Low Potassium Diet Research Articles

Dietary sodium and potassium intake were associated with hypertension, kidney damage and adverse perinatal outcome in pregnant women with preeclampsia

ABSTRACTObjectives: In this study, we hypothesized that dietary salt and potassium intake may be related with blood pressure, kidney damage and perinatal outcome in pregnants with preeclampsia (PE). Methods: In total, 200 women (50 control women with healthy pregnancy, 150 women with PE) were recruited for the study. Daily salt and potassium intake was estimated based on calculation of 24-hour urinary sodium U[Na+] and potassium U[K+] excretion. U[Na+]/[K+] was calculated by dividing U[Na+] by U[K+]. At the end of the measurements, the pregnant women with PE (n=150) were divided into tertiles according to U[Na+]/[K+]: low Na/K group (n=50, mean U[Na+]/[K+]: 1,04±0,32), medium Na/K group (n=50, mean U[Na+]/[K+]: 2,49± 0,54), high Na/K group (n=50, mean U[Na+]/[K+]: 6,62±3,41). Results: The mean SBP and DBP levels were significantly lower in low Na/K group compared with medium or high Na/K groups (p=0.024, p=0.0002; respectively). Serum creatinine was significantly lower in low Na/K group than high Na/K group (p=0.025). Frequency of severe preeclampsia is lower in low Na/K group than medium or high Na/K groups (p=0.002, p=0.0001; respectively). Birth weight and gestational age at birth were higher in low Na/K group compared with high Na/K group (p=0.045, p=0.0002; respectively). After adjusting for covariates, SBP and DBP and creatinine levels were independently associated with 24 hours urinary [Na+]/[K+] Conclusion: These findings suggest that pregnant with PE with high dietary salt and low potassium intake may have greater maternal and neonatal morbidity risk than pregnant with PE under low dietary salt and high potassium intake.

PP.30.07] DIURNAL PATTERN OF URINARY SODIUM/POTASSIUM RATIO IN FREE LIVING JAPANESE IN DIVIDUALS

Objective: High dietary sodium (Na), low dietary potassium (K) intakes and high Na/K ratio are associated with adverse blood pressure levels and excess risks of cardiovascular diseases. Handy urinary Na/K ratio measurement device provides feedback in several ten seconds with far lower patient burden as compared to conventional methods. Since there is no report on diurnal variation of casual urinary Na/K ratio, we clarified it under free living conditions in Japanese participants.Design and method: This study is a cross sectional study. A total of 122 normotensve and hypertensive individuals (ages 25–69 years) were recruited. Participants were instructed to collect all casual urine samples in aliquot tubes (10 mL), and to report urine volume and the time at each voiding under free living conditions for 10 to 22 days. Urinary sodium and potassium concentration was measured by ion-specific electrodes, and Na/K ratio was calculated. 13,277 specimens were collected and classified into hourly data from 00:00 hours to 23:00 hours on the hour. Diurnal pattern of urinary Na/K ratio, urinary concentrations and excretions of sodium and potassium, and urine volume were evaluated. Results: Mean value of 24-hr urinary Na/K ratio were 4.37 and 3.43 in normotensive and hypertensive individuals, respectively. Of the individuals on anti-hypertensive medications, 14 participants, 9 participants, 15 participants and 5 participants were taking calcium channel blockers (CCB), angiotensin 2 receptor blockers (ARB), both CCB and ARB, and other drugs, respectively. Overall mean value of urinary Na/K ratio was highest (4.1–5.0) in the early morning, lower (3.3–3.8) in daytime and higher (4.0–4.4) toward evening hours. Mean urinary sodium and potassium concentration was lowest (90–110mmol/L, 24–32mmol/L, respectively) in the early morning, and higher (110–140mmol/L, 35–43mmol/L, respectively) after second voiding. Diurnal variability ratio of potassium concentration was larger than sodium concentration. In subgroup analysis, diurnal patterns of mean urinary Na/K ratio were comparable between normotensive and hypertensive individuals. Conclusions: We identified a diurnal pattern in urinary Na/K ratio under free living conditions. This fluctuation of urinary Na/K ratio was 1 to 1.5, and its variation is not likely to be explained by postprandial surges.

