title: Potassium: friend or foe?
abstract: The kidney plays an essential role in maintaining homeostasis of ion concentrations in the blood. Because the concentration gradient of potassium across the cell membrane is a key determinant of the membrane potential of cells, even small deviations in serum potassium level from the normal setpoint can lead to severe muscle dysfunction, resulting in respiratory failure and cardiac arrest. Less severe hypo- and hyperkalemia are also associated with morbidity and mortality across various patient populations. In addition, deficiencies in potassium intake have been associated with hypertension and adverse cardiovascular and renal outcomes, likely due in part to the interrelated handling of sodium and potassium by the kidney. Here, data on the beneficial effects of potassium on blood pressure and cardiovascular and renal outcomes will be reviewed, along with the physiological basis for these effects. In some patient populations, however, potassium excess is deleterious. Risk factors for the development of hyperkalemia will be reviewed, as well as the risks and benefits of existing and emerging therapies for hyperkalemia.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, 75390-8856, USA. Aylin.rodan@utsouthwestern.edu.
authors.forename: Aylin R
authors.initials: AR
authors.lastname: Rodan
mesh_terms: D000450:Aldosterone / Q000378:metabolism; D002411:Cation Exchange Resins / Q000627:therapeutic use; D002462:Cell Membrane / Q000502:physiology*; D002648:Child; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology; D006706:Homeostasis; D006801:Humans; D006947:Hyperkalemia / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D006973:Hypertension / Q000097:blood / Q000503:physiopathology; D007008:Hypokalemia / Q000097:blood / Q000503:physiopathology*; D007668:Kidney / Q000502:physiology; D008564:Membrane Potentials; D011108:Polymers / Q000627:therapeutic use; D011188:Potassium / Q000097:blood / Q000502:physiology*; D017419:Potassium, Dietary / Q000009:adverse effects; D017346:Protein Serine-Threonine Kinases / Q000378:metabolism; D064167:Recommended Dietary Allowances; D065667:Renal Elimination; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology; D012131:Respiratory Insufficiency / Q000097:blood* / Q000503:physiopathology; D012307:Risk Factors; D015398:Signal Transduction; D017640:Silicates / Q000627:therapeutic use; D012964:Sodium / Q000378:metabolism; D049992:Sodium Chloride Symporters / Q000378:metabolism; D000076204:WNK Lysine-Deficient Protein Kinase 1 / Q000378:metabolism
chemical_list: D002411:Cation Exchange Resins; D011108:Polymers; D017419:Potassium, Dietary; D017640:Silicates; D049992:Sodium Chloride Symporters; C568789:patiromer; D000450:Aldosterone; D012964:Sodium; C000597310:sodium zirconium cyclosilicate; C118135:OXSR1 protein, human; D017346:Protein Serine-Threonine Kinases; C486409:STK39 protein, human; D000076204:WNK Lysine-Deficient Protein Kinase 1; C498743:WNK1 protein, human; D011188:Potassium
keywords: Hyperkalemia; Hypokalemia; Patiromer; Potassium homeostasis; Potassium intake; Sodium polystyrene sulfonate; ZS-9