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Bai Z, Lu G, Yang H, Zhang D, Zhang Y, Sun Z. Seasonal variation of serum potassium in hemodialysis patients: myth or reality? A narrative review of literature. Ren Fail 2024; 46:2359640. [PMID: 38832483 DOI: 10.1080/0886022x.2024.2359640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/20/2024] [Indexed: 06/05/2024] Open
Abstract
Research has shown that patients undergoing hemodialysis experience seasonal variations in their serum potassium levels. There was inconsistent seasonal fluctuation in serum potassium levels among the hemodialysis population across different locations. In the form of narrative review for the first time, the article discusses the seasonal changes of serum potassium in this population and its potential reasons, this article demonstrates that it is primarily attributable to seasonal dietary potassium intake. However, existing studies have not quantified seasonal dietary potassium intake, so the results are still speculative. Furthermore, future research ought to further expound upon the clinical implications of seasonal variations in serum potassium levels among dialysis patients, as well as other influencing mechanisms such as the pathophysiological causes of these seasonal changes, particularly those pertaining to dietary, geographical, and regional factors. These findings contribute to a more thorough interpretation of laboratory results in hemodialysis patients and provide important guidance for their individualized dietary management.
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Affiliation(s)
- Zhe Bai
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, PR China
| | - Gang Lu
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, PR China
| | - Hengchao Yang
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, PR China
| | - Dahao Zhang
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, PR China
| | - Yuanyuan Zhang
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, PR China
| | - Zuoya Sun
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, PR China
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2
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Yuan W, Wang T, Yue W. The potassium puzzle: exploring the intriguing connection to albuminuria. Front Nutr 2024; 11:1375010. [PMID: 38860157 PMCID: PMC11163079 DOI: 10.3389/fnut.2024.1375010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/14/2024] [Indexed: 06/12/2024] Open
Abstract
Background Studies have revealed a relationship between dietary potassium intake and albuminuria, despite the fact that the human body needs a lot of potassium. Our study concentrated on the link between dietary potassium intake and albuminuria. Methods This study used subgroup analysis and weighted multivariate regression analysis. Data from the National Health and Nutrition Examination Survey (NHANES) were examined to determine the urinary albumin-to-creatinine ratio (ACR) and participant age (20 years or older). ACR >30 mg/g was the threshold for albuminuria. Results 7,564 individuals in all were included in the study. The link between the two was significant in both our original model (OR = 0.99; 95% CI, 0.98-0.99, p < 0.0001) and the minimum adjusted model (OR = 0.99; 95% CI, 0.98-0.99, p < 0.0001). A fully adjusted model did not change the significance of the negative correlation between potassium consumption and albuminuria (OR = 0.99; 95% CI, 0.98-1.00, p = 0.0005), indicating that each unit increase in potassium intake was related with a 1% decrease in the chance of developing albuminuria. The negative correlation between potassium intake and albuminuria was not significantly influenced by sex, age, BMI, hypertension, diabetes, or smoking, according to interaction tests (p for interaction >0.05). Conclusion Reduced risk of albuminuria was linked to higher dietary potassium intake. The particular mechanism linking the two still has to be explained by several inventive and prospective studies.
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Affiliation(s)
- Weihua Yuan
- School of Acupuncture-Moxibustion and Tuina, Anhui University of Chinese Medicine, Hefei, China
| | - Tiancheng Wang
- School of Integrated Traditional and Western Medicine, Anhui University of Chinese Medicine, Hefei, China
- Yancheng TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, China
| | - Wei Yue
- Yancheng TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, China
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3
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Yasin F, Khraim F, Santos M, Forgrave D, Hamad A. Factors influencing self-care management in adult hemodialysis patients: An integrative review. Qatar Med J 2024; 2024:12. [PMID: 38654818 PMCID: PMC11037095 DOI: 10.5339/qmj.2024.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/04/2024] [Indexed: 04/26/2024] Open
Abstract
Background: End-stage renal disease (ESRD) poses a significant health challenge, with hemodialysis (HD) being the most prevalent therapy. Patients undergoing HD must comply with a strict therapeutic regimen, including dietary control, fluid restriction, and medication adherence. Successful disease management and improved outcomes rely on patients' involvement and participation in their care. Aim: To identify the factors that hinder or facilitate self-care management (SCM) in HD patients. Methodology: This review followed Whittemore and Knafl's integrative review framework. A comprehensive literature search of articles published between 2017 and 2022 was conducted in CINAHL, Medline, and PubMed using the keywords end-stage renal disease, hemodialysis, self-care management, self-care, and self-management. This search yielded 21 suitable articles for review. Results: SCM is influenced by three main factors: facilitators, barriers, and outcomes. Facilitators of SCM include self-care management interventions, patient knowledge, socio-demographic factors, family support, healthcare professionals, peer support, and psychological factors. Barriers encompass psychological and physical conditions. Outcomes include both physiological and psychological aspects. Conclusion: Understanding the factors influencing SCM in HD patients is vital for developing reliable and effective self-care strategies and interventions to enhance both physical and psychological outcomes.
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Affiliation(s)
| | - Fadi Khraim
- Faculty of Nursing, Qatar University, Doha, Qatar
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Sriperumbuduri S, Welling P, Ruzicka M, Hundemer GL, Hiremath S. Potassium and Hypertension: A State-of-the-Art Review. Am J Hypertens 2024; 37:91-100. [PMID: 37772757 DOI: 10.1093/ajh/hpad094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 09/30/2023] Open
Abstract
Hypertension is the single most important and modifiable risk factor for cardiovascular morbidity and mortality worldwide. Non pharmacologic interventions, in particular dietary modifications have been established to decrease blood pressure (BP) and hypertension related adverse cardiovascular events. Among those dietary modifications, sodium intake restriction dominates guidelines from professional organizations and has garnered the greatest attention from the mainstream media. Despite guidelines and media exhortations, dietary sodium intake globally has not noticeably changed over recent decades. Meanwhile, increasing dietary potassium intake has remained on the sidelines, despite similar BP-lowering effects. New research reveals a potential mechanism of action, with the elucidation of its effect on natriuresis via the potassium switch effect. Additionally, potassium-substituted salt has been shown to not only reduce BP, but also reduce the risk for stroke and cardiovascular mortality. With these data, we argue that the focus on dietary modification should shift from a sodium-focused to a sodium- and potassium-focused approach with an emphasis on intervention strategies which can easily be implemented into clinical practice.