Reduction of potassium content of green bean pods and chard by culinary processing. Tools for chronic kidney disease

IntroductionIn order to prevent a possible hyperkalemia, chronic renal patients, especially in advanced stages, must follow a low potassium diet. So dietary guidelines for chronic kidney disease recommend limiting the consumption of many vegetables, as well as to apply laborious culinary techniques to maximize the reduction of potassium. ObjectiveThe aim of this work is to analyze potassium content from several vegetable, fresh products, frozen and preserved, as well as check and compare the effectiveness in potassium reduction of different culinary processes, some of them recommended in dietary guidelines such as soaking or double cooking. MethodsSample potassium content was analyzed by triplicate using flamephotometry. ResultsThe results showed significant reductions in potassium content in all culinary processes studied. The degree of loss varied depending on the type of vegetable and processing applied. Frozen products achieved greater reductions than the fresh ones, obtaining in some cases losses greater than 90%. In addition, it was observed how in many cases the single application of a normal cooking reached potassium reductions to acceptable levels for its inclusion in renal patient diet. ConclusionThe results shown in this study are very positive because they provide tools for professionals who deal with this kind of patients. They allow them to adapt more easily to the needs and preferences of their patients and increase dietary variety.

Reducción del contenido de potasio de las judías verdes y las acelgas mediante el procesado culinario. Herramientas para la enfermedad renal crónica

IntroductionIn order to prevent a possible hyperkalemia, chronic renal patients, especially in advanced stages, must follow a low potassium diet. So dietary guidelines for chronic kidney disease recommend limiting the consumption of many vegetables, as well as to apply laborious culinary techniques to maximize the reduction of potassium. ObjectiveThe aim of this work is to analyze potassium content from several vegetable, fresh products, frozen and preserved, as well as check and compare the effectiveness in potassium reduction of different culinary processes, some of them recommended in dietary guidelines such as soaking or double cooking. MethodsSample potassium content was analyzed by triplicate using flamephotometry. ResultsThe results showed significant reductions in potassium content in all culinary processes studied. The degree of loss varied depending on the type of vegetable and processing applied. Frozen products achieved greater reductions than the fresh ones, obtaining in some cases losses greater than 90%. In addition, it was observed how in many cases the single application of a normal cooking reached potassium reductions to acceptable levels for its inclusion in renal patient diet. ConclusionThe results shown in this study are very positive because they provide tools for professionals who deal with this kind of patients. They allow them to adapt more easily to the needs and preferences of their patients and increase dietary variety.

Hydronephrosis and Urinary Bladder Hypertrophy in ROMK Bartter's Mouse

The renal outer medullary potassium channel (ROMK; Kir1.1) plays an important role in Na+ and K+ homeostasis. ROMK knockout mice (KO) show a similar phenotype to Bartter's syndrome of salt wasting and dehydration due to reduced Na‐2Cl‐K‐cotransporter activity. ROMK KO mice also show hydronephrosis; however, the mechanism of this phenotype has not been understood. We investigated ROMK expression and regulation by high and low K intake in mouse bladder, by Western blot and immunofluorescence (IF) staining. We also compared the bladder weight, bladder capacity, and thickness of urothelium and smooth muscle layer between WT and ROMK KO mice. Western blotting detected ROMK expression at 45~48 kDA, and IF staining showed that the luminal membrane of umbrella cells were strongly stained in WT compared to KO mice. The expression of ROMK in the luminal membrane disappeared and signal intensity of the detrusor muscle was decreased by low potassium diet (LK) in WT mice. In contrast, there was no significant change in ROMK intensity, but the thickness of urothelium was increased after mice were treated with HK diet. The thickness of urothelium was 168.1±25.8 μm in normal K (NK) and was 300.7±83.6 μm (p<0.001) in the HK treated group compared with NK in WT mice at the same age. The bladder weight, bladder capacity and the thickness of urothelium in ROMK KO showed average increases 2~4 fold greater than WT at both 2 months and 12 months of age. The thickness of the urothelium was 648.8±33.2 μm vs 302.7±16.5 μm (p<0.001) and the detrusor muscle 1940.7±98.9 μm vs 1308.2±102.1 μm (p=0.013) respectively in 12‐month ROMK KO mice. In conclusion, ROMK expressed in the urinary bladder can be regulated by K+ intake; significant enlargement and hypertrophy of the bladder may contribute to hydronephrosis in ROMK KO mice.Support or Funding InformationNIH RO1 DK099284 and PO1 DK 17433

