Low Serum Potassium Levels Research Articles

Serum Potassium Level in Acute Organophosphorus Poisoning and its Correlation with Severity in Patients Presenting to Emergency Room in a Tertiary Hospital

Background: Organophosphorus compounds (OPCs) are common causes of accidental and suicidal poisoning in agricultural countries like Nepal. Serum cholinesterase, used to diagnose organophosphorus poisoning (OP), is not reliable for predicting its severity. This study aimed to assess serum potassium as an alternative prognostic indicator for OP poisoning severity. Methodology: This single-centric cross-sectional study included patients presenting with OP poisoning at a tertiary care center over six months. Total 86 cases met the inclusion criteria. The Peradeniya organophosphorus poisoning (POP) scale categorized patients by severity. The association between OP poisoning severity and serum potassium level at presentation was studied. Results: Of the 86 cases, 47 (55%) were females. The mean age was 26.96 years (SD: 8.73), ranging from 18 to 65 years. Most cases, 53% (n=46), were aged 20-29 years. Chlorpyriphos (50%) + cypermethrin (5%) was the most common OP compound, used in 29% cases. Malathion (50%) was the least used, in 7% (n=6) of cases. At presentation, 36% (n=31) had hypokalemia, among which 6 had mild poisoning (POP score: 0-3), while 25 had moderate to severe case of poisoning (POP score: 4-11). The association between OP poisoning severity and hypokalemia was statistically significant (p-value <0.001, OR: 23.958, 95% CI). Conclusion: Serum potassium levels in patients presenting within 12 hours of OP poisoning significantly correlate with severity, as determined by the POP scale. Hypokalemia is prevalent in moderate to severe OP poisoning cases, with higher POP scores linked to lower serum potassium levels.

Genotype-phenotype correlations in children with Gitelman syndrome.

This study aimed to analyze genotype-phenotype correlations in children with Gitelman syndrome (GS). This multicenter retrospective study included 50 Korean children diagnosed with SLC12A3 variants in one or both alleles and the typical laboratory findings of GS. Genetic testing was performed using the Sanger sequencing except for one patient. The median age at the diagnosis was 10.5years (interquartile range, 6.8;14.1), and 41 patients were followed up for a median duration of 5.4years (interquartile range, 4.1;9.6). A total of 30 different SLC12A3 variants were identified. Of the patients, 34 (68%) had biallelic variants, and 16 (32%) had monoallelic variants on examination. Among the patients with biallelic variants, those (n=12) with the truncating variants in one or both alleles had lower serum chloride levels (92.2±3.2 vs. 96.5±3.8mMol/L, P=0.002) at onset, as well as lower serum potassium levels (3.0±0.4 vs. 3.4±0.3mMol/L, P=0.016), and lower serum chloride levels (96.1±1.9 vs. 98.3±3.0mMol/L, P=0.049) during follow-up than those without truncating variants (n=22). Patients with monoallelic variants on examination showed similar phenotypes and treatment responsiveness to those with biallelic variants. Patients with GS who had truncating variants in one or both alleles had more severe electrolyte abnormalities than those without truncating variants. Patients with GS who had monoallelic SLC12A3 variants on examination had almost the same phenotypes, response to treatment, and long-term prognosis as those with biallelic variants.