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Affiliation(s)
- Sriram Sriperumbuduri
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Paul Welling
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada
| | - Gregory L Hundemer
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada
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5
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Chung MK, Kim DH, Park JI, Lee S, Park HC, Kim K, Kang YS, Ko K, Kim J, Koo H, Kim HJ, Cha JJ, Kwon YE, Kim JH. Adaptive Nutrition Intervention Stabilizes Serum Phosphorus Levels in Hemodialysis Patients: A Multicenter Decentralized Clinical Trial Using Real-World Data. J Ren Nutr 2024; 34:47-57. [PMID: 37586668 DOI: 10.1053/j.jrn.2023.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/02/2023] [Accepted: 07/21/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE This study aims to evaluate the effect of an adaptive nutritional and educational intervention for patients on hemodialysis (HD) in a routine care setting, using real-world data from electronic health records. METHODS Decentralized clinical trial of seven HD facilities recruited patients who have been on HD for over 3 months (N = 153) for an 8-week adaptive intervention protocol. Patients were divided into four groups: (1) control (2) education intervention (3) meal intervention (4) education and meal interventions. Educational contents were digitally delivered via mobile phones and premade meals tailored on laboratory findings were home-delivered. Changes in serum electrolytes and malnutrition inflammation score (MIS) were analyzed. RESULTS Meal intervention statistically significantly stabilized serum phosphorus level (β = -0.81 mg/dL, 95% confidence interval = [-1.40, -0.22]) at week 8, with increased likelihood of being within target serum value range (odds ratio = 1.21, 95% confidence interval = [1.04, 1.40]). Meal group showed better nutritional status (MIS = 3.65) than the education group (MIS = 5.10) at week 8 (adjusted p < .05). No significant changes were observed in serum potassium level, depression, and self-efficacy. CONCLUSION It was demonstrated that an adaptive meal intervention in a real-world care setting may benefit serum phosphorus control and nutritional status of patients on HD, without negative effect on depression levels or self-efficacy. More work is needed to develop an effective educational intervention.
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Affiliation(s)
- Moon Kyung Chung
- Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Do Hyoung Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ji In Park
- Division of Nephrology, Department of Internal Medicine, Kangwon National University Hospital, Gangwon-do, Republic of Korea
| | - Sunhwa Lee
- Division of Nephrology, Department of Internal Medicine, Kangwon National University Hospital, Gangwon-do, Republic of Korea
| | - Hayne Cho Park
- Division of Nephrology, Department of Internal Medicine, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Kyungmin Kim
- Division of Nephrology, Department of Internal Medicine, Daejeon Eulji University Hospital, Daejeon, Republic of Korea
| | - Young Sun Kang
- Division of Nephrology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Kangji Ko
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jieun Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hoseok Koo
- Division of Nephrology, Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | | | - Jin Joo Cha
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, Republic of Korea.
| | - Young Eun Kwon
- Division of Nephrology, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang-si, Gyeonggi-do, Republic of Korea.
| | - Ju Han Kim
- Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea.
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MacLaughlin HL, McAuley E, Fry J, Pacheco E, Moran N, Morgan K, McGuire L, Conley M, Johnson DW, Ratanjee SK, Mason B. Re-Thinking Hyperkalaemia Management in Chronic Kidney Disease-Beyond Food Tables and Nutrition Myths: An Evidence-Based Practice Review. Nutrients 2023; 16:3. [PMID: 38201833 PMCID: PMC10780359 DOI: 10.3390/nu16010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Potassium dysregulation can be life-threatening. Dietary potassium modification is a management strategy for hyperkalaemia. However, a 2017 review for clinical guidelines found no trials evaluating dietary restriction for managing hyperkalaemia in chronic kidney disease (CKD). Evidence regarding dietary hyperkalaemia management was reviewed and practice recommendations disseminated. A literature search using terms for potassium, hyperkalaemia, and CKD was undertaken from 2018 to October 2022. Researchers extracted data, discussed findings, and formulated practice recommendations. A consumer resource, a clinician education webinar, and workplace education sessions were developed. Eighteen studies were included. Observational studies found no association between dietary and serum potassium in CKD populations. In two studies, 40-60 mmol increases in dietary/supplemental potassium increased serum potassium by 0.2-0.4 mmol/L. No studies examined lowering dietary potassium as a therapeutic treatment for hyperkalaemia. Healthy dietary patterns were associated with improved outcomes and may predict lower serum potassium, as dietary co-factors may support potassium shifts intracellularly, and increase excretion through the bowel. The resource recommended limiting potassium additives, large servings of meat and milk, and including high-fibre foods: wholegrains, fruits, and vegetables. In seven months, the resource received > 3300 views and the webinar > 290 views. This review highlights the need for prompt review of consumer resources, hospital diets, and health professionals' knowledge.
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Affiliation(s)
- Helen L. MacLaughlin
- Nutrition Research Collaborative, Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia (E.P.)
- School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Erynn McAuley
- Nutrition Research Collaborative, Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia (E.P.)
- School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Jessica Fry
- Nutrition Research Collaborative, Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia (E.P.)
| | - Elissa Pacheco
- Nutrition Research Collaborative, Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia (E.P.)
| | - Natalie Moran
- Nutrition Research Collaborative, Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia (E.P.)
| | - Kate Morgan
- Nutrition Research Collaborative, Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia (E.P.)
| | - Lisa McGuire
- Nutrition Research Collaborative, Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia (E.P.)
| | - Marguerite Conley
- School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Nutrition and Dietetics Department, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| | - David W. Johnson
- Department of Kidney and Transplant Services, Division of Medicine, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, St. Lucia, QLD 4067, Australia
| | - Sharad K. Ratanjee
- Kidney Health Service, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia
| | - Belinda Mason
- Nutrition Research Collaborative, Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia (E.P.)
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7
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Sun Z, Jiao J, Lu G, Liu R, Li Z, Sun Y, Chen Z. Overview of research progress on the association of dietary potassium intake with serum potassium and survival in hemodialysis patients, does dietary potassium restriction really benefit hemodialysis patients? Front Endocrinol (Lausanne) 2023; 14:1285929. [PMID: 38093955 PMCID: PMC10716210 DOI: 10.3389/fendo.2023.1285929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
For the general population, increasing potassium intake can reduce the incidence of cardiovascular and cerebrovascular diseases. However, since hyperkalemia is a common and life-threatening complication in maintenance hemodialysis patients, which can increase the risk of malignant arrhythmia and sudden death, the current mainstream of management for hemodialysis patients is dietary potassium restriction in order to prevent hyperkalemia. Hemodialysis patients are usually advised to reduce dietary potassium intake and limit potassium-rich fruits and vegetables, but there is limited evidence to support this approach can reduce mortality and improve quality of life. There is still no consistent conclusion on the association between dietary potassium intake and serum potassium and survival in hemodialysis patients. According to the current small observational studies, there was little or even no association between dietary potassium intake and serum potassium in hemodialysis patients when assurance of adequate dialysis and specific dietary patterns (such as the plant-based diet mentioned in the article) are being followed, and excessive dietary potassium restriction may not benefit the survival of hemodialysis patients. Additionally, when assessing the effect of diet on serum potassium, researchers should not only focus on the potassium content of foods, but also consider the type of food and the content of other nutrients. However, more large-scale, multi-center clinical trials are required to provide high-quality evidence support. Besides, further research is also needed to determine the optimal daily potassium intake and beneficial dietary patterns for hemodialysis patients.
