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Nutrients
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The Effect of Potassium on Human Health
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The Effect of Potassium on Human Health

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Micronutrients and Human Health".

Deadline for manuscript submissions: 5 November 2024 | Viewed by 13919

Special Issue Editor

Dr. Lanfranco D’Elia

E-Mail Website
Guest Editor
Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School Via S. Pansini, 5 -80131 Naples, Italy
Interests: potassium intake; salt intake; cardiovascular disease; hypertension; metabolism; meta-analysis

Special Issue Information

Dear Colleagues,

Dietary potassium is highly relevant to human nutrition. The effect of potassium on the human’s body is wide, involving all cells and tissues. Potassium plays a key role in several physiological mechanisms, especially in the neuroendocrine system and in the regulation of blood pressure. Several experimental and clinical data have shown a favorable relationship between potassium-rich diet and cardiovascular disease. However, these results do not allow the detection of appropriate potassium intake thresholds to prevent cardiovascular disease and reduce cardiovascular risk in different settings (e.g., general population, patients with chronic kidney disease or in pharmacological treatment that affects potassium handling). Similarly, few data are also available on potassium supplement (e.g., potassium-enriched salt) and on involvement of potassium intake in non-cardiovascular diseases, such as nephrolithiasis, bone disease, and altered glucose metabolism. Given these premises, this Special Issue aims to focus on new evidence or reviews of current literature about the effect of potassium intake on different outcomes in order to collect a large body of data on plausible thresholds of recommended dietary or supplemental potassium intake in healthy individuals and in different conditions to support primary or secondary prevention of different diseases.

Dr. Lanfranco D’Elia
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • dietary potassium
  • potassium supplement
  • salt substitute
  • cardiovascular disease
  • blood pressure
  • atherosclerosis
  • kidney
  • nephrolithiasis
  • bone
  • glucose metabolism

Published Papers (6 papers)

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Editorial

Jump to: Research, Review

5 pages, 188 KiB  
Editorial
Potassium Intake and Human Health
by Lanfranco D’Elia
Nutrients 2024, 16(6), 833; https://0-doi-org.brum.beds.ac.uk/10.3390/nu16060833 - 14 Mar 2024
Cited by 1 | Viewed by 1094
Abstract
Potassium is a monovalent cation widely present in nature, where it is not in metallic form, but always in combination with other substances, especially chloride [...] Full article
(This article belongs to the Special Issue The Effect of Potassium on Human Health)