Abstract P190: Associations of 24-h Urinary Sodium/potassium (Na/K) Ratio with Recommended Intakes of Na and K: The INTERMAP Study

Background: High dietary sodium (Na), low dietary potassium (K) and high dietary sodium/potassium (Na/K) ratio are associated with adverse blood pressure levels and excess risks of cardiovascular diseases. 24-h urine collection is the gold standard for measuring dietary Na, K and Na/K ratio. Recommended levels of Na and K intakes are suggested in WHO guidelines; less than 85 mmol/day for Na; at least 90 mmol/day for K; there is no definitive guideline for Na/K ratio. Objective: Our primary aim was to compare the level of urinary Na/K ratio with the current recommended levels of Na and K intakes suggested in WHO guidelines. Methods: INTERMAP is an international study on associations of multiple dietary variables with blood pressure (BP), based on two timed 24-hr urine collections and dietary data from 4 in-depth 24-h dietary recalls in 4,680 men and women ages 40-59 years in China, Japan, United Kingdom and United States (US). Na/K ratio of 24-hr urine stratified in 1 unit intervals was compared with the current recommended levels of Na and K intakes suggested in WHO guidelines. Na intake was evaluated by urinary Na excretion; K intake by dietary K intake. Results: Thirty-one of the 4,680 INTERMAP participants (0.7%) had urinary Na/K ratio less than 1. The proportions of participants with Na excretion less than 2 g/day (85 mmol/day) among all 4,680 individuals were 77% (n=24), 19% (n=117), and 0.2% (n=11) in those with urinary Na/K ratio less than 1, 1 to 2, and more than 4, respectively. In US samples (n=2,195) the proportions were 88% (n=15), 19% (n=70), and 0.3% (n=6), respectively. The proportions of participants with dietary K intake more than 3.51 g/day (90 mmol/day) among all 4,680 individuals were 71% (n=22), 38% (n=233), and 2.4% (n=111) in those with urinary Na/K ratio less than 1, 1 to 2, and more than 4, respectively. In US samples the proportions were 59% (n=10), 38% (n=138), and 2.1% (n=47), respectively. Conclusions: WHO recommends Na intake less than 85 mmol/day, and K intake more than 90 mmol/day. Urinary Na/K ratio less than 1 is needed to ensure reasonable compliance with these recommendations. Currently, very few people satisfy urinary Na/K ratio less than 1, so population-wide efforts are needed to reduce salt (sodium chloride) and increase K intake.

Modifiable risk factors of hypertension: A hospital-based case-control study from Kerala, India

