Physiology and Pathophysiology of Potassium Homeostasis: Core Curriculum 2019
Abstract
Total-body potassium (K+) content and appropriate distribution of K+ across the cell membrane is vitally important for normal cellular function. Total-body K+ content is determined by changes in excretion of K+ by the kidneys in response to intake levels. Under normal conditions, insulin and β-adrenergic tone also make important contributions in maintaining internal distribution of K+. However, despite these homeostatic pathways, disorders of altered K+ homeostasis are common. Appreciating the pathophysiology and regulatory influences that determine the internal distribution and external balance of K+ is critical in designing effective treatments to restore K+ homeostasis. We provide an up-to-date review of the regulatory aspects of normal K+ physiology as a preface to highlighting common disorders in K+ homeostasis and their treatment. This review of K+ homeostasis is designed as a resource for clinicians and a tool for educators who are teaching trainees to understand the pivotal factors involved in K+ balance.
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There are known sex differences in renal K+ handling, aldosterone concentration, and plasma K+ concentration.
“We refer to this as a model of a man, instead of more generally as a human model, due to the known sex differences in renal K+ handling [24–26], ALD concentration [27], and plasma K+ concentration [28], all of which affect K+ homeostasis.”
From A mathematical model of potassium homeostasis: Effect of feedforward and feedback controls (2022) · cites this paper as [28]
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“…Hoorn, Gritter, Cuevas, & Fenton, 2020; D. H. Lin, Duan, Zheng, & Wang, 2022; McDonough & Fenton, 2022; McDonough & Youn, 2017; Mutig & Bachmann, 2019; Nomura, Shoda, & Uchida, 2019; Palmer & Clegg, 2019; Su, Ellison, & Wang, 2019; Tabibzadeh & Crambert, 2023; Wei et al., 2020; Welling, 2016)).”
BackgroundKamel, K. S., & Halperin, M. L. (2021) · Kidney International Reports · doi:10.1016/j.ekir.2021.02.003 · Cited by 49 · see citing works
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BackgroundRakugi, H., Yamakawa, S., & Sugimoto, K. (2020) · Hypertension Research · doi:10.1038/s41440-020-00569-y · Cited by 45 · see citing works
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“36 The calcium-sensing receptor is located on the apical surface of the distal convoluted tubule.”
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Pérez-Aizpurua, X., Benavente, R. C., Serrano, G. B., et al. (2024) · World Journal of Nephrology · doi:10.5527/wjn.v13.i2.93322 · Cited by 33 · see citing works
Budnicka, M., Sobiech, M., Kolmas, J., & Luliński, P. (2022) · TrAC Trends in Analytical Chemistry · doi:10.1016/j.trac.2022.116711 · Cited by 30 · see citing works
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Sun, H., & Weaver, C. M. (2020) · Journal of Agricultural and Food Chemistry · doi:10.1021/acs.jafc.0c05139 · Cited by 29 · see citing works
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Tang, P., Geddes, R. F., Chang, Y., Jepson, R. E., Bijsmans, E. S., & Elliott, J. (2020) · Journal of Veterinary Internal Medicine · doi:10.1111/jvim.15996 · Cited by 25 · see citing works
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Diagnostic value of parameters from a spot urine sample for renal potassium loss in hypokalemia
Li, J., Ma, H., Lei, Y., & Wan, Q. (2020) · Clinica Chimica Acta · doi:10.1016/j.cca.2020.10.024 · Cited by 15 · see citing works
Calabrese, V., Cernaro, V., Battaglia, V., Gembillo, G., Longhitano, E., Siligato, R., Sposito, G., Ferlazzo, G., & Santoro, D. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11010244 · Cited by 15 · see citing works
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Palmer, B. F., & Clegg, D. J. (2020) · Minerva Endocrinology · doi:10.23736/s0391-1977.19.03059-1 · Cited by 17 · see citing works
Self-citationGrams, M. E., Hoenig, M. P., & Hoorn, E. J. (2021) · JAMA · doi:10.1001/jama.2020.17672 · Cited by 15 · see citing works
Welland, N. L., Hæstad, H., Fossmo, H. L., Giltvedt, K., Ørstavik, K., & Nordstrøm, M. (2021) · Journal of Neuromuscular Diseases · doi:10.3233/jnd-200604 · Cited by 14 · see citing works
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Zhang, Y., Ma, K., Fang, X., Zhang, Y., Miao, R., Guan, H., & Tian, J. (2025) · Pharmacological Research · doi:10.1016/j.phrs.2025.107579 · Cited by 13 · see citing works