Research

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10 pages, 691 KiB  
Article
RAASi Therapy Attenuates the Association between 24-h Urinary Potassium Excretion and Dietary Potassium Intake in CKD Patients
by Domenico Giannese, Claudia D’Alessandro, Nicola Pellegrino, Vincenzo Panichi and Adamasco Cupisti
Nutrients 2023, 15(11), 2454; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15112454 - 24 May 2023
Cited by 1 | Viewed by 1111
Abstract
The aim of this study was to evaluate urinary potassium (K) excretion as a reliable marker of dietary K intake, in a cohort of CKD patients with or without Renin-Angiotensin-Aldosterone System (RAAS) inhibitor therapy. One hundred and thirty-eight consecutive out-patients (51 f and [...] Read more.
The aim of this study was to evaluate urinary potassium (K) excretion as a reliable marker of dietary K intake, in a cohort of CKD patients with or without Renin-Angiotensin-Aldosterone System (RAAS) inhibitor therapy. One hundred and thirty-eight consecutive out-patients (51 f and 87 m) aged 60 ± 13 years and affected by CKD stage 3–4, who were metabolically and nutritionally stable, entered the study between November 2021 and October 2022. No difference was observed between patients with (n = 85) or without (n = 53) RAAS inhibitor therapy, regarding dietary intakes, blood biochemistry, and 24-h urine excretion parameters. Considering all patients, urinary K showed a weak relationship with eGFR (r = 0.243, p < 0.01), and with dietary K intake (r = 0.184, p < 0.05). Serum K was not associated with dietary K intake, but an inverse relationship was observed with eGFR (r = −0.269, p < 0.01). When patients were examined depending on whether they were receiving RAAS inhibitor therapy, the weak inverse relationship between serum K and eGFR was maintained in both groups. Conversely, urinary K excretion remained positively associated with dietary K intake only in the no RAAS inhibitor group. In conclusion, 24-h urine K excretion may be used as a surrogate of K intake, but RAAS inhibitor therapy reduces the association between 24-h urine K excretion and dietary K intake in CKD patients. Full article
(This article belongs to the Special Issue The Effect of Potassium on Human Health)
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17 pages, 6761 KiB  
Article
Machine Learning Models Predicting Cardiovascular and Renal Outcomes and Mortality in Patients with Hyperkalemia
by Eiichiro Kanda, Suguru Okami, Shun Kohsaka, Masafumi Okada, Xiaojun Ma, Takeshi Kimura, Koichi Shirakawa and Toshitaka Yajima
Nutrients 2022, 14(21), 4614; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14214614 - 03 Nov 2022
Cited by 2 | Viewed by 2651
Abstract
Hyperkalemia is associated with increased risks of mortality and adverse clinical outcomes. The treatment of hyperkalemia often leads to the discontinuation or restriction of beneficial but potassium-increasing therapy such as renin-angiotensin-aldosterone inhibitors (RAASi) and high-potassium diet including fruits and vegetables. To date, limited [...] Read more.
Hyperkalemia is associated with increased risks of mortality and adverse clinical outcomes. The treatment of hyperkalemia often leads to the discontinuation or restriction of beneficial but potassium-increasing therapy such as renin-angiotensin-aldosterone inhibitors (RAASi) and high-potassium diet including fruits and vegetables. To date, limited evidence is available for personalized risk evaluation in this heterogeneous and multifactorial pathophysiological condition. We developed risk prediction models using extreme gradient boosting (XGB), multiple logistic regression (LR), and deep neural network. Models were derived from a retrospective cohort of hyperkalemic patients with either heart failure or chronic kidney disease stage ≥3a from a Japanese nationwide database (1 April 2008–30 September 2018). Studied outcomes included all-cause death, renal replacement therapy introduction (RRT), hospitalization for heart failure (HHF), and cardiovascular events within three years after hyperkalemic episodes. The best performing model was further validated using an external cohort. A total of 24,949 adult hyperkalemic patients were selected for model derivation and internal validation. A total of 1452 deaths (16.6%), 887 RRT (10.1%), 1,345 HHF (15.4%), and 621 cardiovascular events (7.1%) were observed. XGB outperformed other models. The area under receiver operator characteristic curves (AUROCs) of XGB vs. LR (95% CIs) for death, RRT, HHF, and cardiovascular events were 0.823 (0.805–0.841) vs. 0.809 (0.791–0.828), 0.957 (0.947–0.967) vs. 0.947 (0.936–0.959), 0.863 (0.846–0.880) vs. 0.838 (0.820–0.856), and 0.809 (0.784–0.834) vs. 0.798 (0.772–0.823), respectively. In the external dataset including 86,279 patients, AUROCs (95% CIs) for XGB were: death, 0.747 (0.742–0.753); RRT, 0.888 (0.882–0.894); HHF, 0.673 (0.666–0.679); and cardiovascular events, 0.585 (0.578–0.591). Kaplan–Meier curves of the high-risk predicted group showed a statistically significant difference from that of the low-risk predicted groups for all outcomes (p < 0.005; log-rank test). These findings suggest possible use of machine learning models for real-world risk assessment as a guide for observation and/or treatment decision making that may potentially lead to improved outcomes in hyperkalemic patients while retaining the benefit of life-saving therapies. Full article
(This article belongs to the Special Issue The Effect of Potassium on Human Health)
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10 pages, 1373 KiB  
Article
Prediction Tool to Estimate Potassium Diet in Chronic Kidney Disease Patients Developed Using a Machine Learning Tool: The UniverSel Study
by Maelys Granal, Lydia Slimani, Nans Florens, Florence Sens, Caroline Pelletier, Romain Pszczolinski, Catherine Casiez, Emilie Kalbacher, Anne Jolivot, Laurence Dubourg, Sandrine Lemoine, Celine Pasian, Michel Ducher and Jean Pierre Fauvel
Nutrients 2022, 14(12), 2419; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14122419 - 10 Jun 2022
Cited by 3 | Viewed by 2124
Abstract
There is a need for a reliable and validated method to estimate dietary potassium intake in chronic kidney disease (CKD) patients to improve prevention of cardiovascular complications. This study aimed to develop a clinical tool to estimate potassium intake using 24-h urinary potassium [...] Read more.
There is a need for a reliable and validated method to estimate dietary potassium intake in chronic kidney disease (CKD) patients to improve prevention of cardiovascular complications. This study aimed to develop a clinical tool to estimate potassium intake using 24-h urinary potassium excretion as a surrogate of dietary potassium intake in this high-risk population. Data of 375 adult CKD-patients routinely collecting their 24-h urine were included to develop a prediction tool to estimate potassium diet. The prediction tool was built from a random sample of 80% of patients and validated on the remaining 20%. The accuracy of the prediction tool to classify potassium diet in the three classes of potassium excretion was 74%. Surprisingly, the variables related to potassium consumption were more related to clinical characteristics and renal pathology than to the potassium content of the ingested food. Artificial intelligence allowed to develop an easy-to-use tool for estimating patients’ diets in clinical practice. After external validation, this tool could be extended to all CKD-patients for a better clinical and therapeutic management for the prevention of cardiovascular complications. Full article
(This article belongs to the Special Issue The Effect of Potassium on Human Health)
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Review