EFFICACY, SAFETY, AND PATIENT OUTCOMES OF EMERGENCY TREATMENT WITH IV INSULIN-DEXTROSE IN PATIENTS WITH HYPERKALEMIA

Hyperkalemia is a potentially life-threatening condition often encountered in emergency settings. Insulin-dextrose infusion is a common treatment to rapidly lower serum potassium levels, but this approach carries risks, particularly related to glucose imbalances. Objective: To evaluate the efficacy, safety, and clinical outcomes of insulin-dextrose infusion in the emergency treatment of patients with hyperkalemia. Methods: This retrospective study was conducted in the Emergency Department of Shifa International Hospital Islamabad from June 2023 to June 2024. The study included 400 patients with recorded potassium levels. Patients were categorized into non-hyperkalemic (K+ <5.5 mmol/L) and hyperkalemic (K+ ≥ 5.5 mmol/L) groups. Hyperkalemic patients received an insulin-dextrose infusion consisting of an average of 10 units of Actrapid insulin and 50 milliliters of 50% dextrose. Clinical outcomes, including efficacy and safety, were compared between treated hyperkalemic patients and those with moderate-severe hyperkalemia who did not receive the treatment. Statistical analysis was performed using odds ratios (OR) and 95% confidence intervals (CI) to assess the association between treatment variables and outcomes. Results: Glucose imbalances were observed in 60% of patients treated with insulin, with 50% developing hyperglycemia and 20% experiencing hypoglycemia, including 5% with severe hypoglycemia six hours post-treatment. Factors significantly associated with hypoglycemia included multiple insulin doses (OR: 2.9, 95% CI: 2.0-3.9), chronic kidney disease (CKD) (OR: 1.3, 95% CI: 1.0-2.1), and baseline glucose levels below seven mmol/L (OR: 3.0, 95% CI: 2.2-4.2). Hypoglycemic patients had a higher risk of mortality (OR: 1.49, 95% CI: 1.11-2.11). ICU admission occurred in three patients treated with insulin, with a higher risk associated with multiple doses (OR: 1.8, 95% CI: 1.4-2.9) and insulin doses greater than ten units (OR: 5.3, 95% CI: 2.9-10). Conclusion: The use of insulin-dextrose infusion in the emergency management of hyperkalemia is associated with a significant risk of hypoglycemia, ICU admission, and prolonged hospital stay. These findings suggest the need for improved treatment protocols to enhance patient safety in emergency settings.

Impact of sequential (first- to third-generation) EGFR-TKI treatment on corrected QT interval in NSCLC patients.

To evaluate the impact of sequential (first- to third-generation) epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) treatment on top-corrected QT interval (top-QTc) in non-small cell lung cancer (NSCLC) patients. We retrospectively reviewed the medical records of NSCLC patients undergoing sequential EGFR-TKI treatment at Shanghai Chest Hospital between October 2016 and August 2021. The heart rate (HR), top-QT interval, and top-QTc of their ECGs were extracted from the institutional database and analyzed. Logistic regression was performed to identify predictors for top-QTc prolongation. Overall, 228 patients were enrolled. Compared with baseline (median, 368 ms, same below), both first-generation (376 ms vs. 368 ms, p < 0.001) and sequential third-generation EGFR-TKIs (376 ms vs. 368 ms, p = 0.002) prolonged top-QT interval to a similar extent (p = 0.635). Top-QTc (438 ms vs. 423 ms, p < 0.001) and HR (81 bpm vs.79 bpm, p = 0.008) increased after first-generation EGFR-TKI treatment. Further top-QTc prolongation (453 ms vs. 438 ms, p < 0.001) and HR increase (88 bpm vs. 81 bpm, p < 0.001) occurred after treatment advanced. Notably, as HR elevated during treatment, top-QT interval paradoxically increased rather than decreased, and the top-QTc increased rather than slightly fluctuated. Moreover, such phenomena were more significant after treatment advanced. After adjusting for confounding factors, pericardial effusion and lower serum potassium levels were independent predictors of additional QTc prolongation during sequential third-generation EGFR-TKI treatment. First-generation EGFR-TKI could prolong top-QTc, and sequential third-generation EGFR-TKI induced further prolongation. Top-QT interval paradoxically increased and top-QTc significantly increased as HR elevated, which was more significant after sequential EGFR-TKI treatment. Pericardial effusion and lower serum potassium levels were independent predictors of additional QTc prolongation after sequential EGFR-TKI treatment.

