular function after cessation of antibiotic therapy. These cases emphasize the need to routinely monitor patients receiving gentamicin therapy for electrolyte abnormalities to avoid potential morbidity.
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Affiliation(s)
- A K Shetty
- Department of Pediatrics, Louisiana State University Medical Center and Children's Hospital, New Orleans, USA
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Abstract
Na-K-ATPase activity and "in vitro" PAH uptake were used to determine the possible presence of ischemic injuries in cadaver kidneys after different periods of cold storage, and the data were compared with those obtained for an experimental rabbit group. In rabbit kidneys, Na-K-ATPase activity remained stable up to 168 h of cold storage in the outer medulla and superficial cortex, and PAH uptake decreased significantly after 72 h. In human kidneys, Na-K-ATPase activity in the outer medulla was low during the first phase of the study (cold storage less than 20 h), suggesting early injury to the thick ascending limb of Henle's loop. In the superficial cortex, no apparent progression of injury was observed between PAH uptake and Na-K-ATPase activity. In conclusion, our results suggest the presence of early signs of injury in the thick ascending limb of Henle's loop and preservation of proximal tubule function in cadaver kidneys for up to 70 h of cold storage.
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Affiliation(s)
- C M Helou
- Laboratório de Pesquisa Básica, Nefrologia Faculdade de Medicina, Universidade de São Paulo, Brazil
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