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

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Abstract

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 < 0.001) resulted in increased kaliuresis (62.25 (40.69–97.0) vs 54.0 (23.28–79.60) mEq/day, p = 0.001) and a decrease of serum potassium (5.2 (5–5.70) vs 4.6 (3.8–5.1) mEq/L, p < 0.001), while serum sodium (139 (133–141) vs 1 39 (135–144) mEq/L) and mean systolic (130 (105–141 vs. 130 (106–141) mmHg) and diastolic (76 (53–85) vs75 (53–84) mmHg) BP remained stable. These findings were unchanged after 6 months of free salt consumption. BMI remained constant, while plasma renin and serum aldosterone decreased following salt repletion. Adequate salt consumption attenuates MRA-induced hyperkalemia in relatively salt-restricted PA patients without affecting BP or BMI.

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  1. Stelios Fountoulakis and Labrini Papanastasiou contributed equally to this work.

Authors and Affiliations

  1. Department of Endocrinology and Diabetes Center, General Hospital of Athens ‘G. Gennimatas’, 154 Mesogion Avenue, 11527, Athens, Greece

    Stelios Fountoulakis, Labrini Papanastasiou, Nikos Voulgaris, Theodora Kounadi, Athina Markou & George Piaditis

  2. Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, Children’s Hospital ‘Aghia Sophia’, National and Kapodistrian University of Athens Medical School, Athens, Greece

    George P. Chrousos

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  1. Stelios Fountoulakis
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Contributions

SF examined the patients and wrote the article. LP organized the study, analyzed the data, and wrote the article. NV collected the data. TK carried out laboratory work. AM collected the data. GC contributed intellectually and edited the article. GP designed the study and assigned duties. All authors read and approved the final manuscript.

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Correspondence to Stelios Fountoulakis.

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Fountoulakis, S., Papanastasiou, L., Voulgaris, N. et al. Salt intake in mineralocorticoid receptor antagonist-treated primary aldosteronism: foe or ally?. Hormones 19, 223–232 (2020). https://doi.org/10.1007/s42000-019-00167-9

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