Dialysis in Critically Ill Patients with Hypokalemia: A Challenge to Beat by Adjusting Potassium Bath in Dialysate

Acute renal injury (ARI) is common in critically ill patients and frequently makes renal replacement therapy necessary. Low serum potassium level is associated with arrhythmias and mortality in critically ill patients. Adjusting dialysate fluid potassium to higher level helps preventing post hemodialysis hypokalemia. Objective: To establish role of high potassium dialysate in management of hypokalemia in critically ill patients undergoing renal replacement therapy for ARI. Methods: We did a pilot study and performed a cohort on critically ill patients who developed acute renal injury and required renal replacement therapy for acute indications. We designed two groups each consisting 50 patients. Control group underwent hemodialysis with conventional dialysate. For interventional group, we added potassium bath of 3.0meq/l. Pre and post hemodialysis serum potassium levels were measured results mentioned in the form of bar chart. Results: For intervention group mean pre and post hemodialysis serum potassium levels were 3.43±0.36mg/dl and 4.45±5.00mg/dl respectively with no statistically significant difference in pre and post hemodialysis potassium (p=0.156). While, for control group mean pre and post hemodialysis serum potassium levels were 3.69±0.38mg/dl and 2.97±0.29mg/dl respectively. Difference in pre-post mean serum potassium in control group was statistically significant (p&lt;0.001). Furthermore, three patients in control group developed atrial fibrillation in which hypokalemia was confirmed by laboratory testing. Conclusions: Acute dialysis in critical care on hypokalemic patients can be performed safely by adjusting potassium bath in dialysate.

Joint Association of Low Nadir Serum Sodium and Potassium with Worse Outcomes after Ischemic Stroke

Background. Potassium and sodium are inextricably linked to the maintenance of cell potential and electrolyte homeostasis. Few studies have examined their joint relationship with outcomes after stroke. The objective of this study is to ascertain whether combined low nadir serum sodium and potassium levels are correlated with an unfavorable outcome in ischemic stroke. Methods. Retrospective cohort study of 2,920 consecutive patients with first-ever ischemic stroke. Serum sodium and potassium levels were measured at 10 consecutive time points over 10 days poststroke. The Youden Index was performed to identify patients with low nadir sodium (&lt;140 mmol/L) and potassium (&lt;3.65 mmol/L) levels, defined as a NaK score of 2. Multivariable logistic regression and Cox proportional hazard analysis were used to evaluate the independent relationship of sodium and potassium levels with clinical outcomes at three months. Results. A total of 2,920 patients with ischemic stroke were analyzed (mean age 62.14±14.13 years; 60.19% male), of whom 740 (25.3%) with both low nadir sodium and potassium levels had a quintuple 3-month case fatality compared to other patients (10.6% vs. 2.1%). Multivariable analyses identified NaK=2 as an independent predictor of 3-month death (adjusted odds ratio (OR) 2.23; 95% confidence interval (CI) 1.17-4.53; p=0.019) and an unfavorable shift in the distribution of scores on the modified Rankin scale (adjusted OR 1.51, 95% CI 1.12-2.04; p=0.007). Conclusions. Low sodium and potassium levels are common after ischemic stroke and are independent predictors of subsequent death.

Differences in the clinical and hormonal presentation of patients with familial and sporadic primary aldosteronism.

To compare the clinical and hormonal characteristics of patients with familial hyperaldosteronism (FH) and sporadic primary aldosteronism (PA). A systematic review of the literature was performed for the identification of FH patients. The SPAIN-ALDO registry cohort of patients with no suspicion of FH was chosen as the comparator group (sporadic group). A total of 360 FH (246 FH type I, 73 type II, 29 type III, and 12 type IV) cases and 830 sporadic PA patients were included. Patients with FH-I were younger than sporadic cases, and women were more commonly affected (P = 0.003). In addition, the plasma aldosterone concentration (PAC) was lower, plasma renin activity (PRA) higher, and hypokalemia (P < 0.001) less frequent than in sporadic cases. Except for a younger age (P < 0.001) and higher diastolic blood pressure (P = 0.006), the clinical and hormonal profiles of FH-II and sporadic cases were similar. FH-III had a distinct phenotype, with higher PAC and higher frequency of hypokalemia (P < 0.001), and presented 45 years before sporadic cases. Nevertheless, the clinical and hormonal phenotypes of FH-IV and sporadic cases were similar, with the former being younger and having lower serum potassium levels. In addition to being younger and having a family history of PA, FH-I and III share other typical characteristics. In this regard, FH-I is characterized by a low prevalence of hypokalemia and FH-III by a severe aldosterone excess causing hypokalemia in more than 85% of patients. The clinical and hormonal phenotype of type II and IV is similar to the sporadic cases.