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13 pages, 1158 KiB  
Review
Effect of Potassium Supplementation on Endothelial Function: A Systematic Review and Meta-Analysis of Intervention Studies
by Lanfranco D’Elia, Francesco P. Cappuccio, Maria Masulli, Ersilia La Fata, Domenico Rendina and Ferruccio Galletti
Nutrients 2023, 15(4), 853; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15040853 - 08 Feb 2023
Cited by 3 | Viewed by 2757
Abstract
(1) Background: Endothelial dysfunction is an early predictor of cardiovascular diseases. Although a large body of evidence shows an inverse association between potassium intake and cardiovascular risk, the studies on endothelial function provided contrasting results. Thus, we carried out a systematic review and [...] Read more.
(1) Background: Endothelial dysfunction is an early predictor of cardiovascular diseases. Although a large body of evidence shows an inverse association between potassium intake and cardiovascular risk, the studies on endothelial function provided contrasting results. Thus, we carried out a systematic review and a meta-analysis of the available intervention studies of the potassium supplementation on endothelial function. (2) Methods: A systematic search of the online databases available (up to December 2022) was conducted including the intervention trials that reported flow-mediated dilation (FMD) changes—a non-invasive method of assessing endothelial function—after two different potassium intake regimens. For each study, the mean difference (MD) and 95% confidence intervals were pooled using a random effect model. (3) Results: Five studies met the pre-defined inclusion criteria and provided eight cohorts with 332 participants. In the pooled analysis, potassium supplementation was associated with a significant increase in FMD (MD: 0.74%), with a higher effect for a urinary potassium excretion higher than 90 mmol/day. There was a moderate heterogeneity among studies (I2 = 59%), explained by the different amount of potassium supplementation. (4) Conclusions: The results of our meta-analysis indicate that dietary potassium supplement improves endothelial function. This effect is directly associated with the amount of potassium supplement. The findings support the campaigns in favour of an increase in dietary potassium intake to reduce cardiovascular risk. Full article
(This article belongs to the Special Issue The Effect of Potassium on Human Health)
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12 pages, 1323 KiB  
Review
Dietary Potassium Intake and Risk of Diabetes: A Systematic Review and Meta-Analysis of Prospective Studies
by Lanfranco D’Elia, Maria Masulli, Francesco P. Cappuccio, Aquilino F. Zarrella, Pasquale Strazzullo and Ferruccio Galletti
Nutrients 2022, 14(22), 4785; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14224785 - 12 Nov 2022
Cited by 9 | Viewed by 3277
Abstract
(1) Background: Dietary potassium intake is positively associated with reduction of cardiovascular risk. Several data are available on the relationship between dietary potassium intake, diabetes risk and glucose metabolism, but with inconsistent results. Therefore, we performed a meta-analysis of the prospective studies that [...] Read more.
(1) Background: Dietary potassium intake is positively associated with reduction of cardiovascular risk. Several data are available on the relationship between dietary potassium intake, diabetes risk and glucose metabolism, but with inconsistent results. Therefore, we performed a meta-analysis of the prospective studies that explored the effect of dietary potassium intake on the risk of diabetes to overcome these limitations. (2) Methods: A random-effects dose–response meta-analysis was carried out for prospective studies. A potential non-linear relation was investigated using restricted cubic splines. (3) Results: A total of seven prospective studies met the inclusion criteria. Dose–response analysis detected a non-linear relationship between dietary potassium intake and diabetes risk, with significant inverse association starting from 2900 mg/day by questionnaire and between 2000 and 5000 mg/day by urinary excretion. There was high heterogeneity among studies, but no evidence of publication bias was found. (4) Conclusions: The results of this meta-analysis indicate that habitual dietary potassium consumption is associated with risk of diabetes by a non-linear dose–response relationship. The beneficial threshold found supports the campaigns in favour of an increase in dietary potassium intake to reduce the risk of morbidity and mortality. Further studies should be carried out to explore this topic. Full article
(This article belongs to the Special Issue The Effect of Potassium on Human Health)
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