Nephrol Dial Transplant (2003) 18: 341-347
© 2003 European Renal Association-European Dialysis and Transplant Association
Dietary potassium and laxatives as regulators of colonic potassium secretion in end-stage renal disease
Molecular Medicine Unit, St James's University Hospital, Leeds, UK
Background. In end-stage renal disease (ESRD), colonic potassium (K+) secretion increases as renal K+ excretion declines. The nature of this adaptive process is poorly understood, but post-prandial increases in plasma K+ concentration may be a determining factor. In addition, even though colonic K+ secretion increases in ESRD, interdialytic hyperkalaemia is a serious problem in haemodialysis patients, which might be reduced by stimulating colonic K+ secretion still further using laxatives.
Methods. Plasma K+ concentrations were measured in the fasting state, and for 180 min after the oral administration of 30 mmol of K+ to nine control subjects and 16 normokalaemic patients with ESRD (eight ‘predialysis' patients and eight patients undergoing continuous ambulatory peritoneal dialysis (CAPD)). Plasma K+ concentrations were also monitored for 180 min in fasting controls and ESRD patients who were not given the oral K+ load. To study the effect of laxatives on interdialytic hyperkalaemia, plasma K+ concentrations were measured in eight control subjects and 13 haemodialysis patients before and during 2 weeks treatment with bisacodyl (a cAMP-mediated laxative) and in five haemodialysis patients before and during 2 weeks treatment with lactulose (an osmotic laxative).
Results. Oral K+ loading caused plasma K+ concentration to rise within the normal range (3.5–5.1 mmol/l) in control subjects, while significantly higher concentrations were achieved in the ‘predialysis' patients and sustained hyperkalaemia developed in the CAPD patients. Bisacodyl treatment had no effect on plasma K+ concentrations in control subjects, but significantly decreased the mean interdialytic plasma K+ concentration (from 5.9±0.2 to 5.5±0.2 mmol/l, P<0.0005) in haemodialysis patients, whereas plasma K+ concentration did not change during lactulose treatment.
Conclusions. Higher plasma K+ concentrations after food may help to maintain K+ homeostasis in ESRD by enhancing colonic K+ secretion. Bisacodyl may be useful for reducing interdialytic hyperkalaemia in patients undergoing haemodialysis.
Keywords: bisacodyl; cAMP; colon; continuous ambulatory peritoneal dialysis; potassium secretion; renal failure
Correspondence and offprint requests to: Professor G. I. Sandle, Molecular Medicine Unit, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK. Email: g.i.sandle{at}leeds.ac.uk
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  G. I. Sandle and M. Hunter Apical potassium (BK) channels and enhanced potassium secretion in human colon QJM, November 5, 2009; (2009) hcp159v1. [Abstract] [Full Text] [PDF]
|
|