High carbohydrate diet induced hypokalemic periodic paralysis: A case report

Hypokalemic periodic paralysis (HypoKPP) is a rare disorder characterised by the sudden onset of muscle weakness associated with low serum potassium levels. A 54-year-old man was admitted to the hospital with an abrupt onset of weakness in his right upper and lower extremities which slowly progressed to involve his left upper and lower extremities. He reported having consumed a carbohydrate-rich meal the day before the episode. Laboratory tests indicated severe hypokalemia with a serum potassium level of 2.3 mEq/L. He was treated with intravenous potassium chloride and his paralysis resolved after correction of hypokalemia. The patient was discharged on potassium supplementation and dietary guidelines were advised.

A multicentral prospective cohort trial of a pharmacist-led nutritional intervention on serum potassium levels in outpatients with chronic kidney disease: The MieYaku-Chronic Kidney Disease project.

Although dietary potassium restriction is an acceptable approach to hyperkalemia prevention, it may be insufficient for outpatients with chronic kidney disease (CKD). Most outpatients with CKD use community pharmacies owing to the free access scheme in Japan. The MieYaku-CKD project included a community pharmacist-led nutritional intervention for dietary potassium restriction, with the goal of determining its efficacy for patients' awareness of potassium restriction and serum potassium levels in outpatients with CKD. This was a five-community pharmacy multicenter prospective cohort study with an open-label, before-and-after comparison design. Eligible patients (n = 25) with an estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73 m2 received nutritional guidance from community pharmacists. The primary outcome was a change in serum potassium levels at 12 weeks post-intervention. The eligible patients' knowledge, awareness, and implementation of potassium restriction were evaluated using a questionnaire. The median value of serum potassium was significantly reduced from 4.7 mEq/L before to 4.4 mEq/L after the intervention [p < 0.001, 95% confidence interval (CI): 0.156-0.500], with no changes in eGFR (p = 0.563, 95% CI: -2.427-2.555) and blood urine nitrogen/serum creatinine ratio (p = 0.904, 95% CI: -1.793-1.214). The value of serum potassium had a tendency of attenuation from 5.3 to 4.6 mEq/L (p = 0.046, 95% CI: 0.272-1.114) in the eGFR < 30 mL/min/1.73 m2 group. A questionnaire revealed that after the intervention, knowledge and attitudes regarding dietary potassium restriction were much greater than before, suggesting that the decrease in serum potassium levels may be related to this nutritional guidance. Our findings indicate that implementing a dietary potassium restriction guidance program in community pharmacies is feasible and may result in lower serum potassium levels in outpatients with CKD.

Hypokalemia as a risk factor for prolonged QT interval and arrhythmia in inherited salt-losing tubulopathy

Purpose: To analyze electrocardiograms (ECGs) of patients with a salt-losing tubulopathy (SLT) and to determine the frequency and risk factors for long QT and arrhythmia.Methods: A total of 203 patients aged &lt;19 years with SLT, specifically Bartter syndrome and Gitelman syndrome, who had a 12-lead ECG were included in this retrospective study. We analyzed the presence of an arrhythmia or prolonged corrected QT (QTc) on ECGs obtained for these patients. Demographic and laboratory data were compared between patients with abnormal and normal ECG findings.Results: Out of the 203 SLT patients, 38 (18.7%) underwent electrocardiography and 10 (40.0%) of 25 patients with inherited SLT had abnormal ECG findings, including prolonged QTc and arrhythmias. The abnormal ECG group had significantly lower serum potassium levels than the normal group (median [interquartile range]: 2.50 mmol/L [2.20–2.83] vs. 2.90 mmol/L [2.70–3.30], &lt;i&gt;p&lt;/i&gt;=0.036), whereas other serum chemistry values did not show significant differences. The cutoff level for a significant difference in QTc interval was serum potassium level &lt;2.50 mmol/L. One cardiac event occurred in a 13-year-old boy, who developed paroxysmal supraventricular tachycardia and underwent cardiac ablation. No sudden cardiac deaths occurred in this cohort.Conclusions: The incidence of ECG abnormalities in patients with inherited SLT was 40.0%, whereas the ECG screening rate was relatively low (18.7%). Therefore, we recommend ECG screening in patients with inherited SLT, especially in those with serum potassium level &lt;2.50 mmol/L.

