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Changes in Serum and Urinary Potassium Handling Associated with Renin-Angiotensin-Aldosterone System Inhibitors in Advanced Chronic Kidney Disease Patients

Objective This study aimed to (i) compare the extent of urinary potassium (K(+)) excretion in addition to the changes in serum K(+) concentration: and (ii) clarify the association between changes in serum K(+) concentration, urinary K(+) excretion, and acid-base status with or without renin-angioten...

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Autores principales: Ueda, Yuichiro, Ookawara, Susumu, Miyazawa, Haruhisa, Ito, Kiyonori, Hirai, Keiji, Hoshino, Taro, Morishita, Yoshiyuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820673/
https://www.ncbi.nlm.nih.gov/pubmed/31695981
http://dx.doi.org/10.7759/cureus.5561
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author Ueda, Yuichiro
Ookawara, Susumu
Miyazawa, Haruhisa
Ito, Kiyonori
Hirai, Keiji
Hoshino, Taro
Morishita, Yoshiyuki
author_facet Ueda, Yuichiro
Ookawara, Susumu
Miyazawa, Haruhisa
Ito, Kiyonori
Hirai, Keiji
Hoshino, Taro
Morishita, Yoshiyuki
author_sort Ueda, Yuichiro
collection PubMed
description Objective This study aimed to (i) compare the extent of urinary potassium (K(+)) excretion in addition to the changes in serum K(+) concentration: and (ii) clarify the association between changes in serum K(+) concentration, urinary K(+) excretion, and acid-base status with or without renin-angiotensin-aldosterone system (RAAS) inhibitors in patients with advanced chronic kidney disease (CKD) stages. Methods Six hundred and ninety-one patients with advanced CKD (CKD G3b, 161; G4, 271; G5, 259) were retrospectively evaluated. Differences in serum K(+) concentration, urinary K(+) excretion, and serum sodium and chloride differences (Na(+)−Cl(-)) were compared among patients with RAAS inhibitors, RAAS inhibitors and diuretic agents, and without either medication in each CKD stage. Results Serum K(+) concentrations in patients with RAAS inhibitors were significantly higher than in those with RAAS inhibitors and diuretics in CKD stage G3b and the other two treatment groups in CKD stage G4. Urinary K(+) excretion among the three groups did not differ significantly in each CKD stage. Serum Na(+)−Cl(-) differences in patients with RAAS inhibitors were significantly smaller than in those with RAAS inhibitors and diuretics in CKD stages G3b (p = 0.006) and the other two groups in CKD stage G4 (vs. RAAS inhibitors and diuretics, p <0.001; vs. without either medication, p = 0.008). Conclusion Our study demonstrated that RAAS inhibitor use might be associated with hyperkalemia via not decreased urinary K(+) excretion but rather K(+) redistribution from intracellular to extracellular fluid induced by the progression of metabolic acidosis in patients with advanced CKD, particularly stages G3b and G4.
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spelling pubmed-68206732019-11-06 Changes in Serum and Urinary Potassium Handling Associated with Renin-Angiotensin-Aldosterone System Inhibitors in Advanced Chronic Kidney Disease Patients Ueda, Yuichiro Ookawara, Susumu Miyazawa, Haruhisa Ito, Kiyonori Hirai, Keiji Hoshino, Taro Morishita, Yoshiyuki Cureus Nephrology Objective This study aimed to (i) compare the extent of urinary potassium (K(+)) excretion in addition to the changes in serum K(+) concentration: and (ii) clarify the association between changes in serum K(+) concentration, urinary K(+) excretion, and acid-base status with or without renin-angiotensin-aldosterone system (RAAS) inhibitors in patients with advanced chronic kidney disease (CKD) stages. Methods Six hundred and ninety-one patients with advanced CKD (CKD G3b, 161; G4, 271; G5, 259) were retrospectively evaluated. Differences in serum K(+) concentration, urinary K(+) excretion, and serum sodium and chloride differences (Na(+)−Cl(-)) were compared among patients with RAAS inhibitors, RAAS inhibitors and diuretic agents, and without either medication in each CKD stage. Results Serum K(+) concentrations in patients with RAAS inhibitors were significantly higher than in those with RAAS inhibitors and diuretics in CKD stage G3b and the other two treatment groups in CKD stage G4. Urinary K(+) excretion among the three groups did not differ significantly in each CKD stage. Serum Na(+)−Cl(-) differences in patients with RAAS inhibitors were significantly smaller than in those with RAAS inhibitors and diuretics in CKD stages G3b (p = 0.006) and the other two groups in CKD stage G4 (vs. RAAS inhibitors and diuretics, p <0.001; vs. without either medication, p = 0.008). Conclusion Our study demonstrated that RAAS inhibitor use might be associated with hyperkalemia via not decreased urinary K(+) excretion but rather K(+) redistribution from intracellular to extracellular fluid induced by the progression of metabolic acidosis in patients with advanced CKD, particularly stages G3b and G4. Cureus 2019-09-04 /pmc/articles/PMC6820673/ /pubmed/31695981 http://dx.doi.org/10.7759/cureus.5561 Text en Copyright © 2019, Ueda et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Nephrology
Ueda, Yuichiro
Ookawara, Susumu
Miyazawa, Haruhisa
Ito, Kiyonori
Hirai, Keiji
Hoshino, Taro
Morishita, Yoshiyuki
Changes in Serum and Urinary Potassium Handling Associated with Renin-Angiotensin-Aldosterone System Inhibitors in Advanced Chronic Kidney Disease Patients
title Changes in Serum and Urinary Potassium Handling Associated with Renin-Angiotensin-Aldosterone System Inhibitors in Advanced Chronic Kidney Disease Patients
title_full Changes in Serum and Urinary Potassium Handling Associated with Renin-Angiotensin-Aldosterone System Inhibitors in Advanced Chronic Kidney Disease Patients
title_fullStr Changes in Serum and Urinary Potassium Handling Associated with Renin-Angiotensin-Aldosterone System Inhibitors in Advanced Chronic Kidney Disease Patients
title_full_unstemmed Changes in Serum and Urinary Potassium Handling Associated with Renin-Angiotensin-Aldosterone System Inhibitors in Advanced Chronic Kidney Disease Patients
title_short Changes in Serum and Urinary Potassium Handling Associated with Renin-Angiotensin-Aldosterone System Inhibitors in Advanced Chronic Kidney Disease Patients
title_sort changes in serum and urinary potassium handling associated with renin-angiotensin-aldosterone system inhibitors in advanced chronic kidney disease patients
topic Nephrology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820673/
https://www.ncbi.nlm.nih.gov/pubmed/31695981
http://dx.doi.org/10.7759/cureus.5561
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