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Affiliation(s)
- Zuoya Sun
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jian Jiao
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Jinan, Shandong, China
| | - Gang Lu
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ruihong Liu
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zhuo Li
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yi Sun
- Department of Nephrology, Beijing Huairou Hospital of University of Chinese Academy of Sciences, Beijing, China
| | - Zhiyuan Chen
- Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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8
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Wang AYM, Mallamaci F, Zoccali C. What is central to renal nutrition: protein or sodium intake? Clin Kidney J 2023; 16:1824-1833. [PMID: 37915942 PMCID: PMC10616450 DOI: 10.1093/ckj/sfad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Indexed: 11/03/2023] Open
Abstract
Historically, nutrition intervention has been primarily focused on limiting kidney injury, reducing generation of uraemic metabolites, as well as maintaining nutrition status and preventing protein-energy wasting in patients with chronic kidney disease (CKD). This forms an important rationale for prescribing restricted protein diet and restricted salt diet in patients with CKD. However, evidence supporting a specific protein intake threshold or salt intake threshold remains far from compelling. Some international or national guidelines organizations have provided strong or 'level 1' recommendations for restricted protein diet and restricted salt diet in CKD. However, it is uncertain whether salt or protein restriction plays a more central role in renal nutrition management. A key challenge in successful implementation or wide acceptance of a restricted protein diet and a restricted salt diet is patients' long-term dietary adherence. These challenges also explain the practical difficulties in conducting randomized trials that evaluate the impact of dietary therapy on patients' outcomes. It is increasingly recognized that successful implementation of a restricted dietary prescription or nutrition intervention requires a highly personalized, holistic care approach with support and input from a dedicated multidisciplinary team that provides regular support, counselling and close monitoring of patients. With the advent of novel drug therapies for CKD management such as sodium-glucose cotransporter-2 inhibitors or non-steroidal mineralocorticoid receptor antagonist, it is uncertain whether restricted protein diet and restricted salt diet may still be necessary and have incremental benefits. Powered randomized controlled trials with novel design are clearly indicated to inform clinical practice on recommended dietary protein and salt intake threshold for CKD in this new era.
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Affiliation(s)
- Angela Yee-Moon Wang
- University Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China
| | - Francesca Mallamaci
- Nefrologia and CNR Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Carmine Zoccali
- Renal Research Institute, New York, USA
- Institute of Molecular Biology and Genetics (Biogem), Ariano Irpino, Italy
- Associazione Ipertensione Nefrologia Trapianto Renal (IPNET), Nefrologia, Grande Ospedale Metropolitano, Reggio Calabria, Italy
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9
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Sumida K, Biruete A, Kistler BM, Khor BH, Ebrahim Z, Giannini R, Sussman-Dabach EJ, Avesani CM, Chan M, Lambert K, Yee-Moon Wang A, Clegg DJ, Burrowes JD, Palmer BF, Carrero JJ, Kovesdy CP. New Insights Into Dietary Approaches to Potassium Management in Chronic Kidney Disease. J Ren Nutr 2023; 33:S6-S12. [PMID: 37610407 PMCID: PMC10872890 DOI: 10.1053/j.jrn.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/07/2022] [Accepted: 12/13/2022] [Indexed: 08/24/2023] Open
Abstract
Potassium disorders are one of the most common electrolyte abnormalities in patients with chronic kidney disease (CKD), contributing to poor clinical outcomes. Maintaining serum potassium levels within the physiologically normal range is critically important in these patients. Dietary potassium restriction has long been considered a core strategy for the management of chronic hyperkalemia in patients with CKD. However, this has been challenged by recent evidence suggesting a paradigm shift toward fostering more liberalized, plant-based dietary patterns. The advent of novel potassium binders and an improved understanding of gastrointestinal processes involved in potassium homeostasis (e.g., gastrointestinal potassium wasting) may facilitate a paradigm shift and incorporation of heart-healthy potassium-enriched food sources. Nevertheless, uncertainty regarding the risk-benefit of plant-based diets in the context of potassium management in CKD remains, requiring well-designed clinical trials to determine the efficacy of dietary potassium manipulation toward improvement of clinical outcomes in patients with CKD.
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Affiliation(s)
- Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
| | - Annabel Biruete
- Department of Nutrition and Dietetics, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana; Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Brandon M Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Department of Nutrition and Health Science, Ball State University, Muncie, Indiana
| | - Ban-Hock Khor
- Faculty of Food Science and Nutrition, University Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Zarina Ebrahim
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Rossella Giannini
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy
| | - Elizabeth J Sussman-Dabach
- Department of Family and Consumer Sciences, California State University, Northridge, Northridge, California
| | - Carla Maria Avesani
- Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Maria Chan
- Departments of Nutrition and Dietetics and Renal Medicine, The St. George Hospital, Kogarah, New South Wales, Australia
| | - Kelly Lambert
- Faculty of Science, Medicine and Health, School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Deborah J Clegg
- Department of Internal Medicine, Paul Foster School of Medicine, Texas Tech Medical Center, El Paso, Texas
| | - Jerrilynn D Burrowes
- Department of Health Sciences and Administration, Program in Nutrition and Dietetics, Long Island University-Post, Greenvale, New York
| | - Biff F Palmer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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10
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Babich JS, Dupuis L, Kalantar-Zadeh K, Joshi S. Hyperkalemia and Plant-Based Diets in Chronic Kidney Disease. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:487-495. [PMID: 38453264 DOI: 10.1053/j.akdh.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 03/09/2024]
Abstract
Traditional dietary guidelines for patients with kidney disease recommend restriction of plant foods due to concerns about hyperkalemia and associated adverse events. Studies conducted over several decades have shown that the basis for these guidelines does not match the evidence. Serum potassium levels can be elevated in patients with reduced kidney function after consumption of foods with potassium-based additives or with highly concentrated potassium content such as juices, dried fruit, or purees. However, plant foods may have certain qualities that may blunt potassium retention including their alkalinizing effects, the lack of bioavailable potassium, and the impact of dietary fiber in organic plant foods on colonic potassium excretion. Furthermore, there are many benefits of plant foods that patients with kidney disease may be missing by excluding them from their diets by recommending the historical low-potassium "renal diet." Revised dietary recommendations for kidney health may encourage patient-centered kidney recipes that revolve around plant foods and do not restrict them.
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Affiliation(s)
- John Sebastian Babich
- SUNY Upstate Medical University Norton College of Medicine, Syracuse, NY; Volunteer Services, NYC Health + Hospitals/Bellevue, New York, NY
| | - Léonie Dupuis
- University of Central Florida College of Medicine, Orlando, FL
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Shivam Joshi
- Department of Veteran Affairs, Orlando, FL; Department of Medicine, New York University Grossman School of Medicine, New York, NY.
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11
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Pan J, Xu X, Wang Z, Ma T, Dong J. Dietary Potassium and Clinical Outcomes among Patients on Peritoneal Dialysis. Nutrients 2023; 15:4271. [PMID: 37836555 PMCID: PMC10574508 DOI: 10.3390/nu15194271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The association between dietary potassium and clinical prognosis is unclear in patients with chronic kidney disease (CKD). Here, we explored the association between dietary potassium intake and all-cause and cardiovascular (CV) mortality in peritoneal dialysis (PD) patients. METHODS Here, we present a retrospective analysis of a prospective study. Patients that began incident PD in our center between 1 October 2002 and 31 August 2014 were screened. We recorded all demographic and clinical data at baseline. Repeated measurements were recorded at regular intervals to calculate time-averaged values. Spline regression analysis and Cox proportional regression models were used to evaluate the relationship between dietary potassium and mortality. RESULTS We followed 881 PD patients for 45.0 (21.5, 80.0) months; 467 patients died, of which 189 (40.5%) died of CV death and 93 were still on PD treatment. Compared with those who had baseline dietary potassium ≥1200 mg/d, the majority of patients with lower dietary potassium were female, older, or poorly educated. They were prone to have poorer nutritional status, CV disease, and diabetes mellitus (p < 0.05). In the unadjusted analysis, both baseline and time-averaged dietary potassium <1200 mg/d predicted higher all-cause and CV mortality (p < 0.001~0.01). After adjusting for demographic and laboratory data, the association between potassium intake and all-cause and CV mortality weakened, which even disappeared after additional adjustment for dietary fiber, protein, and energy intake. CONCLUSIONS Dietary potassium in PD patients was not independently associated with all-cause and CV mortality.