PREVALENCE OF PATIENT WITH TREATMENT-RESISTANT HYPERTENSION AND SCREENING RATE FOR PRIMARY HYPERALDOSTERONISM IN THAI AMBULATORY CARE SETTING

Objective: Patients with treatment-resistant hypertension (TRH) have significantly higher mortality outcomes when compared with controlled hypertension. Primary hyperaldosteronism (PA) is one of the common treatable causes of this condition. Although the practice guidelines recommend testing for PA among those with TRH, the screening rates in Thailand's ambulatory care setting are unknown. Design and method: This is a single-center cross-sectional study. All hypertensive adults followed at ambulatory clinics of a tertiary care hospital between January 2020, and May 2022 were screened. Patients who met one of two following criteria were diagnosed as TRH: 1) uncontrolled blood pressure (BP) despite the use of 3 antihypertensive drug classes, including diuretics 2) concurrent use of greater than or equal to 4 antihypertensive drug classes, regardless of BP control. Patients without data of consecutive office BP records at least one month apart or lack of laboratory results were excluded. Hypokalemia was defined as a low serum potassium level identified on at least 2 visits. Results: Among 2,047 patients diagnosed with hypertension, the prevalence of TRH was 9.4% (192 patients) with a mean (±SD) age of 74 (±10) years, 59% were women, and the mean number of antihypertensive agents was 3.8±0.7. The screening rate for PA in TRH and non-TRH groups were 3.1% and 0.8%, respectively (p = 0.001). Among those with TRH, the screened PA group significantly had more prevalence of hypokalemia than the non-screened group (33.3% vs 2.7%, p&lt;0.001). From subgroup analysis of all patients with hypokalemia and without hypokalemia, the testing rates for PA were 18.2% and 0.6%, respectively (p&lt;0.001). The average duration from first hypokalemia detection to receiving testing for PA was 19 months. Five of the 20 patients received screening were diagnosed with PA and had better BP control after receiving appropriate treatment. Conclusions: This is the first study in Thailand to examine a PA screening rate in a real-life, ambulatory care setting. The low screening rate reflects the unawareness and inertia of physicians to adhere to guideline-recommended practices. Initiatives to encourage PA screening should be more emphasized and barriers that caused low screening rate should be further explored.

Effect of end-stage kidney disease on the return of spontaneous circulation in Taiwanese adults with out-of-hospital cardiac arrest

Rescuing patients with out-of-hospital cardiac arrest (OHCA), especially those with end-stage kidney disease (ESKD), is challenging. This study hypothesizes that OHCA patients with ESKD undergoing maintenance hemodialysis have (1) higher rates of return of spontaneous circulation (ROSC) during cardio-pulmonary resuscitation (CPR) and (2) lower rates of hyperkalemia and less severe acidosis than those without ESKD. OHCA patients who received CPR between 2011 and 2020 were dichotomized into ESKD and non-ESKD groups. The association of ESKD with “any” and “sustained” ROSC were examined using logistic regression analysis. Furthermore, the effect of ESKD on hospital outcomes for OHCA patients who survived to admission was evaluated using Kaplan–Meier analysis. ESKD patients without “any” ROSC displayed lower potassium and higher pH levels than non-ESKD patients. ESKD was positively associated with “any” ROSC (adjusted-OR: 4.82, 95% CI 2.70–5.16, P < 0.01) and “sustained” ROSC (adjusted-OR: 9.45, 95% CI 3.83–24.13, P < 0.01). Kaplan–Meier analysis demonstrated ESKD patients had a non-inferior hospital survival than non-ESKD patients. OHCA patients with ESKD had lower serum potassium level and less severe acidosis compared to the general population in Taiwan; therefore, should not be treated under the stereotypical assumption that hyperkalemia and acidosis always occur.

Thyroid hypokalemic periodic paralysis.

An unusual presentation of thyrotoxicosis resulting in hypokalemic periodic paralysis is reported here. The patients with this disorder have very low serum potassium levels during the active phase of the disease. Very often, several months pass before the diagnosis is made. Once recognized and the thyrotoxicosis is treated, the patient does well.

