Abstract
Potassium (K), the main cation inside cells, plays roles in maintaining cellular osmolarity and acid–base equilibrium, as well as nerve stimulation transmission, and regulation of cardiac and muscle functions. It has also recently been shown that K has an antihypertensive effect by promoting sodium excretion, while it is also attracting attention as an important component that can suppress hypertension associated with excessive sodium intake. Since most ingested K is excreted through the kidneys, decreased renal function is a major factor in increased serum levels, and target values for its intake according to the degree of renal dysfunction have been established. In older individuals with impaired renal function, not only hyperkalemia but also hypokalemia due to anorexia, K loss by dialysis, and effects of various drugs are likely to develop. Thus, it is necessary to pay attention to K management tailored to individual conditions. Since abnormalities in K metabolism can also cause lethal arrhythmia or sudden cardiac death, it is extremely important to monitor patients with a high risk of hyper- or hypokalemia and attempt to provide early and appropriate intervention.
Highlights
Abnormalities in potassium (K) metabolism are induced by a variety of factors
In cases of acidosis caused by accumulation of inorganic acids (e.g., HCl), hyperkalemia is exacerbated because K efflux from the cells is enhanced, whereas in acidosis caused by accumulation of organic acids, the concentration of K in serum remains nearly unchanged because organic acids enter the cells together with H
An observational retrospective cohort study that used a Japanese hospital claims database (n = 1,022,087) reported that the prevalence of hyperkalemia was significantly higher in chronic kidney disease (CKD) patients (227.9; 95% confidence interval (CI): 224.3–231.5) as compared to all enrolled subjects (67.9; 95% CI: 67.1–68.8) [21]
Summary
Abnormalities in potassium (K) metabolism are induced by a variety of factors. Since K metabolism is regulated in a large part by the kidneys, most cases of hyperand hypokalemia are caused by renal mechanisms [1]. Decreased renal function increases the risk of developing abnormal K metabolism, though aging of affected patients, and the increasing complexity introduced by various medications and dialysis treatments make the pathogenesis more complicated (Figure 1). The basics of K metabolism, the pathogenesis of abnormal K metabolism, and the relationships among factors related to K and its dynamics are examined, along with a review of relevant literature. 1. Factors affecting potassium metabolismininchronic chronic kidney kidney disease. Sweat intestinal tract providecompensatory compensatory mechanisms, with medicain affected patients. Sweat andand thethe intestinal tract provide mechanisms,correction correction with medication is usually needed
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