Introduction:Hypertension is a major cause of cardiovascular morbidity and mortality in Kerala. Excess dietary salt, low dietary potassium, overweight and obesity, physical inactivity, excess alcohol, smoking, socioeconomic status, psychosocial stressors, and diabetes are considered as modifiable risk factors for hypertension.Objectives:To estimate and compare the distribution of modifiable risk factors among hypertensive (cases) and nonhypertensive (controls) patients and to estimate the effect relationship of risk factors.Materials and Methods:Age- and sex-matched case–control study was conducted in a tertiary care hospital in Kerala using a pretested interviewer-administered structured questionnaire based on the WHO STEPS instrument for chronic disease risk factor surveillance. Bivariate and multiple logistic regression analyses were done.Results:A total of 296 subjects were included in the study. The mean age of study sample was 50.13 years. All modifiable risk factors studied vis-ΰ-vis obesity, lack of physical activity, inadequate fruits and vegetable intake, diabetes, smoking, and alcohol use were significantly different in proportion among cases and controls. Obesity, lack of physical activity, smoking, and diabetes were found to be significant risk factors for hypertension after adjusting for other risk factors.Conclusion:Hypertension is strongly driven by a set of modifiable risk factors. Massive public awareness campaign targeting risk factors is essential in controlling hypertension in Kerala, especially focusing on physical exercise and control of diabetes, obesity, and on quitting smoking.

Sodium and potassium urinary excretion and dietary intake: a cross-sectional analysis in adolescents

BackgroundHypertension is the leading cause for heart disease and stroke, for mortality and morbidity worldwide, and a high sodium-to-potassium intake ratio is considered a stronger risk factor for hypertension than sodium alone.ObjectiveThis study aims to evaluate sodium and potassium urinary excretion, and assess the food sources of these nutrients in a sample of Portuguese adolescents.DesignA cross-sectional study with a sample of 250 Portuguese adolescents. Sodium and potassium excretion were measured by one 24-h urinary collection, and the coefficient of creatinine was used to validate completeness of urine collections. Dietary sources of sodium and potassium were assessed using a 24-h dietary recall.ResultsValid urine collections were provided by 200 adolescents (118 girls) with a median age of 14.0 in both sexes (p=0.295). Regarding sodium, the mean urinary excretion was 3,725 mg/day in boys and 3,062 mg/day in girls (p<0.01), and 9.8% of boys and 22% of girls met the World Health Organization (WHO) recommendations for sodium intake. Concerning potassium, the mean urinary excretion was 2,237 mg/day in boys and 1,904 mg/day in girls (p<0.01), and 6.1% of boys and 1.7% of girls met the WHO recommendations for potassium intake. Major dietary sources for sodium intake were cereal and cereal products (41%), meat products (16%), and milk and milk products (11%); and for potassium intake, main sources were milk and milk products (21%), meat products (17%), and vegetables (15%).ConclusionsAdolescents had a high-sodium and low-potassium diet, well above the WHO recommendations. Health promotion interventions are needed in order to decrease sodium and increase potassium intake.

Practical Nutrition Management of Children with Chronic Kidney Disease

Chronic kidney disease (CKD) introduces a unique set of nutritional challenges for the growing and developing child. This article addresses initial evaluation and ongoing assessment of a child with CKD. It aims to provide an overview of nutritional challenges unique to a pediatric patient with CKD and practical management guidelines. Caloric assessment in children with CKD is critical as many factors contribute to poor caloric intake. Tube feeding is a practical option to provide the required calories and fluid in children who have difficulty with adequate oral intake. Protein intake should not be limited and should be further adjusted for protein loss with dialysis. Supplementation or restriction of sodium is patient specific. Urine output, fluid status, and modality of dialysis are factors that influence sodium balance. Hyperkalemia poses a significant cardiac risk, and potassium is closely monitored. In addition to a low potassium diet, potassium binders may be prescribed to reduce potassium load from oral intake. Phosphorus and calcium play a significant role in cardiovascular and bone health. Phosphorus binders have helped children and families manage phosphorus levels in conjunction with a phosphorus-restricted diet. Nutritional management of children with CKD is a challenge that requires continuous reassessment and readjustment as the child ages, CKD progresses, and urine output decreases.

Unique chloride-sensing properties of WNK4 permit the distal nephron to modulate potassium homeostasis.

