Challenges to potassium metabolism: internal distribution and external balance

Potassium status and the risk of type 2 diabetes, cardiovascular diseases, and mortality: a meta-analysis of prospective observational studies

Epidemiological evidence on the association between potassium and cardiometabolic outcomes remains controversial. This study aimed to examine associations of dietary intake and blood and urinary levels of potassium with risk of type 2 diabetes, cardiovascular disease (CVD), and mortality. Relevant prospective studies were retrieved through a comprehensive search of four electronic databases up to July 1, 2023. Random-effects models were used to pool the study-specific relative risks (RRs) and 95% confidence intervals (CIs). Fifty-six studies were included in this meta-analysis. A higher intake of potassium was significantly associated with a 16% lower risk of CVD (RR: 0.84, 95% CI: 0.78-0.90). Similar inverse associations were also observed between potassium intake and mortality. Each 1.0 g/d increment in potassium intake was associated with a decreased risk of CVD (RR: 0.85, 95% CI: 0.80-0.91) and all-cause mortality (RR: 0.93, 95% CI: 0.88-0.99). For blood and urinary potassium levels, higher level of blood potassium increased the risk of all-cause mortality by 23% (RR: 1.23, 95% CI: 1.11-1.36). The association of blood potassium levels with mortality was nonlinear (Pnon-linearit<0.001). However, urinary potassium levels were inversely associated with the risk of all-cause mortality (RR: 0.84, 95% CI: 0.76-0.93). Our findings support the benefits of moderate potassium consumption for primary prevention of chronic diseases and premature death.

Potassium homeostasis - Physiology and pharmacology in a clinical context

Membrane voltage controls the function of excitable cells and is mainly a consequence of the ratio between the extra- and intracellular potassium concentration. Potassium homeostasis is safeguarded by balancing the extra-/intracellular distribution and systemic elimination of potassium to the dietary potassium intake. These processes adjust the plasma potassium concentration between 3.5 and 4.5 mmol/L. Several genetic and acquired diseases but also pharmacological interventions cause dyskalemias that are associated with increased morbidity and mortality. The thresholds at which serum K+ not only associates but also causes increased mortality are hotly debated. We discuss physiologic, pathophysiologic, and pharmacologic aspects of potassium regulation and provide informative case vignettes. Our aim is to help clinicians, epidemiologists, and pharmacologists to understand the complexity of the potassium homeostasis in health and disease and to initiate appropriate treatment strategies in dyskalemic patients.

Concentration of Potassium in Plasma, Erythrocytes, and Muscle Tissue in Cows with Decreased Feed Intake and Gastrointestinal Ileus

BACKGROUND

Healthy cows consume large amounts of potassium and a sudden loss in appetite can lead to hypokalemia. The routine method to evaluate potassium homeostasis is the measurement of the extracellular potassium in plasma or serum, but this does not provide information about the intracellular potassium pool.

HYPOTHESIS/OBJECTIVES

To evaluate potassium homeostasis by comparing the extracellular and intracellular potassium concentration in cows with reduced feed intake and gastrointestinal ileus.

ANIMALS

Twenty cows 1-3 days postpartum (group 1) and 20 cows with gastrointestinal ileus (group 2).

METHODS

Observational cross-sectional study. Plasma potassium was measured by using an ion-sensitive electrode. Intracellular potassium was measured in erythrocytes and muscle tissue (muscle biopsy) by using inductively coupled plasma optical emission spectroscopy.

RESULTS

Cows of group 1 did not have hypokalemia. Overall cows with gastrointestinal ileus were hypokalemic (mean ± SD, 2.9 mmol/L ± 0.78), but potassium concentration in erythrocytes and muscle tissue was not lower than in postpartum cows. Intracellular potassium in erythrocytes varied very widely; group 1: 3497-10735 mg/kg (5559 ± 2002 mg/kg), group 2: 4139-21678 mg/kg (7473 ± 4034 mg/kg). Potassium in muscle tissue did not differ between group 1 (3356 ± 735 mg/kg wet weight) and group 2 (3407 ± 1069 mg/kg wet weight). No association between extracellular and intracellular potassium concentrations was detected.

CONCLUSIONS AND CLINICAL IMPORTANCE

That measurement of plasma potassium concentration is not sufficient to evaluate potassium metabolism of cows.

A Long Affair with Renal Tubules

This essay provides a summary of my professional activities. My interest in renal physiology started as a medical student in Vienna, when I became acquainted with Homer Smith's essays on kidney function. After moving to the United States in 1951, I was fortunate to be mentored by Robert Pitts, in whose Department of Physiology at Cornell Medical College in New York I was given early independence, intellectual stimulation, and the opportunity to pursue experiments on single renal tubules. The problem of how the nephron manages its myriad of transport functions has never lost its fascination for me, and I am profoundly grateful to the many colleagues at Cornell Medical College and at Yale University School of Medicine who shared my passion for the kidney.

Abnormalities of serum potassium concentration in dialysis-associated hyperglycemia and their correction with insulin: a unique clinical/physiologic exercise in internal potassium balance

The absence of significant losses of potassium in the urine makes dialysis-associated hyperglycemia (DH) a model for the study of the internal potassium balance. Studies of DH have revealed that hyperkalemia is frequent at presentation, insulin infusion is usually the only treatment required, and the magnitude of the decrease in serum potassium concentration (K(+)) during treatment of DH with insulin depends on the starting serum K(+) level, the decreases in serum glucose concentration and tonicity, and the increase in serum total carbon dioxide level. We present an analysis of these findings based on previously studied actions of insulin. Calculations of transcellular potassium shifts based on the combined effects of insulin-the increase in the electrical potential differences (hyperpolarization) of the cell membranes and the correction of the hyperglycemic intracellular dehydration through decrease in serum glucose concentration-produced quantitative predictions of the decrease in serum K(+) similar to the reported changes in serum K(+) during treatment of DH with insulin. The lessons from analyzing serum K(+) changes during treatment of DH with insulin are applicable to other conditions where internal potassium balance is called upon to protect serum K(+), such as the postprandial state. The main questions related to internal potassium balance in DH that await clarification include the structure and function of cell membrane potassium channels, the effect of insulin on these channels, and the mechanisms of feedforward potassium regulation.

Allometry (scaling) of blood components in mammals: connection with economy of energy?

Hematocrit (HCT), blood hemoglobin (HGB), and serum concentrations of 14 commonly measured serum constituents in mammals were extracted from 131 publications published within the last 35 years and then subjected to allometric study (Y = aWb, where Y is the characteristic studied, W is body mass, and b is the scaling exponent). HCT and HGB values decreased (b < 0; p < 0.001) with body mass (W), as did serum K+, glucose, triglycerides, and urea values. In contrast, serum total protein and creatinine values increased (b > 0; p < 0.02 and p < 0.001, respectively) with W. The associations of HCT, HGB, glucose, triglycerides, and urea values with W may be assumed to coincide with the well-known reduction of metabolic rate per unit mass with increasing W of mammals. The decrease in serum K+values (p < 0.001) has yet to be adequately explained. Despite the ratio of muscle mass and W being constant for large and small mammals, serum values of creatinine rose (b = 0.14; p < 0.0001) with W. This suggests increased phosphocreatine turnover in muscles with W, which in turn might be connected to the increased efficiency reported for leg muscles in larger animals and, conceivably, might affect the measurement of metabolic rate and hence its scaling in mammals.

Flow-activated transport events along the nephron

PURPOSE OF REVIEW

It is well recognized that an increase in glomerular filtration rate leads to an increase in fluid, Na+ and HCO3- absorption in proximal tubules; however, underlying mechanisms of this modulation have not been delineated. This review provides an update of flow-activated transport events along the nephron. Transporters, flow-sensors and secondary messengers that may modulate flow are also discussed.

RECENT FINDINGS

We have demonstrated that both NHE3 and H-ATPase activities are modulated by axial flow in mouse proximal tubules in vitro. Experimental data and modeling calculations provide strong evidence that brush-border microvilli function as flow sensors in the proximal tubule. In addition, AngII receptor localization is regulated by flow in cultured proximal tubule cells, and flow induces eNOS translocation in TAL.

SUMMARY

Flow-modulated NHE3 activity is the regulatory mechanism for GTB. It is independent of neuron and systemic hormonal regulation, but requires the intact actin cytoskeleton to transmit the signal of altered axial flow sensed by brush-border microvilli. Unanswered questions include the identification of specific signaling transduction mechanisms and second messengers in response to flow. Whether the Na+/2Cl-/K+-cotransporter in TAL is flow-activated, and whether a divalent cation, Ca2+ and Mg2+ transport, can be regulated by flow is unknown.