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Affiliation(s)
- Jinru Pan
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100871, China; (J.P.); (X.X.); (Z.W.); (T.M.)
- Key Laboratory of Renal Disease, Ministry of Health, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing 100034, China
| | - Xiao Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100871, China; (J.P.); (X.X.); (Z.W.); (T.M.)
- Key Laboratory of Renal Disease, Ministry of Health, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing 100034, China
| | - Zi Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100871, China; (J.P.); (X.X.); (Z.W.); (T.M.)
- Key Laboratory of Renal Disease, Ministry of Health, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing 100034, China
| | - Tiantian Ma
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100871, China; (J.P.); (X.X.); (Z.W.); (T.M.)
- Key Laboratory of Renal Disease, Ministry of Health, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing 100034, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100871, China; (J.P.); (X.X.); (Z.W.); (T.M.)
- Key Laboratory of Renal Disease, Ministry of Health, Beijing 100034, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing 100034, China
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12
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Massicotte-Azarniouch D, Canney M, Sood MM, Hundemer GL. Managing Hyperkalemia in the Modern Era: A Case-Based Approach. Kidney Int Rep 2023; 8:1290-1300. [PMID: 37441466 PMCID: PMC10334407 DOI: 10.1016/j.ekir.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 07/15/2023] Open
Abstract
The last decade has seen tremendous advances in the prevention and treatment of recurrent hyperkalemia. In this narrative review, we aim to highlight contemporary data on key areas in the epidemiology and management of hyperkalemia. Focusing on drug-induced hyperkalemia (the implications of renin-angiotensin-aldosterone system inhibitors [RAASi] discontinuation and the role of mineralocorticoid receptor antagonists), newer concurrent therapies that modify potassium handling (sodium-glucose transporter 2 inhibitors [SGLT2i]), the introduction of new treatment agents (oral potassium binding agents), and the controversial role of dietary potassium restriction, we apply recent research findings and review the evidence in a case-based format.
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Affiliation(s)
- David Massicotte-Azarniouch
- Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mark Canney
- Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Manish M. Sood
- Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gregory L. Hundemer
- Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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13
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Ito Y, Sun T, Tanaka H, Yamaguchi M, Kinashi H, Sakata F, Kunoki S, Sakai Y, Ishimoto T. Tissue Sodium Accumulation Induces Organ Inflammation and Injury in Chronic Kidney Disease. Int J Mol Sci 2023; 24:ijms24098329. [PMID: 37176037 PMCID: PMC10179540 DOI: 10.3390/ijms24098329] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
High salt intake is a primary cause of over-hydration in chronic kidney disease (CKD) patients. Inflammatory markers are predictors of CKD mortality; however, the pathogenesis of inflammation remains unclear. Sodium storage in tissues has recently emerged as an issue of concern. The binding of sodium to tissue glycosaminoglycans and its subsequent release regulates local tonicity. Many cell types express tonicity-responsive enhancer-binding protein (TonEBP), which is activated in a tonicity-dependent or tonicity-independent manner. Macrophage infiltration was observed in the heart, peritoneal wall, and para-aortic tissues in salt-loading subtotal nephrectomized mice, whereas macrophages were not prominent in tap water-loaded subtotal nephrectomized mice. TonEBP was increased in the heart and peritoneal wall, leading to the upregulation of inflammatory mediators associated with cardiac fibrosis and peritoneal membrane dysfunction, respectively. Reducing salt loading by a diuretic treatment or changing to tap water attenuated macrophage infiltration, TonEBP expression, and inflammatory marker expression. The role of TonEBP may be crucial during the cardiac fibrosis and peritoneal deterioration processes induced by sodium overload. Anti-interleukin-6 therapy improved cardiac inflammation and fibrosis and peritoneal membrane dysfunction. Further studies are necessary to establish a strategy to regulate organ dysfunction induced by TonEBP activation in CKD patients.
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Affiliation(s)
- Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Ting Sun
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Hiroya Tanaka
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Makoto Yamaguchi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Hiroshi Kinashi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
| | - Fumiko Sakata
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya 464-0813, Japan
| | - Shunnosuke Kunoki
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
- Department of Nephrology, Nippon Medical School, Tokyo 113-8602, Japan
| | - Yukinao Sakai
- Department of Nephrology, Nippon Medical School, Tokyo 113-8602, Japan
| | - Takuji Ishimoto
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
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14
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McCormick JA, Topf J, Tomacruz ID, Grimm PR. A New Understanding of Potassium's Influence Upon Human Health and Renal Physiology. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:137-147. [PMID: 36868729 DOI: 10.1053/j.akdh.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 03/05/2023]
Abstract
Potassium channels are expressed in virtually all cell types, and their activity is the dominant determinant of cellular membrane potential. As such, potassium flux is a key regulator of many cellular processes including the regulation of action potentials in excitable cells. Subtle changes in extracellular potassium can initiate signaling processes vital for survival (insulin signaling) while more extreme and chronic changes may lead to pathological states (acid-base disturbances and cardiac arrhythmia). While many factors acutely influence extracellular potassium levels, it is principally the role of the kidneys to maintain potassium balance by matching urinary excretion with dietary intake. When this balance is disrupted, human health is negatively impacted. In this review, we discuss evolving views of dietary potassium intake as means of preventing and mitigating diseases. We also provide an update on a molecular pathway called the potassium switch, a mechanism by which extracellular potassium regulates distal nephron sodium reabsorption. Finally, we review recent literature describing how several popular therapeutics influence potassium homeostasis.
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Affiliation(s)
- James A McCormick
- Division of Nephrology and Hypertension, Oregon Health and Science University, Portland, OR
| | - Joel Topf
- Department of Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI
| | | | - P Richard Grimm
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD.
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15
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Joshi S, Kalantar-Zadeh K, Chauveau P, Carrero JJ. Risks and Benefits of Different Dietary Patterns in CKD. Am J Kidney Dis 2023; 81:352-360. [PMID: 36682903 DOI: 10.1053/j.ajkd.2022.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/08/2022] [Indexed: 01/21/2023]
Abstract
Food has the potential to cause and exacerbate many lifestyle diseases. Or it can be used to prevent and treat illnesses like primary hypertension, the metabolic syndrome, and insulin resistance. In parallel, there is also a growing body of evidence of the role of diet in the treatment of kidney disease and its ensuing complications. Popular diets for this purpose have included low-carbohydrate diets, including the ketogenic diet, and higher carbohydrate diets like Mediterranean diets and other plant-based dietary patterns. Low-carbohydrate diets have not shown harm in patients with kidney disease and may benefit a select few. Mediterranean diets have an established record of cardioprotective benefits but also may be beneficial for the kidney. Intermittent fasting has benefits for metabolic health, but limited research exists on the risk or benefit for patients with kidney disease. Plant-based diets, especially those that are lower in protein, may slow kidney disease progression, mitigate uremia, and delay dialysis initiation. Although each dietary pattern has its unique pros and cons, most healthful dietary patterns favor the inclusion of whole, unprocessed foods, preferably from plant-based sources. In this perspective, we discuss the risks and benefits of major popular diets to help guide health care professionals in treating patients with kidney disease.