Tacail, T., Lewis, J., Clauß, M., Coath, C. D., Evershed, R. P., Albalat, E., Elliott, T. R., & Tütken, T. (2023) · Metallomics · doi:10.1093/mtomcs/mfad065 · Cited by 13 · see citing works
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Schiemsky, T., Croes, K., Vermeersch, P., et al. (2019) · Biochemia Medica · doi:10.11613/bm.2020.010802 · Cited by 13 · see citing works
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Olapoju, S. O., Adejobi, O. I., & Thi, X. L. (2019) · Vascular Pharmacology · doi:10.1016/j.vph.2019.106636 · Cited by 12 · see citing works
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Ortíz, A., del Arco, C., Fernández‐García, J. C., Cerezo, J. G., Ochoa, R. I., Núñez, J. E., Gutiérrez, F. P., & Navarro‐González, J. F. (2023) · Nefrología (English Edition) · doi:10.1016/j.nefroe.2023.12.002 · Cited by 11 · see citing works
Thongprayoon, C., Cheungpasitporn, W., Chewcharat, A., Mao, M. A., Vallabhajosyula, S., Bathini, T. J., Thirunavukkarasu, S., & KASHANI, K. B. (2020) · Hospital Practice · doi:10.1080/21548331.2020.1729621 · Cited by 11 · see citing works
Kreitzer, N. P., Albert, N. M., Amin, A., Beavers, C. J., Becker, R. C., Fonarow, G. C., Gibler, W. B., Kwon, K. W., Mentz, R. J., Palmer, B. F., et al. (2025) · Cardiorenal Medicine · doi:10.1159/000543385 · Cited by 12 · see citing works
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InfluentialSelf-citationDing, M., Zhang, Q., Shi, F., Zhou, L., Guo, X., Li, Q., Luo, L., Miao, Y., & Huo, Y. (2025) · Chemical Engineering Journal · doi:10.1016/j.cej.2025.165564 · Cited by 10 · see citing works
Predialysis Potassium Variability and Postdialysis Mortality in Patients With Advanced CKD
Dashputre, A. A., Potukuchi, P. K., Sumida, K., et al. (2021) · Kidney International Reports · doi:10.1016/j.ekir.2020.11.022 · Cited by 10 · see citing works
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BackgroundAlSahow, A. (2023) · World Journal of Nephrology · doi:10.5527/wjn.v12.i4.73 · Cited by 9 · see citing works
Desai, N. B., & Hoenig, M. P. (2024) · Advances in Kidney Disease and Health · doi:10.1053/j.akdh.2024.08.001 · Cited by 9 · see citing works
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Granal, M., Fouque, D. P., Ducher, M., & Fauvel, J. (2023) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfad015 · Cited by 9 · see citing works
Jiménez‐Marrero, S., Cainzos‐Achirica, M., Monterde, D., Vela, E., Clèries, M., García‐Eroles, L., Enjuanes, C., Yun, S., Garay, A., Moliner, P., et al. (2020) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2020.06.013 · Cited by 9 · see citing works
Chhabria, M., Portales‐Castillo, I., Chowdhury, M., et al. (2020) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2019.12.020 · Cited by 9 · see citing works
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BackgroundJiménez‐Marrero, S., Cainzos‐Achirica, M., Monterde, D., Vela, E., Clèries, M., García‐Eroles, L., Enjuanes, C., Yun, S., Garay, A., Moliner, P., et al. (2020) · Revista Española de Cardiología · doi:10.1016/j.recesp.2020.06.016 · Cited by 9 · see citing works
Liu, Y., Qiu, T., Fu, Z.-Z., et al. (2024) · Medicine · doi:10.1097/md.0000000000039041 · Cited by 8 · see citing works
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BackgroundStrizzi, C. T., D’Ambrosio, V., Grandaliano, G., & Pesce, F. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26188829 · Cited by 13 · see citing works
“• Aldosterone upregulates HKA activity, particularly during hypokalemia [92,93].”
Genetic diagnosis and treatment of hereditary renal tubular disease with hypokalemia and alkalosis
Guo, W., Ji, P., & Xie, Y. (2022) · Journal of Nephrology · doi:10.1007/s40620-022-01428-4 · Cited by 8 · see citing works
Guo, Y., Qiu, Y., Xue, T., Yan, P., Zhao, W., Wang, M., Liu, C., & Zhang, N. (2024) · PLoS ONE · doi:10.1371/journal.pone.0309764 · Cited by 7 · see citing works
“Potassium ion (K+), one of the cations widely located in intracellular, plays a crucial role in the maintenance of cell membrane potential, pH stability, metabolism and energy homeostasis, as well as the regulation of many cellular functions [11,12].”
Potassium binding for conservative and preservative management of chronic kidney disease
Clegg, D. J., & Palmer, B. F. (2019) · Current Opinion in Nephrology & Hypertension · doi:10.1097/mnh.0000000000000564 · Cited by 7 · see citing works
Self-citationStatsenko, Y. A., Habuza, T., Talako, T., Pazniak, M., Likhorad, E., