Salt intake in mineralocorticoid receptor antagonist-treated primary aldosteronism: foe or ally?

Mild hyperkalemia is a common side effect of mineralocorticoid receptor antagonist (MRA) treatment of patients with primary aldosteronism (PA), which can be worsened by instructions to minimize salt intake. Our objective was to evaluate the effect of salt consumption on serum potassium levels and me...

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Bibliographic Details
Published in:Hormones (Athens, Greece) Greece), 2020-06, Vol.19 (2), p.223-232
Main Authors: Fountoulakis, Stelios, Papanastasiou, Labrini, Voulgaris, Nikos, Kounadi, Theodora, Markou, Athina, Chrousos, George P., Piaditis, George
Format: Article
Language:English
Subjects:
Aged
Blood Pressure
Endocrinology
Female
Follow-Up Studies
Humans
Hyperaldosteronism - blood
Hyperaldosteronism - drug therapy
Hyperkalemia - blood
Hyperkalemia - chemically induced
Hyperkalemia - physiopathology
Hyperkalemia - urine
Male
Medicine
Medicine & Public Health
Metabolic Diseases
Middle Aged
Mineralocorticoid Receptor Antagonists - adverse effects
Original Article
Potassium - blood
Potassium - urine
Sodium - blood
Sodium - urine
Sodium Chloride, Dietary - administration & dosage
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Summary:Mild hyperkalemia is a common side effect of mineralocorticoid receptor antagonist (MRA) treatment of patients with primary aldosteronism (PA), which can be worsened by instructions to minimize salt intake. Our objective was to evaluate the effect of salt consumption on serum potassium levels and mean, mean minimal, and mean maximal systolic and diastolic blood pressure (BP) in MRA-treated hyperkalemic PA patients under relative salt restriction. Seventeen consecutive mildly hyperkalemic MRA-treated PA patients aged 66.3 ± 8.37 years were recruited. Body mass index (BMI) and BP were assessed, and serum and 24-h urinary sodium and potassium levels, plasma renin, and serum aldosterone were measured, while patients followed a relatively salt-restricted diet, after 1 month of controlled salt supplementation (usual salt-restricted diet plus 4 g salt/day) and after 6 months on instructions for free dietary salt consumption. Baseline salt consumption was additionally evaluated in two more patient groups (normotensive subjects and normokalemic MRA-treated PA patients). One month of controlled salt supplementation (24-h urine sodium (median, min, max): 195.2 (120.30–275.20) vs 110.13 (34.30–139.20) mEq/day, p  
ISSN:1109-3099
2520-8721
DOI:10.1007/s42000-019-00167-9