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Affiliation(s)
- Shivam Joshi
- Department of Medicine, Grossman School of Medicine, New York University, New York, New York; Department of Medicine, NYC Health + Hospitals/Bellevue, New York, New York.
| | | | | | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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16
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Tian R, Li R, Zhou X. Recent Progresses in Non-Dialysis Chronic Kidney Disease Patients with Hyperkalemia: Outcomes and Therapeutic Strategies. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020353. [PMID: 36837554 PMCID: PMC9966910 DOI: 10.3390/medicina59020353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
Chronic kidney disease (CKD) affects about 10% of the world's population. Hyperkalemia is a life-threatening complication in patients with CKD, as it is associated with adverse cardiovascular and kidney outcomes. There are still many challenges and questions to address to improve the currently available therapeutic strategies to treat hyperkalemia, such as how to approach the emergency management of hyperkalemia. In recent years, in addition to novel oral potassium binders, great progress has been made in the application of novel kidney protective strategies, such as mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors (SGLT2i) in hyperkalemia therapy. This review will discuss the recent advances from clinical trials in the effective management of hyperkalemia in non-dialysis CKD patients, enhancing the knowledge of physicians and internists concerning these newer agents and providing a helpful reference for clinical practice.
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Affiliation(s)
- Ruixue Tian
- The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan 030012, China
| | - Rongshan Li
- Department of Nephrology, Shanxi Provincial People’s Hospital, The Fifth Clinical Medical College of Shanxi Medical University, Shanxi Kidney Disease Institute, 29 Shuang Ta East Street, Taiyuan 030012, China
- Correspondence: (R.L.); (X.Z.)
| | - Xiaoshuang Zhou
- Department of Nephrology, Shanxi Provincial People’s Hospital, The Fifth Clinical Medical College of Shanxi Medical University, Shanxi Kidney Disease Institute, 29 Shuang Ta East Street, Taiyuan 030012, China
- Correspondence: (R.L.); (X.Z.)
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17
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Chu N, Chan TY, Chu YK, Ling J, He J, Leung K, Ma RCW, Chan JCN, Chow E. Higher dietary magnesium and potassium intake are associated with lower body fat in people with impaired glucose tolerance. Front Nutr 2023; 10:1169705. [PMID: 37139459 PMCID: PMC10150130 DOI: 10.3389/fnut.2023.1169705] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/22/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Obesity and diabetes are public health concerns worldwide, but few studies have examined the habitual intake of minerals on body composition in people with prediabetes. Methods In this prospective cross-sectional study, 155 Chinese subjects with IGT [median age: 59 (53-62) years, 58% female] had an assessment of body composition including body fat percentage, oral glucose tolerance tests (OGTT), Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and 3-day food records from nutritional programme analysis. Results Dietary intake of minerals was negatively correlated with body fat. People with obesity had the lowest daily consumption of iron median (IQR) 10.3 (6.9-13.3) mg, magnesium 224 (181-282) mg, and potassium 1973 (1563-2,357) mg when compared to overweight [10.5 (8.0-14.5) mg, 273 (221-335) mg, and 2,204 (1720-2,650) mg] and normal weight individuals [13.2 (10.0-18.6) mg, 313 (243-368) mg, and 2,295 (1833-3,037) mg] (p = 0.008, <0.0001, and 0.013 respectively). Amongst targeted minerals, higher dietary magnesium and potassium intake remained significantly associated with lower body fat after the adjustment of age, gender, macronutrients, fibre, and physical activity. Conclusion Dietary magnesium and potassium intake may be associated with lower body fat in people with impaired glucose tolerance. Inadequate dietary mineral intake may play contribute to obesity and metabolic disorders independent of macronutrients and fibre consumption.
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Affiliation(s)
- Natural Chu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China
- *Correspondence: Natural Chu,
| | - Tsz Yeung Chan
- Department of Life Sciences, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China
| | - Yuen Kiu Chu
- Department of Life Sciences, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China
| | - James Ling
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China
| | - Jie He
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China
| | - Kathy Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China
| | - Ronald C. W. Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China
| | - Juliana C. N. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China
- Elaine Chow,
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18
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Larivée NL, Michaud JB, More KM, Wilson JA, Tennankore KK. Hyperkalemia: Prevalence, Predictors and Emerging Treatments. Cardiol Ther 2022; 12:35-63. [PMID: 36503972 PMCID: PMC9742042 DOI: 10.1007/s40119-022-00289-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/02/2022] [Indexed: 12/14/2022] Open
Abstract
It is well established that an elevated potassium level (hyperkalemia) is associated with a risk of adverse events including morbidity, mortality and healthcare system cost. Hyperkalemia is commonly encountered in many chronic conditions including kidney disease, diabetes and heart failure. Furthermore, hyperkalemia may result from the use of renin-angiotensin-aldosterone system inhibitors (RAASi), which are disease-modifying treatments for these conditions. Therefore, balancing the benefits of optimizing treatment with RAASi while mitigating hyperkalemia is crucial to ensure patients are optimally treated. In this review, we will briefly discuss the definition, causes, epidemiology and consequences of hyperkalemia. The majority of the review will be focused on management of hyperkalemia in the acute and chronic setting, emphasizing contemporary approaches and evolving data on the relevance of dietary restriction and the use of novel potassium binders.
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Affiliation(s)
- Natasha L. Larivée
- Dalhousie University and Nova Scotia Health, 5820 University Avenue, Halifax, NS B3H 1V8 Canada ,Dalhousie University and Horizon Health Network, Saint John, NB Canada
| | - Jacob B. Michaud
- Dalhousie University and Nova Scotia Health, 5820 University Avenue, Halifax, NS B3H 1V8 Canada ,Dalhousie University and Horizon Health Network, Saint John, NB Canada
| | - Keigan M. More
- Dalhousie University and Nova Scotia Health, 5820 University Avenue, Halifax, NS B3H 1V8 Canada
| | - Jo-Anne Wilson
- Dalhousie University and Nova Scotia Health, 5820 University Avenue, Halifax, NS B3H 1V8 Canada
| | - Karthik K. Tennankore
- Dalhousie University and Nova Scotia Health, 5820 University Avenue, Halifax, NS B3H 1V8 Canada
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19
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Kwon YJ, Lee HS, Park G, Lee JW. Association between dietary sodium, potassium, and the sodium-to-potassium ratio and mortality: A 10-year analysis. Front Nutr 2022; 9:1053585. [PMID: 36438773 PMCID: PMC9691953 DOI: 10.3389/fnut.2022.1053585] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/25/2022] [Indexed: 10/05/2023] Open
Abstract
There is inconclusive evidence of the association between dietary sodium, potassium, and the sodium-to-potassium ratio and all-cause and cardiovascular disease mortality. To investigate the association between dietary sodium, potassium, and the sodium-to-potassium ratio and all-cause and cardiovascular disease mortality risks. Data from 143,050 adult participants were analyzed from prospective 10-year community-based cohort analysis. Dietary sodium, potassium, and the sodium-to-potassium ratio at baseline were assessed by a food frequency questionnaire. In Cox proportional hazards regression models, the association between dietary sodium, potassium, and their ratio and all-cause and cardiovascular disease mortality was estimated using hazard ratios and 95% confidence intervals, and their predictive ability as mortality predictors was evaluated using Harrell's c-index. During the mean (range) 10.1 (0.2-15.9) years of follow-up, 5,436 participants died, of whom 985 died of cardiovascular causes. After adjustment for age, sex, body mass index, alcohol intake, smoking, regular exercise, total calorie intake, dyslipidemia, hypertension, diabetes, chronic kidney diseases (CKDs), and potassium or sodium intake, respectively, sodium intake was unassociated with all-cause mortality whereas potassium intake was significantly associated inversely with all-cause (Quintile-5 vs. Quintile-1, hazard ratio, 95% confidence interval, 1.09, 0.97-1.22, and 0.79, 0.69-0.91, respectively). The sodium-to-potassium ratio was not significantly associated with all-cause mortality in the adjusted model, and similar trends were observed for cardiovascular disease mortality.