Dietary potassium deficiency activates thiazide-sensitive sodium chloride cotransport along the distal nephron. This may explain, in part, the hypertension and cardiovascular mortality observed in individuals who consume a low potassium diet. Recent data suggest plasma potassium affects the distal nephron directly by influencing intracellular chloride, an inhibitor of the With no lysine kinase (WNK)-Ste20p-related proline-and alanine-rich kinase (SPAK) pathway. Since previous studies used extreme dietary manipulations, we sought to determine if the relationship between potassium and NCC is physiologically relevant and clarify the mechanisms involved. We report that modest changes in both dietary and plasma potassium affect the thiazide-sensitive sodium-chloride cotransporter, NCC, in vivo. Kinase assay studies showed that chloride inhibits WNK4 kinase activity at lower concentrations than it inhibits activity of WNK1 or WNK3. Also, chloride inhibited WNK4 within the range of distal cell chloride. Mutation of a previously identified WNK chloride-binding motif converted WNK4 effects on SPAK from inhibitory to stimulatory in mammalian cells. Disruption of this motif in WNKs 1, 3 and 4 had different effects on NCC, consistent with the three WNKs having different chloride sensitivities. Thus, potassium effects on NCC are graded within the physiological range, which explains how unique chloride-sensing properties of WNK4 enable kinase mediating effects of potassium on NCC in vivo.

Effect of chronic low potassium on K+ uptake rate in myocardium and skeletal muscle of rabbits

Objective To evaluate the effect of chronic low potassium on K+ uptake rate in the myocardium and skeletal muscle of rabbits. Methods Thirty-two adult male rabbits, aged 12-14 weeks, weighing 2.0-2.7 kg, were randomly divided into 4 groups (n=8 each) using a random number table: normal feeding group (group N), low potassium feeding group (group L), potassium supplementation control group (group SC) and potassium supplementation experimental group (group SE). N and SC groups were given a normal diet only, and L and SE groups were fed with a low potassium diet for 15 days. Potassium chloride (KCl) 0.5 mol/L was then infused intravenously at the initial rate of 60 μmol·kg-1·min-1 in SE and SC groups. Blood samples were obtained from the central artery of the left ear every 5 min for measurement of plasma K+ concentrations. The infusion rat of KCl was then adjusted until the plasma K+ concentration reached 5.5 mmol/L and maintained at this level for 1 h, and then infusion was stopped. The total volume of KCl infused was recorded. The hearts and soleus muscle of animals were excised for determination of K+ content. K+ uptake and uptake rate were calculated. Results Compared with N group, the plasma K+ concentration, and K+ content in the myocardium and soleus muscle were significantly decreased in group L(P<0.05). Compared with SC group, the total volume of KCl infused, and K+ uptake and uptake rate in the myocardium and soleus muscle were significantly increased in group SE(P<0.05). Conclusion Chronic hypokalaemia can increase K+ uptake rate in the myocardium and skeletal muscle of rabbits. Key words: Hypokalemia; Myocardium; Muscle, skeletal

The role of dietary potassium in hypertension and diabetes.

Potassium is an essential mineral which plays major roles for the resting membrane potential and the intracellular osmolarity. In addition, for several years, it has been known that potassium also affects endothelial and vascular smooth muscle functions and it has been repeatedly shown that an increase in potassium intake shifts blood pressure to a more preferable level. Meanwhile, the blood pressure lowering effects of potassium were presented in several intervention trials and summarized in a handful of meta-analyses. Furthermore, accumulating epidemiological evidence from, especially, the last decade relates low dietary potassium intake or serum potassium levels to an increased risk for insulin resistance or diabetes. However, intervention trials are required to confirm this association. So, in addition to reduction of sodium intake, increasing dietary potassium intake may positively affect blood pressure and possibly also glucose metabolism in many populations. This concise review not only summarizes the studies linking potassium to blood pressure and diabetes but also discusses potential mechanisms involved, like vascular smooth muscle relaxation and endothelium-dependent vasodilation or stimulation of insulin secretion in pancreatic β-cells, respectively.