Prognostic Implications of Urinary Potassium to Creatinine Ratio in Patients With Predialysis Chronic Kidney Disease: A Cohort Study

Although a low or high serum potassium level in chronic kidney disease (CKD) is associated with worsening renal function and increased cardiovascular disease (CVD) events, urinary potassium excretion has been found to predict adverse health outcomes with conflicting results. We conducted a cohort study to determine whether urinary potassium to creatinine (K/Cr) ratio is an independent risk for further deterioration in renal function or increased CVD events. We identified 650 predialysis patients with CKD hospitalized for an educational program regarding CKD between January 2010 and December 2018. The study outcomes were CKD progression and incident CVD events, with baseline urinary K/Cr ratio categorized into quartiles-Q1, <19.8; Q2, 19.9-27.7; Q3, 27.8-37.9; and Q4, >38.0. During follow-up (median, 35 months), 509 CKD progressions and 129 incident CVD events were identified. Sixty-two patients died during follow-up. Multivariate Cox proportional hazard model showed that after adjustment for demographic factors and laboratory data, patients in Q1 had a 2.02-fold higher risk of worsening renal function than those in Q4 (95% confidence interval, 1.50-2.71; P < 0.001), whereas urinary K/Cr ratio had no association with the incidence of CVD events. Similarly, inverse probability weighting analysis showed an increased risk of CKD progression in the lowest quartile. Furthermore, the association between low fractional excretion of potassium and worsening renal function was confirmed. A low urinary K/Cr ratio is independently associated with worsening renal function but not with a risk of incident CVD event in predialysis patients with CKD.

Impact of clinico-biochemical variations on the etiopathogenesis of cataract: a case-control study.

Purpose: Cataract is a major cause of blindness worldwide with a greater prevalence in developing countries like India. Owing to speculations about the relationship of various biochemical markers and cataract formation this case-control study was designed with the aim to know the impact of serum blood sugar, serum electrolytes and serum calcium on the etiopathogenesis of cataract in Kashmiri population. Methods: A total of 300 cases diagnosed with cataract and 360 healthy controls were taken for the study. Serum of all the cases and controls was analyzed for blood sugar and calcium using spectrometric techniques. Sodium and potassium were analyzed using Ion-Selective Electrode technology. All the investigations were done on ABBOTT c4000 fully automatic clinical chemistry analyzer. Results: Most of the patients in our study were ≥50 years of age having posterior subcapsular cataract. The mean levels of serum fasting blood sugar (mg/dL), serum sodium (mmol/L), serum potassium (mmol/L) and serum calcium (mg/dL) were 99.4 ± 7.7; 140.4 ± 2.5; 4.2 ± 0.5; and 8.9 ± 0.5, respectively, in cases compared to 107.7 ± 12.3; 142.9 ± 5.0; 3.8 ± 0.5; and 8.3 ± 1.7, respectively, in healthy controls. A significantly higher number of cataract cases had elevated serum glucose and sodium levels, low serum potassium and calcium levels compared to healthy controls. Conclusions: Hyperglycemia, hypernatremia, hypokalemia and hypocalcemia can independently increase the patients’ risk to cataracts. Corrections in these biochemical parameters may reduce cataract incidence.

Model-based exploration of hypokalemia in dairy cows

Hypokalemia in dairy cows, which is characterized by too low serum potassium levels, is a severe mineral disorder that can be life threatening. In this paper, we explore different originating conditions of hypokalemia—reduced potassium intake, increased excretion, acid-base disturbances, and increased insulin—by using a dynamic mathematical model for potassium balance in non-lactating and lactating cows. The simulations confirm observations described in literature. They illustrate, for example, that changes in dietary intake or excretion highly effect intracellular potassium levels, whereas extracellular levels vary only slightly. Simulations also show that the higher the potassium content in the diet, the more potassium is excreted with urine. Application of the mathematical model assists in experimental planning and therefore contributes to the 3R strategy: reduction, refinement and replacement of animal experiments.

The metabolic phenotype of patients with primary aldosteronism: impact of subtype and sex - a multicenter-study of 3566 Caucasian and Asian subjects.