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Affiliation(s)
- Yu-Jin Kwon
- Department of Family Medicine, Yonsei University College of Medicine, Yongin Severance Hospital, Seoul, Gyeonggi, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, South Korea
| | - Goeun Park
- Biomedical Statistics Center, Samsung Medical Center, Research Institute for Future Medicine, Seoul, South Korea
| | - Ji-Won Lee
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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20
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Bernier-Jean A, Drüeke TB. Potassium intake in patients with chronic kidney disease. Kidney Int 2022; 102:706-707. [PMID: 36150765 DOI: 10.1016/j.kint.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/28/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Amélie Bernier-Jean
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Nord-de-l'île-de-Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Tilman B Drüeke
- Centre de recherche en épidémiologie et santé des populations (CESP), INSERM UMRS 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France.
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21
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De Nicola L, Garofalo C, Borrelli S, Minutolo R. Recommendations on nutritional intake of potassium in CKD: it's now time to be more flexible! Kidney Int 2022; 102:700-703. [PMID: 36150763 DOI: 10.1016/j.kint.2022.04.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/02/2022] [Accepted: 04/28/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Luca De Nicola
- Nephrology Dialysis Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
| | - Carlo Garofalo
- Nephrology Dialysis Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Silvio Borrelli
- Nephrology Dialysis Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Roberto Minutolo
- Nephrology Dialysis Unit, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
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22
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Burton JO, Coats AJ, Kovesdy CP, Palmer BF, Piña IL, Rosano G, Sood MM, Zieroth S. An international Delphi consensus regarding best practice recommendations for hyperkalaemia across the cardiorenal spectrum. Eur J Heart Fail 2022; 24:1467-1477. [PMID: 35791065 PMCID: PMC9804940 DOI: 10.1002/ejhf.2612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/05/2022] [Indexed: 01/09/2023] Open
Abstract
AIMS Renin-angiotensin-aldosterone system inhibitors (RAASi) are guideline-recommended therapy for individuals with cardiorenal disease. They are associated with increased risk of hyperkalaemia, a common and life-threatening disorder for this population. RAASi-induced hyperkalaemia often leads to dose reduction or discontinuation, reducing cardiorenal protection. Guideline recommendations differ between specialties for the clinical management of hyperkalaemia. Using a modified Delphi method, we developed consensus recommendations for optimal management of hyperkalaemia in adults with cardiorenal disease. METHODS AND RESULTS An international steering group of cardiologists and nephrologists developed 39 statements regarding hyperkalaemia care, including risk factors and risk stratification, prevention, correction, and cross-specialty coordination. Consensus was determined by agreement on an online questionnaire administered to cardiorenal specialists across Europe and North America. The threshold for consensus agreement was established a priori by the steering group at 67%. Across November 2021, 520 responses were received from Canada (n = 50), France (n = 50), Germany (n = 54), Italy (n = 58), Spain (n = 57), the UK (n = 49), and the US (n = 202); 268 from cardiologists and 252 from nephrologists. Twenty-nine statements attained very high agreement (≥90%) and 10 attained high agreement (≥67%-<90%), with strong alignment between cardiologists and nephrologists. CONCLUSION A high degree of consensus regarding hyperkalaemia evaluation and management exists among healthcare professionals. Based on high levels of agreement, the steering group derived six key recommendations for hyperkalaemia prevention and management in people with cardiorenal disease. Future studies examining the quality of hyperkalaemia care delivery are required.
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Affiliation(s)
- James O. Burton
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | | | | | - Biff F. Palmer
- University of Texas Southwestern Medical CenterDallasTXUSA
| | | | | | - Manish M. Sood
- Ottawa Hospital Research InstituteUniversity of OttawaOttawaOntarioCanada
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Nerbass FB, Lima HDN, Sesso R, Lugon JR. Prevalência elevada de hipercalemia em pacientes brasileiros em diálise crônica e diferenças entre as regiões geográficas. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2022-0053pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Introdução: A hipercalemia é uma condição multifatorial comum em pessoas em diálise crônica e está associada à mortalidade. Nosso objetivo foi informar e discutir a prevalência de hipercalemia em uma grande população de pacientes em diálise crônica no Brasil e diferenças entre as regiões geográficas. Métodos: A prevalência de hipercalemia (potássio sérico ≥6,0 mEq/L) foi avaliada por meio do Censo Brasileiro de Diálise (CBD) em Julho de 2019, uma pesquisa online de participação voluntária na qual foram convidados todos os centros de diálise registrados na Sociedade Brasileira de Nefrologia. Resultados: Aproximadamente um terço (n=263 de 805) das clínicas de diálise brasileiras participaram. A prevalência de hipercalemia na população total foi de 16,1% (n=7.457 de 46.193; IC95%=15,8-16,5%), e variou de 12,1% no Norte a 18,7% no Nordeste. Conclusão: Encontramos uma elevada prevalência de hipercalemia em umagrande população brasileira em diálise crônica. É necessária uma investigação nacional dos fatores de risco, opções de tratamento e se esta alta prevalência contribui para a mortalidade desta população.
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Nerbass FB, Lima HDN, Sesso R, Lugon JR. High prevalence of hyperkalemia in Brazilian chronic dialysis patients and differences across geographic regions. J Bras Nefrol 2022; 45:106-109. [PMID: 35920444 PMCID: PMC10139716 DOI: 10.1590/2175-8239-jbn-2022-0053en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/22/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Hyperkalemia is a common multifactorial condition of people on chronic dialysis and is associated with mortality. We aimed to inform and discuss the prevalence of hyperkalemia in a large population of chronic dialysis patients in Brazil and its geographic regions. METHODS Prevalence of hyperkalemia (serum potassium ≥6.0 mEq/L) was assessed in the Brazilian Dialysis Survey (BDS) in July 2019, an online survey of voluntary participation in which all dialysis centers registered at the Brazilian Society of Nephrology were invited. RESULTS Approximately one-third (n=263 of 805) of the Brazilian dialysis clinics participated. The prevalence of hyperkalemia in the whole population was 16.1% (n=7,457 of 46,193; 95%CI=15.8-16.5%,), and varied from 12.1% in the North to 18.7% in the Northeast. CONCLUSION We found a high prevalence of hyperkalemia in a large Brazilian chronic dialysis population. A nationwide investigation of risk factors, treatment options, and whether this high prevalence contributes to dialysis mortality is warranted.
