Silvio Borrelli Unit, Nephrology Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Piazza Miraglia, 80138 Naples, Italy.
Nephrology, Dialysis and Transplant Unit of the University of Bologna "Alma Mater Studiorum", 40126 Bologna, Italy.
Int J Mol Sci. 2022 Jun 7;23(12):6378. doi: 10.3390/ijms23126378.
Increasing potassium intake ameliorates blood pressure (BP) and cardiovascular (CV) prognoses in the general population; therefore the World Health Organization recommends a high-potassium diet (90-120 mEq/day). Hyperkalaemia is a rare condition in healthy individuals due to the ability of the kidneys to effectively excrete dietary potassium load in urine, while an increase in serum K is prevalent in patients with chronic kidney disease (CKD). Hyperkalaemia prevalence increases in more advanced CKD stages, and is associated with a poor prognosis. This scenario generates controversy on the correct nutritional approach to hyperkalaemia in CKD patients, considering the unproven link between potassium intake and serum K levels. Another concern is that drug-induced hyperkalaemia leads to the down-titration or withdrawal of renin-angiotensin system inhibitors (RASI) and mineralocorticoids receptors antagonists (MRA) in patients with CKD, depriving these patients of central therapeutic interventions aimed at delaying CKD progression and decreasing CV mortality. The new K-binder drugs (Patiromer and Sodium-Zirconium Cyclosilicate) have proven to be adequate and safe therapeutic options to control serum K in CKD patients, enabling RASI and MRA therapy, and possibly, a more liberal intake of fruit and vegetables.
增加钾的摄入量可以改善一般人群的血压（BP）和心血管（CV）预后；因此，世界卫生组织建议采用高钾饮食（90-120mEq/天）。在健康个体中，由于肾脏能够有效地将饮食钾负荷从尿液中排出，因此高钾血症是一种罕见的情况，而在慢性肾脏病（CKD）患者中，血清 K 增加则很普遍。高钾血症的患病率在更晚期的 CKD 阶段增加，并与预后不良相关。这种情况在 CKD 患者的高钾血症的正确营养方法上产生了争议，因为钾的摄入量与血清 K 水平之间的关联尚未得到证实。另一个问题是，药物引起的高钾血症导致 CKD 患者的肾素-血管紧张素系统抑制剂（RASI）和盐皮质激素受体拮抗剂（MRA）的剂量下调或停药，剥夺了这些患者延迟 CKD 进展和降低 CV 死亡率的核心治疗干预措施。新型 K 结合剂药物（Patiromer 和 Sodium-Zirconium Cyclosilicate）已被证明是控制 CKD 患者血清 K 的合适且安全的治疗选择，能够进行 RASI 和 MRA 治疗，并且可能可以更自由地摄入水果和蔬菜。