Tolerating Extreme Hyperkalemia in a Non-Compliant Dialysis Patient

Dialysis patients are known to tolerate high potassium due to the chronic hyperkalemia that is inherent in their disease. Despite this, most reports of extremely high potassium (>9 mmol/L) are in the setting of cardiac arrest. We describe the case of a 57-year-old Caucasian male with past medical history significant for end stage renal disease known to be non-adherent to a low potassium diet as well as missed dialysis appointments. Stat potassium off of a basic metabolic panel was 10.2 mmol/L, which was non-hemolyzed and confirmed on repeat testing. A stat EKG was performed which revealed peaked T waves, mildly increased PR interval (200 ms), and mild QRS widening (142 ms). There was no evidence of bradycardia or sinusoidal wave form. The patient received emergent dialysis and his EKG normalized.

Encapsulated sodium supplementation of 4 weeks does not alter salt taste preferences in a controlled low sodium and low potassium diet

Preference for saltiness is learned by oral exposure to salt taste; however, some data suggest a role for bodily sodium and potassium levels on salt taste preferences as well. The objective was to investigate whether encapsulated sodium and potassium supplementation lead to altered salt taste responses among adults with high blood pressure on a low sodium and low potassium diet. Twenty-six participants with untreated upper-range prehypertension or stage 1 hypertension were on a fully controlled low sodium and low potassium diet (both targeted at 2g/day) for 13weeks. Participants received capsules with sodium (3g/d), potassium (3g/d), or placebo, for 4weeks each, in randomized order in a double blind crossover design. Sensory evaluation was done before and after each supplementation period and involved ratings of pleasantness and intensity in different salt (NaCl) concentrations in food and water, desire-to-eat salty food, and detection threshold for NaCl. Neither sodium supplementation nor potassium supplementation led to alterations in salt taste responses in food and water, and did not affect detection threshold (P=0.59). There was no clear role for sodium or potassium supplementation on desire-to-eat salty food. In addition, we did not find effects of reduced oral exposure to salt over weeks, through the sodium-reduced diet, on salt taste preferences, in contrast to earlier studies. In conclusion, the results of this study suggest preference for saltiness is independent of changes in bodily sodium or potassium levels.

Association between High Blood Pressure and Intakes of Sodium and Potassium among Korean Adults: Korean National Health and Nutrition Examination Survey, 2007-2012

BackgroundThe association between dietary sodium and potassium, the ratio of sodium to potassium, and blood pressure remains unclear. ObjectiveWe evaluated the associations between blood pressure and dietary sodium and potassium intake in terms of the amount and ratio in Korean adults. DesignThis cross-sectional study was based on data from the fourth and fifth Korean National Health and Nutrition Examination Survey, 2007-2012. Participants/settingA total of 24,096 adults (aged ≥19 years) without history of antihypertensive medication use were selected. The 24-hour recall method was used for dietary assessment. We categorized the subjects into four groups using median intakes of sodium and potassium, and defined the low sodium/high potassium intake group as the reference group. Main outcome measuresHigh blood pressure (HBP) was defined as mean systolic or diastolic blood pressures of ≥140 or ≥90 mm Hg, respectively. Statistical analyses performedMultivariate logistic regression was performed to estimate the odds ratio and 95% CI to investigate the association between the four groups of sodium and potassium intakes and HBP. ResultsSodium intake was positively associated with diastolic blood pressure, with an increase of 0.21 mm Hg per 1 mg/kcal increase in sodium (P<0.001). In contrast, potassium intake was negatively associated with systolic blood pressure, with a decrease of 1.01 mm Hg per 1 mg/kcal increase in potassium (P<0.001). After adjusting for confounders, the high sodium/low potassium (odds ratio 1.21, 95% CI 1.02 to 1.44) and low sodium/low potassium intake groups (odds ratio 1.19, 95% CI 1.01 to 1.40) were at higher risk of HBP than the reference group. The risk of HBP in the high sodium/high potassium group did not differ from that in the reference group. ConclusionsLow potassium intake was associated with an increased risk of hypertension. These results suggest that increasing potassium intake might be beneficial for hypertension control among populations with low-potassium diets.