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Affiliation(s)
| | | | - Ricardo Sesso
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Romero-González G, Bover J, Arrieta J, Salera D, Troya M, Graterol F, Ureña-Torres P, Cozzolino M, Di Lullo L, Cippà PE, Urrutia M, Paúl-Martinez J, Boixeda R, Górriz JL, Ara J, Bayés-Genís A, Bellasi A, Ronco C. The “FIFTY SHADOWS” of the RALES Trial: Lessons about the Potential Risk of Dietary Potassium Supplementation in Patients with Chronic Kidney Disease. J Clin Med 2022; 11:jcm11143970. [PMID: 35887733 PMCID: PMC9318835 DOI: 10.3390/jcm11143970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/24/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
Hyperkalaemia (HK) is one of the most common electrolyte disorders and a frequent reason for nephrological consultations. High serum potassium (K+) levels are associated with elevated morbidity and mortality, mainly due to life-threatening arrhythmias. In the majority of cases, HK is associated with chronic kidney disease (CKD), or with the use of renin–angiotensin–aldosterone system inhibitors (RAASis) and/or mineral corticoid antagonists (MRAs). These drugs represent the mainstays of treatment in CKD, HF, diabetes, hypertension, and even glomerular diseases, in consideration of their beneficial effect on hard outcomes related to cardiovascular events and CKD progression. However, experiences in relation to the Randomised Aldactone Evaluation Study (RALES) cast a long shadow that extends to the present day, since the increased risk for HK remains a major concern. In this article, we summarise the physiology of K+ homeostasis, and we review the effects of dietary K+ on blood pressure and cardiovascular risk in the general population and in patients with early CKD, who are often not aware of this disease. We conclude with a note of caution regarding the recent publication of the SSaSS trial and the use of salt substitutes, particularly in patients with a limited capacity to increase K+ secretion in response to an exogenous load, particularly in the context of “occult” CKD, HF, and in patients taking RAASis and/or MRAs.
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Affiliation(s)
- Gregorio Romero-González
- Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain; (G.R.-G.); (M.T.); (F.G.); (M.U.); (J.P.-M.); (J.A.)
- REMAR-IGTP Group, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, 08916 Barcelona, Spain
- International Renal Research Institute of Vicenza, 36100 Vicenza, Italy;
| | - Jordi Bover
- Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain; (G.R.-G.); (M.T.); (F.G.); (M.U.); (J.P.-M.); (J.A.)
- REMAR-IGTP Group, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, 08916 Barcelona, Spain
- Correspondence:
| | - Javier Arrieta
- Nephrology Department, University Hospital Basurto, 48013 Bilbao, Spain;
| | - Davide Salera
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (D.S.); (P.E.C.); (A.B.)
| | - Maribel Troya
- Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain; (G.R.-G.); (M.T.); (F.G.); (M.U.); (J.P.-M.); (J.A.)
| | - Fredzzia Graterol
- Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain; (G.R.-G.); (M.T.); (F.G.); (M.U.); (J.P.-M.); (J.A.)
| | - Pablo Ureña-Torres
- AURA Nord Saint Ouen Dialysis Service, 93400 Saint Ouen, France;
- Service d’Explorations Fonctionnelles Rénales, Hôpital Necker, Université Paris V, René Descartes, 75006 Paris, France
| | - Mario Cozzolino
- Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy;
| | - Luca Di Lullo
- Nephrology Department, Parodi-Delfino Hospital, 00034 Colleferro, Italy;
| | - Pietro E. Cippà
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (D.S.); (P.E.C.); (A.B.)
| | - Marina Urrutia
- Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain; (G.R.-G.); (M.T.); (F.G.); (M.U.); (J.P.-M.); (J.A.)
| | - Javier Paúl-Martinez
- Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain; (G.R.-G.); (M.T.); (F.G.); (M.U.); (J.P.-M.); (J.A.)
| | - Ramón Boixeda
- Internal Medicine Department, Mataró Hospital, 08304 Mataró, Spain;
| | - José Luis Górriz
- Department of Nephrology, Clínico University Hospital, INCLIVA, Universitat de València, 46010 Valencia, Spain;
| | - Jordi Ara
- Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain; (G.R.-G.); (M.T.); (F.G.); (M.U.); (J.P.-M.); (J.A.)
| | - Antoni Bayés-Genís
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol (HGTiP), 08916 Badalona, Spain;
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Antonio Bellasi
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (D.S.); (P.E.C.); (A.B.)
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, 36100 Vicenza, Italy;
- Department of Nephrology, DIMED–University of Padova, 35122 Padova, Italy
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Abstract
Eating a net acid-producing diet can produce an "acid stress" of severity proportional to the diet net acid load, as indexed by the steady-state renal net acid excretion rate. Depending on how much acid or base is ingested or produced from endogenous metabolic processes and how well our homeostatic mechanisms can buffer or eliminate the additional acids or bases, we can alter our systemic acid-base balance. With increasing age, the kidney's ability to excrete daily net acid loads declines (a condition similar to that of mild CKD), invoking increased utilization of potential base stores (eg, bone, skeletal muscle) on a daily basis to mitigate the acid accumulation, thereby contributing to development of osteoporosis, loss of muscle mass, and age-related renal insufficiency. Patients suffering from more advanced CKD often present with more severe acid stress or metabolic acidosis, as the kidney can no longer excrete the entire acid load. Alkaline diets based on fruits and vegetables may have a positive effect on long-term preservation of renal function while maintaining nutritional status. This chapter discusses the biochemistry of dietary precursors that affect acid or base production.
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Affiliation(s)
- Lynda Frassetto
- Department of Medicine, University of California San Francisco, San Francisco, CA.
| | - Thomas Remer
- Department of Nutrition and Lifestyle Sciences, University of Bonn, Bonn, Germany
| | - Tanushree Banerjee
- Department of Medicine, University of California San Francisco, San Francisco, CA
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Chronic Hyperkaliemia in Chronic Kidney Disease: An Old Concern with New Answers. Int J Mol Sci 2022; 23:ijms23126378. [PMID: 35742822 PMCID: PMC9223624 DOI: 10.3390/ijms23126378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 12/04/2022] Open
Abstract
Increasing potassium intake ameliorates blood pressure (BP) and cardiovascular (CV) prognoses in the general population; therefore the World Health Organization recommends a high-potassium diet (90–120 mEq/day). Hyperkalaemia is a rare condition in healthy individuals due to the ability of the kidneys to effectively excrete dietary potassium load in urine, while an increase in serum K+ is prevalent in patients with chronic kidney disease (CKD). Hyperkalaemia prevalence increases in more advanced CKD stages, and is associated with a poor prognosis. This scenario generates controversy on the correct nutritional approach to hyperkalaemia in CKD patients, considering the unproven link between potassium intake and serum K+ levels. Another concern is that drug-induced hyperkalaemia leads to the down-titration or withdrawal of renin-angiotensin system inhibitors (RASI) and mineralocorticoids receptors antagonists (MRA) in patients with CKD, depriving these patients of central therapeutic interventions aimed at delaying CKD progression and decreasing CV mortality. The new K+-binder drugs (Patiromer and Sodium-Zirconium Cyclosilicate) have proven to be adequate and safe therapeutic options to control serum K+ in CKD patients, enabling RASI and MRA therapy, and possibly, a more liberal intake of fruit and vegetables.
