TY - JOUR
T1 - Potassium homeostasis and management of dyskalemia in kidney diseases
T2 - conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
AU - Clase, Catherine M.
AU - Carrero, Juan Jesus
AU - Ellison, David H.
AU - Grams, Morgan E.
AU - Hemmelgarn, Brenda R.
AU - Jardine, Meg J.
AU - Kovesdy, Csaba P.
AU - Kline, Gregory A.
AU - Lindner, Gregor
AU - Obrador, Gregorio T.
AU - Palmer, Biff F.
AU - Cheung, Michael
AU - Wheeler, David C.
AU - Winkelmayer, Wolfgang C.
AU - Pecoits-Filho, Roberto
AU - Ashuntantang, Gloria E.
AU - Bakker, Stephan J.L.
AU - Bakris, George L.
AU - Bhandari, Sunil
AU - Burdmann, Emmanuel A.
AU - Campbell, Katrina L.
AU - Charytan, David M.
AU - Clegg, Deborah J.
AU - Cuppari, Lilian
AU - Goldsmith, David
AU - Hallan, Stein I.
AU - He, Jiang
AU - Herzog, Charles A.
AU - Hoenig, Melanie P.
AU - Hoorn, Ewout J.
AU - Leipziger, Jens Georg
AU - Leonberg-Yoo, Amanda K.
AU - Lerma, Edgar V.
AU - Lopez-Almaraz, Jose Ernesto
AU - Małyszko, Jolanta
AU - Mann, Johannes F.E.
AU - Marklund, Matti
AU - McDonough, Alicia A.
AU - Nagahama, Masahiko
AU - Navaneethan, Sankar D.
AU - Pitt, Bertram
AU - Pochynyuk, Oleh M.
AU - Proença de Moraes, Thyago
AU - Rafique, Zubaid
AU - Robinson, Bruce M.
AU - Roger, Simon D.
AU - Rossignol, Patrick
AU - Singer, Adam J.
AU - Smyth, Andrew
AU - Sood, Manish M.
AU - Walsh, Michael
AU - Weir, Matthew R.
AU - Wingo, Charles S.
N1 - Funding Information:
The conference was sponsored by KDIGO and supported in part by unrestricted educational grants from AstraZeneca, Bayer HealthCare, Boehringer Ingelheim, Fresenius Medical Care, Relypsa, and Vifor Fresenius Medical Care Renal Pharma.
Funding Information:
CMC declared having received consultancy fees from Amgen, Astellas, Baxter, Boehringer-Ingelheim, Janssen, Johnson & Johnson, LEO Pharma, Pfizer, and Ministry of Health Ontario; is expected to receive fees from Ministry of Health Ontario for future consultancy work; and speaker honoraria from Sanofi. J-JC declared having received consultancy fees from Astellas, AstraZeneca, and Baxter; is expected to receive fees from AstraZeneca and Rubio for future consultancy work; speaker honoraria from AstraZeneca and Vifor; and research support from AstraZeneca. MEG declared having received research support from National Kidney Foundation and National Institute of Diabetes and Digestive and Kidney Diseases. MJJ declared having received consultancy fees from Akebia, Baxter, and Vifor; speaker honoraria from Janssen and Vifor; and research support from Eli Lily and Merck Sharpe & Dohme. CPK declared having received consultancy fees from Abbott, Abbvie, Amgen, AstraZeneca, Bayer, Dr. Schar, Fresenius Medical Care, Keryx, Relypsa, Sanofi-Aventis, and Takeda; speaker honoraria from Abbott, Keryx, and Sanofi-Aventis; travel support from Abbott, Abbvie, Amgen, Bayer, Fresenius Medical Care, Keryx, and Sanofi-Aventis; and research support from the National Institutes of Health. GL is expected to receive fees from Otsuka for future consultancy work; and has declared speaker honoraria from Otsuka. GTO declared having received consultancy fees from GSK, Johnson & Johnson, and Roche; and speaker fees from Abbvie and Roche. DCW declared having received consultancy fees from Amgen, AstraZeneca, Boehringer Ingelheim, Janssen, Mitsubishi, Napp/Mundipharma, Ono, and Vifor Fresenius; and speaker honoraria from Amgen, Astellas, Napp/Mundipharma, Pharmacosmos, and Vifor Fresenius. WCW declared having received consultancy fees from Akebia, AMAG, Amgen, AstraZeneca, Bayer, Daichii-Sankyo, Relypsa, and ZS Pharma; speaker honoraria from FibroGen; and research support from the National Institutes of Health. RP-F declared having received consultancy fees from Akebia, AstraZeneca, Fresenius Medical Care, and Novo Nordisk; speaker honoraria from AstraZeneca and Novo Nordisk; and research support from Fresenius Medical Care. All the other authors declared no competing interests.
Publisher Copyright:
© 2019 International Society of Nephrology
PY - 2020/1
Y1 - 2020/1
N2 - Potassium disorders are common in patients with kidney disease, particularly in patients with tubular disorders and low glomerular filtration rate. A multidisciplinary group of researchers and clinicians met in October 2018 to identify evidence and address controversies in potassium management. The issues discussed encompassed our latest understanding of the regulation of tubular potassium excretion in health and disease; the relationship of potassium intake to cardiovascular and kidney outcomes, with increasing evidence showing beneficial associations with plant-based diet and data to suggest a paradigm shift from the idea of dietary restriction toward fostering patterns of eating that are associated with better outcomes; the paucity of data on the effect of dietary modification in restoring abnormal serum potassium to the normal range; a novel diagnostic algorithm for hypokalemia that takes into account the ascendency of the clinical context in determining cause, aligning the educational strategy with a practical approach to diagnosis; and therapeutic approaches in managing hyperkalemia when chronic and in the emergency or hospital ward. In sum, we provide here our conference deliberations on potassium homeostasis in health and disease, guidance for evaluation and management of dyskalemias in the context of kidney diseases, and research priorities in each of the above areas.
AB - Potassium disorders are common in patients with kidney disease, particularly in patients with tubular disorders and low glomerular filtration rate. A multidisciplinary group of researchers and clinicians met in October 2018 to identify evidence and address controversies in potassium management. The issues discussed encompassed our latest understanding of the regulation of tubular potassium excretion in health and disease; the relationship of potassium intake to cardiovascular and kidney outcomes, with increasing evidence showing beneficial associations with plant-based diet and data to suggest a paradigm shift from the idea of dietary restriction toward fostering patterns of eating that are associated with better outcomes; the paucity of data on the effect of dietary modification in restoring abnormal serum potassium to the normal range; a novel diagnostic algorithm for hypokalemia that takes into account the ascendency of the clinical context in determining cause, aligning the educational strategy with a practical approach to diagnosis; and therapeutic approaches in managing hyperkalemia when chronic and in the emergency or hospital ward. In sum, we provide here our conference deliberations on potassium homeostasis in health and disease, guidance for evaluation and management of dyskalemias in the context of kidney diseases, and research priorities in each of the above areas.
KW - acute hyperkalemia
KW - chronic hyperkalemia
KW - dietary potassium
KW - hypokalemia
KW - plasma potassium
KW - potassium homeostasis
KW - serum potassium
UR - http://www.scopus.com/inward/record.url?scp=85075513152&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85075513152&partnerID=8YFLogxK
U2 - 10.1016/j.kint.2019.09.018
DO - 10.1016/j.kint.2019.09.018
M3 - Article
C2 - 31706619
AN - SCOPUS:85075513152
SN - 0085-2538
VL - 97
SP - 42
EP - 61
JO - Kidney International
JF - Kidney International
IS - 1
ER -