Association of low potassium diet and folic acid deficiency in patients with CKD.

BackgroundMost of the folic acid sources are rich also in potassium. Patients with chronic kidney disease (CKD) usually receive a low potassium diet. We investigated the possibility of an association between low potassium diet and folic acid deficiency.MethodsIn total, 128 CKD patients participated in this cross-sectional study. Sixty-four patients with CKD grades 1 and 2 were on an unrestricted potassium diet when enrolled in the study, and 64 patients with CKD grades 3 and 4 had received instructions to restrict their intake of potassium at least 6 months before enrollment in the study. Subjects were evaluated for daily intake of folic acid (DIFA), daily intake of potassium (DIK), and serum folic acid levels (SFA).ResultsDIFA correlated with the estimated glomerular filtration rate, the DIK, and the SFA (P<0.001). SFA correlated with the estimated glomerular filtration rate (P<0.001). Mean DIFA and mean SFA were lower among patients with CKD grades 3 and 4 than among those with CKD grades 1 and 2 (P<0.001). The mean DIFA in patients with folic acid deficiency was lower than that in those with SFA ≥7.1 nmol/L (P<0.001). There was lower SFA and threefold greater frequency of folic acid deficiency among patients with CKD grades 3 and 4 who had received instructions to restrict their intake of potassium than among patients with CKD grades 1 and 2 who were on an unrestricted potassium diet.ConclusionA potassium-restricted diet offered to patients with CKD grades 3 and 4 may be associated with folic acid deficiency. Serum levels of folic acid should be investigated before starting potassium restriction in patients with CKD grades 3 and 4, in order to identify individuals with folic acid deficiency or with marginal serum levels who should receive folic acid replacement therapy.

The relationship between estimated sodium and potassium excretion and subsequent renal outcomes.

Patients are often advised to reduce sodium and potassium intake, but supporting evidence is limited. To help provide such evidence we estimated 24 h urinary sodium and potassium excretion in 28,879 participants at high cardiovascular risk who were followed for a mean of 4.5 years in the ONTARGET and TRANSCEND trials. The primary outcome was eGFR decline of 30% or more or chronic dialysis. Secondary outcomes were eGFR decline of 40% or more or chronic dialysis, doubling of serum creatinine or chronic dialysis, an over 5%/year loss of eGFR, progression of albuminuria, and hyperkalemia. Multinomial logit regression with multivariable fractional polynomials, adjusted for confounders, determined the association between urinary sodium and potassium excretion and renal outcomes, with death as a competing risk. The primary outcome occurred in 2,052 (7.6%) patients. There was no significant association between sodium and any renal outcome (primary outcome odds ratio 0.99; 95% CI 0.89-1.09 for highest [median 6.2 g/day] vs. lowest third [median 3.3 g/day]). Higher potassium was associated with lower odds of all renal outcomes (primary outcome odds ratio 0.74; 95% CI 0.67-0.82 for highest [median 2.7 g/day] vs. lowest third [median 1.7 g/day], except hyperkalemia nonsignificant. Thus, urinary potassium, but not sodium, excretion predicted clinically important renal outcomes. Our findings do not support routine low sodium and potassium diets for prevention of renal outcomes in people with vascular disease with or without chronic kidney disease.