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Vinson AJ, Zanjir W, Nallbani M, Goldstein J, Swain J, Clark DA, More KM, Manderville JR, Fok PT, Wiemer H, Tennankore KK. Predictors of Hyperkalemia among Patients on Maintenance Hemodialysis Transported to the Emergency Department by Ambulance. KIDNEY360 2022; 3:615-626. [PMID: 35721611 PMCID: PMC9136889 DOI: 10.34067/kid.0008132021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Hyperkalemia is common among patients on maintenance hemodialysis (HD) and is associated with mortality. We hypothesized that clinical characteristics available at time of paramedic assessment before emergency department (ED) ambulance transport (ambulance-ED) would associate with severe hyperkalemia (K≥6 mmol/L). Rapid identification of patients who are at risk for hyperkalemia and thereby hyperkalemia-associated complications may allow paramedics to intervene in a timely fashion, including directing emergency transport to dialysis-capable facilities. METHODS Patients on maintenance HD from a single paramedic provider region, who had at least one ambulance-ED and subsequent ED potassium from 2014 to 2018, were examined using multivariable logistic regression to create risk prediction models inclusive of prehospital vital signs, days from last dialysis, and the presence of prehospital electrocardiogram (ECG) features of hyperkalemia. We used bootstrapping with replacement to validate each model internally, and performance was assessed by discrimination and calibration. RESULTS Among 704 ambulance-ED visits, severe hyperkalemia occurred in 75 (11%); 26 patients with ED hyperkalemia did not have a prehospital ECG. Younger age at transport, longer HD vintage, more days from last hemodialysis session (OR=49.84; 95% CI, 7.72 to 321.77 for ≥3 days versus HD the same day [before] ED transport), and prehospital ECG changes (OR=6.64; 95% CI, 2.31 to 19.12) were independently associated with severe ED hyperkalemia. A model incorporating these factors had good discrimination (c-statistic 0.82; 95% CI, 0.76 to 0.89) and, using a cutoff of 25% probability, correctly classified patients 89% of the time. CONCLUSIONS Characteristics available at the time of ambulance-ED were associated with severe ED hyperkalemia. An awareness of these associations may allow health care providers to define novel care pathways to ensure timely diagnosis and management of hyperkalemia.
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Affiliation(s)
- Amanda J Vinson
- Nova Scotia Health, Halifax, Canada
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Canada
| | | | | | - Judah Goldstein
- Emergency Health Services, Dartmouth, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, Canada
| | - Janel Swain
- Emergency Health Services, Dartmouth, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, Canada
| | - David A Clark
- Nova Scotia Health, Halifax, Canada
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Canada
| | - Keigan M More
- Nova Scotia Health, Halifax, Canada
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Canada
| | | | - Patrick T Fok
- Department of Emergency Medicine, Dalhousie University, Halifax, Canada
| | - Hana Wiemer
- Department of Emergency Medicine, Dalhousie University, Halifax, Canada
| | - Karthik K Tennankore
- Nova Scotia Health, Halifax, Canada
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Canada
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Liebman SE, Joshi S. Plant-Based Diets and Peritoneal Dialysis: A Review. Nutrients 2022; 14:nu14061304. [PMID: 35334961 PMCID: PMC8950727 DOI: 10.3390/nu14061304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/05/2022] [Accepted: 03/17/2022] [Indexed: 02/05/2023] Open
Abstract
Whole food plant-based diets are gaining popularity as a preventative and therapeutic modality for numerous chronic health conditions, including chronic kidney disease, but their role and safety in end-stage kidney disease patients on peritoneal dialysis (PD) is unclear. Given the general public’s increased interest in this dietary pattern, it is likely that clinicians will encounter individuals on PD who are either consuming, considering, or interested in learning more about a diet with more plants. This review explores how increasing plant consumption might affect those on PD, encompassing potential benefits, including some specific to the PD population, and potential concerns.
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Affiliation(s)
- Scott E. Liebman
- Department of Medicine, Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
- Correspondence: ; Tel.: +1-585-275-4517
| | - Shivam Joshi
- Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA;
- Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY 10016, USA
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Gong Z, Chen T. Nutritional potassium limitation impact on serum potassium change, and death in chronic kidney disease: A meta-analysis. Ther Apher Dial 2022; 26:1079-1085. [PMID: 35247229 DOI: 10.1111/1744-9987.13831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We performed a meta-analysis to evaluate the impact of nutritional potassium limitation on serum potassium change, and death in chronic kidney disease. METHODS A systematic literature search up to October 2021 was done and 8 studies included 92 558 subjects with chronic kidney disease at the start of the study; 41 474 of them were provided with nutritional potassium limitation and 510 084 were nonrestricted diet. RESULTS Nutritional potassium limitation had significantly lower serum potassium change (MD, -0.33; 95% CI, -0.58- -0.07, p = 0.01) compared to nonrestricted diet in subjects with chronic kidney disease. However, nutritional potassium limitation had no significant impact on the death (OR, 0.80; 95% CI, 0.58-1.10, p = 0.17) compared to nonrestricted diet in subjects with chronic kidney disease. CONCLUSIONS Nutritional potassium limitation had significantly lower serum potassium change compared to nonrestricted diet in subjects with chronic kidney disease. Further studies are required to validate these findings. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zhumei Gong
- Department of Emergency, Yiwu Central Hospital, Zhejiang, China
| | - Taiai Chen
- Department of Nephrology, Qionghai People's Hospital, Hainan, China
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Babich JS, Kalantar-Zadeh K, Joshi S. Taking the Kale out of Hyperkalemia: Plant Foods and Serum Potassium in Patients with Kidney Disease. J Ren Nutr 2022; 32:641-649. [DOI: 10.1053/j.jrn.2022.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 11/11/2022] Open
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32
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Hunter RW, Dhaun N, Bailey MA. The impact of excessive salt intake on human health. Nat Rev Nephrol 2022; 18:321-335. [DOI: 10.1038/s41581-021-00533-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/19/2022]
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Acceptability of Plant-Based Diets for People with Chronic Kidney Disease: Perspectives of Renal Dietitians. Nutrients 2022; 14:nu14010216. [PMID: 35011091 PMCID: PMC8747619 DOI: 10.3390/nu14010216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 12/24/2021] [Accepted: 01/01/2022] [Indexed: 02/08/2023] Open
Abstract
The purpose of this study was to explore the perspective of renal dietitians regarding plant-based diets for chronic kidney disease (CKD) management and evaluate the acceptability of a hypothetical plant-based dietary prescription aiming for the consumption of 30 unique plant foods per week. This study used an exploratory mixed methods design. Forty-six renal dietitians participated in either an online survey (n = 35) or an in-depth interview (n = 11). Dietitians perceived that plant-based diets could address multiple clinical concerns relevant to CKD. Forty percent of survey respondents reported the hypothetical dietary prescription was realistic for people with CKD, 34.3% were unsure, and 25.7% perceived it as unrealistic. Strengths of the hypothetical prescription included shifting the focus to whole foods and using practical resources like recipes. Limited staffing, time, and follow-up opportunities with patients, as well as differing nutrition philosophies were the most commonly reported challenges to implementation; while a supportive multidisciplinary team was identified as an important enabler. To increase patient acceptance of plant-based dietary approaches, education about plant food benefits was recommended, as was implementing small, incremental dietary changes. Successful implementation of plant-based diets is perceived to require frequent patient contact and ongoing education and support by a dietitian. Buy-in from the multidisciplinary team was also considered imperative.
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Kovesdy CP. Should We Let Dialysis Patients Eat Their Fruits and Veggies? Clin J Am Soc Nephrol 2021; 16:1781-1783. [PMID: 34853059 PMCID: PMC8729484 DOI: 10.2215/cjn.13521021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Csaba P. Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center and Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee
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