Sodium ; Wastewater ; Potassium ; Diet ; Blood Pressure ; China ; Sodium, Dietary ; Sodium Chloride, Dietary

BACKGROUND: The clinical importance of hypokalemia is likely underrecognized in Chinese dialysis patients, and whether its clinical effect was mediated by serum albumin is not fully elucidated. This study aimed to explore the association between serum potassium and mortality in dialysis patients of a Chinese nationwide multicenter cohort, taking albumin as a consideration. METHODS: This was a prospective nation-wide multicenter cohort study. Restricted cubic splines were used to test the linearity of serum potassium and relationships with all-cause (AC) and cardiovascular (CV) mortality and a subsequent two-line piecewise linear model was fitted to approach the nadir. A mediation analysis was performed to examine relations of albumin to potassium and mortalities. RESULTS: A total of 10,027 patients were included, of whom 6605 were peritoneal dialysis and 3422 were hemodialysis patients. In the overall population, the mean age was 51.7 ± 14.8 years, 55.3%(5546/10,027) were male, and the median dialysis vintage was 13.60 (4.70, 39.70) months. Baseline serum potassium was 4.30 ± 0.88 mmol/L. After a median follow-up period of 26.87 (14.77, 41.50) months, a U-shape was found between potassium and mortality, and a marked increase in risk at lower potassium but a moderate elevation in risk at higher potassium were observed. The nadir for AC mortality risk was estimated from piecewise linear models to be a potassium concentration of 4.0 mmol/L. Interestingly, the significance of the association between potassium and mortality was attenuated when albumin was introduced into the extended adjusted model. A subsequent significant mediation by albumin for potassium and AC and CV mortalities were found ( P < 0.001 for both), indicating that hypokalemia led to higher mortality mediated by low serum albumin, which was a surrogate of poor nutritional status and inflammation. CONCLUSIONS Associations between potassium and mortalities were U-shaped in the overall population. The nadir for AC mortality risk was at a potassium of 4.0 mmol/L. Serum albumin mediated the association between potassium and AC and CV mortalities.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; East Asian People ; Hypokalemia/etiology* ; Kidney Failure, Chronic/mortality* ; Potassium/blood* ; Prospective Studies ; Renal Dialysis ; Serum Albumin/analysis*

Hypertension is one of the strongest risk factors for cardiovascular diseases, cerebral stroke, and kidney failure. Lifestyle and nutrition are important factors that modulate blood pressure. Hypertension can be controlled by increasing physical activity, decreasing alcohol and sodium intake, and stopping tobacco smoking. Chronic kidney disease patients often have increased blood pressure, which indicates that kidney is one of the major organs responsible for blood pressure homeostasis. The decrease of renal sodium reabsorption and increase of diuresis induced by high potassium intake is critical for the blood pressure reduction. The beneficial effect of a high potassium diet on hypertension could be explained by decreased salt reabsorption by sodium-chloride cotransporter (NCC) in the distal convoluted tubule (DCT). In DCT cells, NCC activity is controlled by with-no-lysine kinases (WNKs) and its down-stream target kinases, Ste20-related proline-alanine-rich kinase (SPAK) and oxidative stress-responsive 1 (OSR1). The kinase activity of WNKs is inhibited by intracellular chloride ([Cl^-]_i) and WNK4 is known to be the major WNK positively regulating NCC. Based on our previous studies, high potassium intake reduces the basolateral potassium conductance, decreases the negativity of DCT basolateral membrane (depolarization), and increases [Cl^-]_i. High [Cl^-]_i inhibits WNK4-SPAK/OSR1 pathway, and thereby decreases NCC phosphorylation. In this review, we discuss the role of DCT in the blood pressure regulation by dietary potassium intake, which is the mechanism that has been best dissected so far.
Blood Pressure ; Diet ; Humans ; Kidney/metabolism* ; Kidney Tubules, Distal/metabolism* ; Phosphorylation ; Potassium/pharmacology* ; Protein Serine-Threonine Kinases ; Solute Carrier Family 12, Member 3/metabolism*

