Potassium management and heart failure: a nephrologist's perspective

Potassium serum concentration is tightly and promptly regulated to allow adequate cell functioning, especially for cardiac rhythm control. Beside absorption/release linked to digestive fluid metabolism, potassium behavior depends on multiple regulatory mechanisms, involving the kidney, the skin and the intra-/extracellular exchanges. Various hormones impact on these regulatory loops, among them aldosterone, corticosteroids, catecholamines, insulin, and IGF-1. Likewise, several drugs also alter serum potassium levels, including diuretics, renin–angiotensin–aldosterone system (RAAS) inhibitors, steroidal and non-steroidal mineraloreceptor antagonists (MRA), sodium-glucose co-transporter 2 (SGLT2) inhibitors, potassium binders and substances that alter the acid–base balance, such as sodium bicarbonate, sodium citrate, etc. Dietary intake of potassium comes from different sources and is variable, generally ranging from 1 to 4 g per day.