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Treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized POTCAST substudy

OBJECTIVE: Hypokalemia is associated with increased risk of arrhythmias and it is recommended to monitor plasma potassium (p-K) regularly in at-risk patients with cardiovascular diseases. It is poorly understood if administration of potassium supplements and mineralocorticoid receptor antagonists (M...

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Autores principales: Winsløw, Ulrik, Sakthivel, Tharsika, Zheng, Chaoqun, Bosselmann, Helle, Haugan, Ketil, Bruun, Niels, Larroudé, Charlotte, Iversen, Kasper, Saffi, Hillah, Frandsen, Emil, Oturai, Peter, Jensen, Holger Jan, Vinther, Michael, Risum, Niels, Bundgaard, Henning, Jøns, Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10355384/
https://www.ncbi.nlm.nih.gov/pubmed/37467227
http://dx.doi.org/10.1371/journal.pone.0288756
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author Winsløw, Ulrik
Sakthivel, Tharsika
Zheng, Chaoqun
Bosselmann, Helle
Haugan, Ketil
Bruun, Niels
Larroudé, Charlotte
Iversen, Kasper
Saffi, Hillah
Frandsen, Emil
Oturai, Peter
Jensen, Holger Jan
Vinther, Michael
Risum, Niels
Bundgaard, Henning
Jøns, Christian
author_facet Winsløw, Ulrik
Sakthivel, Tharsika
Zheng, Chaoqun
Bosselmann, Helle
Haugan, Ketil
Bruun, Niels
Larroudé, Charlotte
Iversen, Kasper
Saffi, Hillah
Frandsen, Emil
Oturai, Peter
Jensen, Holger Jan
Vinther, Michael
Risum, Niels
Bundgaard, Henning
Jøns, Christian
author_sort Winsløw, Ulrik
collection PubMed
description OBJECTIVE: Hypokalemia is associated with increased risk of arrhythmias and it is recommended to monitor plasma potassium (p-K) regularly in at-risk patients with cardiovascular diseases. It is poorly understood if administration of potassium supplements and mineralocorticoid receptor antagonists (MRA) aimed at increasing p-K also increases intracellular potassium. METHODS: Adults aged≥18 years with an implantable cardioverter defibrillator (ICD) were randomized (1:1) to a control group or to an intervention that included guidance on potassium rich diets, potassium supplements, and MRA to increase p-K to target levels of 4.5–5.0 mmol/l for six months. Total-body-potassium (TBK) was measured by a Whole-Body-Counter along with p-K at baseline, after six weeks, and after six months. RESULTS: Fourteen patients (mean age: 59 years (standard deviation 14), 79% men) were included. Mean p-K was 3.8 mmol/l (0.2), and mean TBK was 1.50 g/kg (0.20) at baseline. After six-weeks, p-K had increased by 0.47 mmol/l (95%CI:0.14;0.81), p = 0.008 in the intervention group compared to controls, whereas no significant difference was found in TBK (44 mg/kg (-20;108), p = 0.17). After six-months, no significant difference was found in p-K as compared to baseline (0.16 mmol/l (-0.18;0.51), p = 0.36), but a significant increase in TBK of 82 mg/kg (16;148), p = 0.017 was found in the intervention group compared to controls. CONCLUSIONS: Increased potassium intake and MRAs increased TBK gradually and a significant increase was seen after six months. The differentially regulated p-K and TBK challenges current knowledge on potassium homeostasis and the time required before the full potential of p-K increasing treatment can be anticipated. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT03833089).
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spelling pubmed-103553842023-07-20 Treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized POTCAST substudy Winsløw, Ulrik Sakthivel, Tharsika Zheng, Chaoqun Bosselmann, Helle Haugan, Ketil Bruun, Niels Larroudé, Charlotte Iversen, Kasper Saffi, Hillah Frandsen, Emil Oturai, Peter Jensen, Holger Jan Vinther, Michael Risum, Niels Bundgaard, Henning Jøns, Christian PLoS One Research Article OBJECTIVE: Hypokalemia is associated with increased risk of arrhythmias and it is recommended to monitor plasma potassium (p-K) regularly in at-risk patients with cardiovascular diseases. It is poorly understood if administration of potassium supplements and mineralocorticoid receptor antagonists (MRA) aimed at increasing p-K also increases intracellular potassium. METHODS: Adults aged≥18 years with an implantable cardioverter defibrillator (ICD) were randomized (1:1) to a control group or to an intervention that included guidance on potassium rich diets, potassium supplements, and MRA to increase p-K to target levels of 4.5–5.0 mmol/l for six months. Total-body-potassium (TBK) was measured by a Whole-Body-Counter along with p-K at baseline, after six weeks, and after six months. RESULTS: Fourteen patients (mean age: 59 years (standard deviation 14), 79% men) were included. Mean p-K was 3.8 mmol/l (0.2), and mean TBK was 1.50 g/kg (0.20) at baseline. After six-weeks, p-K had increased by 0.47 mmol/l (95%CI:0.14;0.81), p = 0.008 in the intervention group compared to controls, whereas no significant difference was found in TBK (44 mg/kg (-20;108), p = 0.17). After six-months, no significant difference was found in p-K as compared to baseline (0.16 mmol/l (-0.18;0.51), p = 0.36), but a significant increase in TBK of 82 mg/kg (16;148), p = 0.017 was found in the intervention group compared to controls. CONCLUSIONS: Increased potassium intake and MRAs increased TBK gradually and a significant increase was seen after six months. The differentially regulated p-K and TBK challenges current knowledge on potassium homeostasis and the time required before the full potential of p-K increasing treatment can be anticipated. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT03833089). Public Library of Science 2023-07-19 /pmc/articles/PMC10355384/ /pubmed/37467227 http://dx.doi.org/10.1371/journal.pone.0288756 Text en © 2023 Winsløw et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Winsløw, Ulrik
Sakthivel, Tharsika
Zheng, Chaoqun
Bosselmann, Helle
Haugan, Ketil
Bruun, Niels
Larroudé, Charlotte
Iversen, Kasper
Saffi, Hillah
Frandsen, Emil
Oturai, Peter
Jensen, Holger Jan
Vinther, Michael
Risum, Niels
Bundgaard, Henning
Jøns, Christian
Treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized POTCAST substudy
title Treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized POTCAST substudy
title_full Treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized POTCAST substudy
title_fullStr Treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized POTCAST substudy
title_full_unstemmed Treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized POTCAST substudy
title_short Treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized POTCAST substudy
title_sort treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized potcast substudy
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10355384/
https://www.ncbi.nlm.nih.gov/pubmed/37467227
http://dx.doi.org/10.1371/journal.pone.0288756
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