blood pressure (BP) and physical activity of HF patients. Thirty-nine systolic HF patients with low ejection fraction (EF) < 50% and class III of New York Heart Association functional classification were randomly divided into 2 groups including intervention and placebo to enroll in an 8 weeks double-blind clinical trial. During the trial 6-minute walk test (6MWT), 25-hydroxyvitamin D (25[OH]D) level, BP, sodium and potassium intakes were assessed. The mean 25(OH)D level increased to 28.9 ± 11.7 ng/mL (p < 0.001) in the intervention group. There was a poor but non-significant reduction in systolic BP (−0.033 ± 4.71 mmHg, p = 0.531) in the intervention group. The BP also did not change in the placebo group at the end of the trial. A negligible decrease of 6MWT was observed in the intervention group (−6.6 ± 29.2 m) compared to the placebo (−14.1 ± 40.5 m). However, differences between the 2 groups were not statistically significant (p = 0.325). The results solely showed a slight positive correlation between 25(OH)D level and 6MWT. No significant improvements in BP and 6MWT were observed after vitamin D3 supplementation.TRIAL REGISTRATION: Iranian Registry of Clinical Trials Identifier: IRCT2016102113678N13]]>
Blood Pressure ; Cholecalciferol ; Classification ; Endothelial Cells ; Exercise Test ; Exercise Tolerance ; Heart Failure ; Heart ; Humans ; Motor Activity ; Myocytes, Cardiac ; Potassium ; Sodium ; Vitamin D ; Vitamin D Deficiency ; Vitamins

potassium, chloride, blood glucose, blood urea nitrogen, hematocrit, and hemoglobin), and enzyme-linked immunosorbent assay kits (calcium, magnesium, creatinine, aspartate aminotransferase, alanine aminotransferase, bilirubin, and albumin). Similar trends were found for the parameters of biochemistries, electrolytes, and blood gas, and they revealed no significant changes after blood withdrawal-induced hemorrhagic shock. However, the TBS group showed more effective ability to correct metabolic acidosis than the NS and RS groups. TBS was a feasible and safe resuscitation solution in this study and may be an alternative to NS and RS for resuscitation in hemorrhagic shock patients without liver damage.]]>
Acidosis ; Alanine Transaminase ; Animals ; Aspartate Aminotransferases ; Bilirubin ; Blood Glucose ; Blood Urea Nitrogen ; Carbon Dioxide ; Creatinine ; Electrolytes ; Enzyme-Linked Immunosorbent Assay ; Hematocrit ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Liver ; Magnesium ; Male ; Oxygen ; Potassium ; Rats ; Resuscitation ; Shock, Hemorrhagic ; Sodium

BACKGROUND: Information on biochemical changes following rapid transfusion of blood mixtures in liver transplantation patients is limited. METHODS: A blood mixture composed of red blood cells, fresh frozen plasma, and 0.9% saline was prepared in a ratio of 1 unit:1 unit:250 ml. During massive hemorrhage, 300 ml of the blood mixture was repeatedly transfused. A blood mixture sample as well as pre- and post-transfusion arterial blood samples were collected at the first, third, fifth, and seventh bolus transfusions. Changes in pH, hematocrit, electrolytes, and glucose were measured with a point-of-care analyzer. The biochemical changes were described, and the factors driving the changes were sought through linear mixed effects analysis. RESULTS: A total of 120 blood samples from 10 recipients were examined. Potassium and sodium levels became normalized during preservation. Biochemical changes in the blood mixture were significantly related to the duration of blood bank storage and reservoir preservation (average R2 = 0.41). Acute acidosis and hypocalcemia requiring immediate correction occurred with each transfusion. Both the pre-transfusion value of the patient and the blood mixture value were significant predictors of post-transfusion changes in the body (average R2 = 0.87); however, the former was more crucial. CONCLUSIONS: Rapid infusion of blood mixture is relatively safe because favorable biochemical changes occur during storage in the reservoir, and the composition of the blood mixture has little effect on the body during rapid transfusion in liver recipients. However, acute hypocalcemia and acidosis requiring immediate correction occurred frequently due to limited citrate metabolism in the liver recipients.
Acidosis ; Blood Banks ; Blood Safety ; Blood Transfusion ; Citric Acid ; Electrolytes ; Erythrocytes ; Glucose ; Hematocrit ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Hypocalcemia ; Liver Transplantation* ; Liver* ; Metabolism ; Plasma ; Point-of-Care Systems ; Potassium ; Sodium

