Treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized POTCAST substudy

PLOS ONE · 20 authors, 6 centres

AI SUMMARY

FIDELITY 100%

POPULATIONAdults (mean age 59 years, 79% men) with an implantable cardioverter defibrillator

INTERVENTIONGuidance on potassium-rich diets, potassium supplements, and mineralocorticoid receptor antagonists (MRA) to target plasma potassium of 4.5-5.0 mmol/l

COMPARISONControl group

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AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

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TL;DR

The intervention significantly increased total body potassium after six months, but plasma potassium changes did not mirror this increase over time.

Full summary

914 CHARS

This open-label randomized controlled trial (n=14) evaluated a six-month intervention combining dietary guidance, potassium supplements, and MRAs to increase plasma potassium (p-K) in normokalemic patients with ICDs. The primary outcome was between-group differences in changes from baseline for total body potassium (TBK) and p-K. The intervention produced a significant increase in p-K versus control at six weeks (0.47 mmol/l), but this difference was not significant at six months (0.16 mmol/l). Conversely, TBK showed no significant difference at six weeks but a significant increase of 82 mg/kg at six months. This indicates a dissociation in timing, with p-K rising early and TBK increasing gradually. The study's main limitations are its very small sample size and open-label design. The findings suggest that monitoring p-K alone may not reflect intracellular potassium changes, which develop over months.

PICO

PPOPULATION

Adults (mean age 59 years, 79% men) with an implantable cardioverter defibrillator

IINTERVENTION

Guidance on potassium-rich diets, potassium supplements, and mineralocorticoid receptor antagonists (MRA) to target plasma potassium of 4.5-5.0 mmol/l

OOUTCOME

Change in total body potassium (TBK) and plasma potassium (p-K)

STUDY TYPE

RCT

SPECIALTY

cardiology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10355384

Treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized POTCAST substudy

PLOS ONE

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ABSTRACT

Objective Hypokalemia is associated with increased risk of arrhythmias and it is recommended to monitor plasma potassium (p-K) regularly in at-risk patients with cardiovascular diseases. It is poorly understood if administration of potassium supplements and mineralocorticoid receptor antagonists (MRA) aimed at increasing p-K also increases intracellular potassium. Methods Adults aged≥18 years with an implantable cardioverter defibrillator (ICD) were randomized (1:1) to a control group or to an intervention that included guidance on potassium rich diets, potassium supplements, and MRA to increase p-K to target levels of 4.5–5.0 mmol/l for six months. Total-body-potassium (TBK) was measured by a Whole-Body-Counter along with p-K at baseline, after six weeks, and after six months. Results Fourteen patients (mean age: 59 years (standard deviation 14), 79% men) were included. Mean p-K was 3.8 mmol/l (0.2), and mean TBK was 1.50 g/kg (0.20) at baseline. After six-weeks, p-K had increased by 0.47 mmol/l (95%CI:0.14;0.81), p = 0.008 in the intervention group compared to controls, whereas no significant difference was found in TBK (44 mg/kg (-20;108), p = 0.17). After six-months, no significant difference was found in p-K as compared to baseline (0.16 mmol/l (-0.18;0.51), p = 0.36), but a significant increase in TBK of 82 mg/kg (16;148), p = 0.017 was found in the intervention group compared to controls. Conclusions Increased potassium intake and MRAs increased TBK gradually and a significant increase was seen after six months. The differentially regulated p-K and TBK challenges current knowledge on potassium homeostasis and the time required before the full potential of p-K increasing treatment can be anticipated. Trial registration www.clinicaltrials.gov ( NCT03833089 ).

CITATION EXPORT

Ulrik Winsløw, Tharsika Sakthivel, Chaoqun Zheng et al.. Treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized POTCAST substudy. PLOS ONE. (2023). https://doi.org/10.1371/journal.pone.0288756

AUTHORS

20 · 6 CENTRES

Ulrik Winsløw, Tharsika Sakthivel, Chaoqun Zheng, Helle Bosselmann, Ketil Haugan, Niels Bruun, Charlotte Larroudé, Kasper Iversen, Hillah Saffi, Emil Frandsen, Peter Oturai, Holger Jan Jensen, Michael Vinther, Niels Risum, Henning Bundgaard, Christian Jøns, Yoshihiro Fukumoto, Yoshihiro Fukumoto, Yoshihiro Fukumoto, Yoshihiro Fukumoto

1 Department of Cardiology, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
2 Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
3 Department of Cardiology, Copenhagen University Hospital, Herlev, Gentofte, Denmark
4 Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
5 Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Kurume University School of Medicine, JAPAN

EDITOR / REVIEWER

Yoshihiro Fukumoto