Accumulating evidence suggests that primary aldosteronism (PA) is associated with several features of the metabolic syndrome, in particular with obesity, type 2 diabetes mellitus, and dyslipidemia. Whether these manifestations are primarily linked to aldosterone-producing adenoma (APA) or bilateral idiopathic hyperaldosteronism (IHA) remains unclear. The aim of the present study was to investigate differences in metabolic parameters between APA and IHA patients and to assess the impact of treatment on these clinical characteristics. We conducted a retrospective multicenter study including 3566 patients with APA or IHA of Caucasian and Asian origin. We compared the prevalence of metabolic disorders between APA and IHA patients at the time of diagnosis and 1-year post-intervention, with special references to sex differences. Furthermore, correlations between metabolic parameters and plasma aldosterone, renin, or plasma cortisol levels after 1 mg dexamethasone (DST) were performed. As expected, APA patients were characterized by higher plasma aldosterone and lower serum potassium levels. Only female IHA patients demonstrated significantly worse metabolic parameters than age-matched female APA patients, which were associated with lower cortisol levels upon DST. One-year post-intervention, female adrenalectomized patients showed deterioration of their lipid profile, when compared to patients treated with mineralocorticoid receptor antagonists. Plasma aldosterone levels negatively correlated with the BMI only in APA patients. Metabolic alterations appear more prominent in women with IHA. Although IHA patients have worse metabolic profiles, a correlation with cortisol autonomy is documented only in APAs, suggesting an uncoupling of cortisol action from metabolic traits in IHA patients.

Low potassium disrupt intestinal barrier and result in bacterial translocation

BackgroundBacterial translocation was observed in critical illness and patients with chronic diseases such as liver cirrhosis and chronic kidney disease (CKD). Hypokalemia is a common complication in these diseases. Whether low potassium diet may increase intestinal permeability and result in bacterial translocation lack of evidence. The present study was aimed to investigate the potential effects of LK on intestinal permeability.MethodsGrade 8-week-old male Bal B/C mice were randomly placed either on a normal potassium (NK) mouse chow or a low potassium (LK) diet for 28 days. Intestinal permeability and expression of tight junction proteins were compared between the two groups.ResultsCompared with the NK group, the mice in LK group had significantly lower serum potassium level, increased levels of plasmas endotoxin and plasma d-lactate. The bacterial translocation was higher and in occurred mainly in mesenteric lymph nodes (MLN), liver and spleen. The pathologic change of small intestine was obvious with thinner villus lamina propria, shorter crypt depth and thinner intestinal wall. Slight increases in the expression of proteins and mRNA levels of both claudin-1 and claudin-2 were observed in LK group.ConclusionsLow potassium diet could increase intestinal permeability and thereby lead to bacterial translocation, which was suspected to result from impaired intestinal epithelial barrier and biological barrier.

Potassium Intake-(Un)Expected Non-Predictor of Higher Serum Potassium Levels in Hemodialysis DASH Diet Consumers.

As high serum potassium levels can lead to adverse outcomes in hemodialysis (HD) patients, dietary potassium is frequently restricted in these patients. However, recent studies have questioned whether dietary potassium really affects serum potassium levels. The dietary approaches to stop hypertension (DASH) diet is considered a healthy dietary pattern that has been related to lower risk of developing end-stage kidney disease. The aim of this study was to analyze the association between a dietary pattern with high content of potassium-rich foods and serum potassium levels in HD patients. This was an observational, cross-sectional, multicenter study with 582 HD patients from 37 dialysis centers. Clinical and biochemical data were registered. Dietary intake was obtained using the Food Frequency Questionnaire. Adherence to the DASH dietary pattern was obtained from Fung’s DASH index. All statistical tests were performed using SPSS 26.0 software. A p-value lower than 0.05 was considered statistically significant. Patients’ mean age was 67.8 ± 17.7 years and median HD vintage was 65 (43–104) months. Mean serum potassium was 5.3 ± 0.67 mEq/L, dietary potassium intake was 2465 ± 1005 mg/day and mean Fung´s Dash Index was 23.9 ± 3.9. Compared to the lower adherence to the DASH dietary pattern, patients with a higher adherence to the DASH dietary pattern were older (p < 0.001); presented lower serum potassium (p = 0.021), serum sodium (p = 0.028), total fat intake (p = 0.001) and sodium intake (p < 0.001); and had higher carbohydrate intake (p < 0.001), fiber intake (p < 0.001), potassium intake (p < 0.001), phosphorus intake (p < 0.001) and body mass index (p = 0.002). A higher adherence to this dietary pattern was a predictor of lower serum potassium levels (p = 0.004), even in the adjusted model (p = 0.016). Following the DASH dietary pattern, which is rich in potassium, is not associated with increased serum potassium levels in HD patients. Furthermore, a higher adherence to the DASH dietary pattern predicts lower serum potassium levels. Therefore, generalized dietary potassium restrictions may not be adequate, at least for those with a DASH diet plan.

