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健康与疾病中的钾稳态:由美国国家肾脏基金会和美国高血压学会联合主办的科学研讨会

Potassium homeostasis in health and disease: A scientific workshop cosponsored by the National Kidney Foundation and the American Society of Hypertension.

作者信息

Kovesdy Csaba P, Appel Lawrence J, Grams Morgan E, Gutekunst Lisa, McCullough Peter A, Palmer Biff F, Pitt Bertram, Sica Dominic A, Townsend Raymond R

机构信息

University of Tennessee Health Science Center, Memphis, TN.

Johns Hopkins University School of Medicine, Baltimore, MD.

出版信息

J Am Soc Hypertens. 2017 Dec;11(12):783-800. doi: 10.1016/j.jash.2017.09.011. Epub 2017 Oct 10.

Abstract

While much emphasis, and some controversy, centers on recommendations for sodium intake, there has been considerably less interest in recommendations for dietary potassium intake, in both the general population and patients with medical conditions, particularly acute and chronic kidney disease. Physiology literature and cohort studies have noted that the relative balance in sodium and potassium intakes is an important determinant of many of the sodium-related outcomes. A noteworthy characteristic of potassium in clinical medicine is the extreme concern shared by many practitioners when confronted by a patient with hyperkalemia. Fear of this often asymptomatic finding limits enthusiasm for recommending potassium intake and often limits the use of renin-angiotensin-aldosterone system blockers in patients with heart failure and chronic kidney diseases. New agents for managing hyperkalemia may alter the long-term management of heart failure and the hypertension, proteinuria, and further function loss in chronic kidney diseases. In this jointly sponsored effort between the American Society of Hypertension and the National Kidney Foundation, 3 panels of researchers and practitioners from various disciplines discussed and summarized current understanding of the role of potassium in health and disease, focusing on cardiovascular, nutritional, and kidney considerations associated with both hypo- and hyperkalemia.

摘要

尽管很多重点以及一些争议都集中在钠摄入量的建议上,但无论是普通人群还是患有疾病(尤其是急慢性肾病)的患者,对膳食钾摄入量建议的关注都要少得多。生理学文献和队列研究指出,钠和钾摄入量的相对平衡是许多与钠相关结果的重要决定因素。临床医学中钾的一个值得注意的特点是,许多从业者在面对高钾血症患者时会表现出极度担忧。对这种通常无症状的情况的恐惧限制了推荐钾摄入量的积极性,并且常常限制了心力衰竭和慢性肾病患者使用肾素 - 血管紧张素 - 醛固酮系统阻滞剂。治疗高钾血症的新药物可能会改变心力衰竭的长期管理以及慢性肾病中的高血压、蛋白尿和进一步的功能丧失情况。在美国高血压学会和美国国家肾脏基金会的这项联合倡议中,来自不同学科的3个研究人员和从业者小组讨论并总结了目前对钾在健康和疾病中作用的理解,重点关注与低钾血症和高钾血症相关的心血管、营养和肾脏方面的考虑因素。

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