White blood cells (WBCs) and storage period are the main factors of transfusion reactions. In the present study, cytokine/chemokine concentrations after leukoreduction (LR) and irradiation (IR) in stored canine whole blood were measured. Red blood cell storage lesion caused by IR and LR were also compared. Blood samples from 10 healthy Beagles were divided into four groups (no treatment, LR-, IR-, and LR + IR-treated). Leukocytes were removed by filtration in the LR group and gamma radiation (25 Gy) was applied in the IR group. Immunologic factors (WBCs, interleukin-6 [IL-6], C-X-C motif chemokine ligand 8 [CXCL-8], and tumor necrosis factor-alpha) and storage lesion factors (blood pH, potassium, and hemolysis) were evaluated on storage days 0, 7, 14, 21, and 28. Compared to the treated groups, IL-6 and CXCL-8 concentrations during storage were significantly higher in the control (no treatment) group. LR did not show changes in cytokine/chemokine concentrations, and storage lesion presence was relatively mild. IR significantly increased CXCL-8 after 14 days of storage, but IR of leukoreduced blood did not increase CXCL-8 during 28 days of storage. Storage lesions such as hemolysis, increased potassium, and low pH were observed 7 days after IR and storage of blood, regardless of LR. IR of leukoreduced blood is beneficial to avoid immune reactions; however, storage lesions should be considered upon storage.
Blood Preservation ; Down-Regulation ; Erythrocytes ; Filtration ; Gamma Rays ; Hemolysis ; Hydrogen-Ion Concentration ; Immunologic Factors ; Interleukin-6 ; Leukocyte Reduction Procedures ; Leukocytes ; Necrosis ; Potassium ; Transfusion Reaction

PURPOSE: This study examined the changes in the nutrient intake and the prevalences of obesity and metabolic syndrome according to the eating alone behavior in middle-aged men and women. METHODS: The data from the 2013 ~ 2017 Korean National Health and Nutrition Examination Survey were analyzed. A total of 7,728 adults (3,404 male, 4,324 female) aged 40 ~ 64 years old were included. The subjects were classified into three groups according to the number of times eating alone per day (0, 1 ~ 2, and 3 times/day). Dietary data were collected by a 1-day 24-h recall. The nutrient intakes were compared among the three groups. Survey logistic regression analyses were conducted to examine the association of the eating alone behavior with obesity and metabolic syndrome, adjusting for the related confounding variables. RESULTS: In men, eating alone was associated significantly with a lower intake of potassium (p-for-trend = 0.048) and lower intake of calories from protein (p-for-trend = 0.04). In women, the proportion of subjects consuming energy less than 75% of the estimated energy requirement (p = 0.001) and less than the estimated adequate requirement of riboflavin (p < 0.001) differed significantly according to the eating alone behavior. The eating alone behavior was positively associated with an increased risk of developing metabolic syndrome (p-for-trend = 0.033), increased blood pressure (p-for-trend < 0.001), and increased waist circumference (p-for-trend = 0.004). On the other hand, in women, however, the eating alone behavior was associated with a decreased risks of developing obesity (p-for-trend = 0.02). No association was found between the eating alone behavior and the risk of metabolic syndrome in women. CONCLUSION: These results suggest that the eating alone behavior is a risk factor for the development of metabolic syndrome in middle-aged Korean men.
Adult ; Blood Pressure ; Confounding Factors (Epidemiology) ; Eating ; Female ; Hand ; Humans ; Logistic Models ; Male ; Nutrition Surveys ; Obesity ; Potassium ; Prevalence ; Riboflavin ; Risk Factors ; Waist Circumference

OBJECTIVETo investigate whether the methanol extract of Berberis amurensis Rupr. (BAR) augments penile erection using in vitro and in vivo experiments.

METHODSThe ex vivo study used corpus cavernosum strips prepared from adult male New Zealand White rabbits. In in vivo studies for intracavernous pressure (ICP), blood pressure, mean arterial pressure (MAP), and increase of peak ICP were continuously monitored during electrical stimulation of Sprague-Dawley rats.