Is Reducing Dietary Sodium Controversial? Is It the Conduct of Studies With Flawed Research Methods That Is Controversial? A Perspective From the World Hypertension League Executive Committee

Is Reducing Dietary Sodium Controversial? Is It the Conduct of Studies With Flawed Research Methods That Is Controversial? A Perspective From the World Hypertension League Executive Committee

An unusual case of recurrent hypokalemic paralysis in an adolescent: Answers

A 15-year-old Caucasian girl presented to the emergency department with a 2-day history of generalized body weakness, abdominal pain, and an inability tomove her extremities. She reported poor appetite, fatigue, dizziness, generalized joint pains, back pain, nausea, and two episodes of vomiting. She denied having a history of diarrhea, dysuria, blood in the urine, changes in urine output, and frequent or urgent urination. She also denied having a history of recent upper respiratory symptoms, headaches, chest pain, difficulty breathing, leg or joint swelling. There was no history of seizures, rash, syncope, speech difficulty, lightheadedness or numbness. She denied recent intense exercise, starvation, high-carbohydrate and/or low-potassium diet, and ingestion of an illicit drug or alcohol. Her past medical history was significant for a history of medullary sponge kidneys (MSK) and renal tubular acidosis (RTA) diagnosed 2 years ago in her home town when being worked up for generalized muscle weakness. She reported having had three previous episodes of similar presentations over the past 2 years and was told that she had low serum potassium levels. All three episodes necessitated a hospital admission lasting for about a day and the episode resolved with intravenous potassium supplements and hydration. The patient’s mother was unsure of what the serum potassium levels had been between those episodes. She had been placed on daily potassium and bicarbonate supplements for the past 1 year, but had not been taking it for the past 2 months. She was born at full term with a birth weight of 7 lbs 6 oz (3.35 kg). Her growth and development was appropriate with no history of failure to thrive or repeated hospitalizations for dehydration episodes. There was no history of deafness, polyuria or bone loss. There was no history suggestive of autoimmune disorders. She was sexually active with one male partner and had no history of sexually transmitted disease. Her family history was insignificant for consanguinity, similar problems, low serum potassium or any other renal diseases. On physical examination, her vitals were as follows: blood pressure (BP) 114/56 mmHg manually in the right upper extremity with an adequate sized cuff (95th percentile BP: 126/82 mmHg), pulse 100/min, respiratory rate 16/min, temperature 36.6° Celsius, weight 58.9 kg (70th centile), height 157 cm (20th centile), body mass index 24 kg/m (82nd centile), and SPO2 99 % on room air. She was alert and oriented. She was otherwise well-developed and wellnourished. Extraocular movements were normal. There was no periorbital edema. There was no moon facies. There was no cervical adenopathy. She did have mild neck tenderness with restricted neck movements. Speech was not slurred. Heart soundswere normal with regular rhythm andwith nomurmurs. Lungs were clear to auscultation with symmetric chest expansion and no use of accessory muscles. Abdomen examination showed mild generalized tenderness. Bowel sounds were normal. There was marked tenderness in both lower extremities. Deep tendon reflexes were present but diminished and the muscle strength was 2 in all 4 extremities. Tone was diminished in all four extremities, more so in the lower extremities. Pain sensation was intact. There were no cranial nerve deficits. Laboratory investigations showed normal complete blood count and liver function test. Initial arterial blood gas showed pH 7.18, pCO2 28 mmHg, PO2 129 mmHg, HCO3 10 mmol/ The answers to these questions can be found at http://dx.doi.org/10.1007/ s00467-014-2929-x.

High blood pressure: why prevention and control are urgent and important: a 2014 fact sheet from the World Hypertension League and the International Society of Hypertension.

BP-related disease has a major impact on healthcare spending. An estimated 10% of healthcare spending is directly related to increased BP and its complications. The costs are estimated to be just under 25% of healthcare spending in Eastern Europe and Central Asia. Behavioral factors play a major role in increasing BP. Unhealthy diet is estimated to be related to about half of hypertension cases. About 30% of cases are related to increased salt consumption, and about 20% are related to low dietary potassium (low fruit and vegetables). Physical inactivity is related to about 20% of hypertension. Obesity is related to about 30% of hypertension. Excess alcohol consumption also causes hypertension. Being tobacco free is especially important for people with hypertension.