MO904: Potassium Intake Does Not Predict High Serum Potassium Levels in Haemodialysis Dash Diet Consumers

Abstract BACKGROUND AND AIMS As high serum potassium levels can lead to adverse outcomes in haemodialysis (HD) patients, dietary potassium is frequently restricted in these patients. However, recent studies have questioned whether dietary potassium really affects serum potassium levels. Dietary approaches to stop hypertension (DASH) emphasizes the consumption of potassium rich foods, specially from plant sources, such as: fruits, vegetables, whole grains, nuts and seeds. The aim of this study was to analyze the association between the DASH dietary pattern and serum potassium levels. METHOD This was an observational cross-sectional multicentre study with 582 HD patients from 37 dialysis centers. Clinical and biochemical data were registered. Dietary intake was obtained using the Food Frequency Questionnaire. Adherence to DASH dietary pattern was obtained from Fung´s DASH index (8–40 points). For the statistical analysis, Fung´s DASH index was categorized into terciles and mean differences were analyzed with one-way ANOVA. Linear regression was used to analyze the relationship between serum potassium and adherence to the Dash dietary pattern. The multivariate model was adjusted to age, gender, presence of diabetes mellitus, energy intake, dietary potassium intake, residual diuresis, dialysis adequacy (Kt/V), dialysis vintage and intake of potassium binders. All statistical tests were performed using SPSS 26.0 software. A P-value lower than 0.05, was considered statistically significant. RESULTS Patients’ mean age was 67.8 ± 17.7 years and median HD vintage was 65 (43–104) months. Mean serum potassium was 5.3 ± 0.67 mEq/L, dietary potassium intake was 2465 ± 1005 mg/day and mean Fung´s Dash Index was 23.9 ± 3.9. Of the whole sample, 36.4% of the patients presented low adherence to the DASH dietary pattern (0–22 points), 39.0% presented a moderate adherence (23–26 points) whereas 24.6% a high adherence (≥27 points). Comparing to the lower adherence, patients with a higher adherence to the DASH dietary pattern were older (P &amp;lt; 0.005), presented lower serum potassium (P = 0.021), serum sodium (P = 0.028), albumin (P = 0.030), creatinine (P &amp;lt; 0.005), energy intake (P = 0.006), protein intake (P = 0.010), total fat intake (P = 0.001), sodium intake (P &amp;lt; 0.005), lean tissue index (P = 0.006) and higher carbohydrates intake (P = 0.007), fiber intake (P &amp;lt; 0.005), potassium intake (P &amp;lt; 0.005), body mass index (P = 0.002) and fat tissue index (P &amp;lt; 0.005). No differences were observed in potassium binders, Kt/V, C-reactive protein nor haemoglobin. A higher adherence to this dietary pattern was a predictor of lower serum potassium levels (P = 0.004), even in the adjusted model (P = 0.016). CONCLUSION Most of the patients presented a moderate adherence to the DASH dietary pattern. Following this dietary pattern, which is rich in potassium, is not associated with increased serum potassium levels in HD patients. What is more, a higher adherence to the DASH dietary pattern predicts lower serum potassium levels. Therefore, tight dietary potassium restrictions may not be adequate, at least for those with a DASH diet plan as a more flexible diet, especially regarding plant-based foods rich in potassium, may promote other health benefits and reduce patient´s dietary plan limitations.