RESULTSPreconstricted with phenylephrine (PE) in isolated endotheliumintact rabbit corus cavernosum, BAR relaxed penile smooth muscle in a dose-dependent manner, which was inhibited by pretreatment with NG-nitro-L-arginine methyl ester (L-NAME), a nitric oxide synthase inhibitor, and H-[1,2,4]-oxadiazole-[4,3-α]-quinoxalin-1-one, a soluble guanylyl cclase inhibitor. BAR significantly relaxed penile smooth muscles dose-dependently in ex vivo, and this was inhibited by pretreatment with L-NAME H-[1,2,4]-oxadiazole-[4,3-α]-quinoxalin-1-one. BAR-induced relaxation was significantly attenuated by pretreatment with tetraethylammonium (TEA, P<0.01), a nonselective K channel blocker, 4-aminopyridine (4-AP, P<0.01), a voltage-dependent K channel blocker, and charybdotoxin (P<0.01), a large and intermediate conductance Ca sensitive-K channel blocker, respectively. BAR induced an increase in peak ICP, ICP/MAP ratio and area under the curve dose dependently.

CONCLUSIONBAR augments penile erection via the nitric oxide/cyclic guanosine monophosphate system and Ca sensitive-K (BK and IK) channels in the corpus cavernosum.

Animals ; Area Under Curve ; Berberis ; chemistry ; Blood Pressure ; drug effects ; Cyclic GMP ; metabolism ; Epoprostenol ; pharmacology ; In Vitro Techniques ; Indomethacin ; pharmacology ; Male ; Models, Biological ; Muscle Relaxation ; drug effects ; Muscle, Smooth ; drug effects ; physiology ; NG-Nitroarginine Methyl Ester ; pharmacology ; Nitric Oxide ; metabolism ; Penile Erection ; drug effects ; Phenylephrine ; pharmacology ; Plant Extracts ; pharmacology ; Potassium Channel Blockers ; pharmacology ; Potassium Channels ; metabolism ; Pressure ; Rabbits

OBJECTIVE: This study evaluated the clinical usefulness of the neutrophil-lymphocyte ratio (NLR), Ottawa subarachnoid hemorrhage (SAH) rule and EMERALD (Emergency Medicine, Registry Analysis, Learning and Diagnosis) SAH rule for predicting SAH in patients with acute headache. METHODS: This clinical retrospective study was conducted at an urban emergency department between January 2008 and December 2017. Alert, neurologically intact adult patients with acute headache were included. All data were drawn from electrical medical charts. The Ottawa SAH rule (positive if any of age ≥40, neck pain, loss of consciousness, onset during exertion, thunderclap headache, and neck stiffness), EMERALD SAH rule (positive if any of systolic blood pressure >150 mmHg, diastolic blood pressure >90 mmHg, serum glucose >115 mg/dL, or serum potassium < 3.9 mEq/L) and NLR were assessed. The sensitivity and specificity of these tools for detecting or ruling out SAH was calculated. RESULTS: Among the 1,230 patients enrolled in this study, 299 (24.3%) were diagnosed with SAH. To predict SAH, the Ottawa SAH rule offered 100% sensitivity but 31.6% specificity. Applying the EMERALD SAH rule to patients positive for the Ottawa SAH rule led to 92.6% sensitivity and 48.0% specificity. As the NLR alone showed less efficacy with the area under curve of 0.696 by receiver operating analysis, NLR (>2.1) was added to the last step to have achieve 99.0% sensitivity and 56.7% specificity. CONCLUSION: The stepwise application of the Ottawa, EMERALD SAH rule, and NLR increased the specificity compared to each application. On the other hand, further studies will be needed to increase the sensitivity.
Adult ; Area Under Curve ; Blood Glucose ; Blood Pressure ; Diagnosis, Differential ; Emergencies* ; Emergency Service, Hospital* ; Hand ; Headache Disorders, Primary ; Headache* ; Humans ; Learning ; Neck ; Neck Pain ; Potassium ; Retrospective Studies ; Sensitivity and Specificity ; Subarachnoid Hemorrhage* ; Unconsciousness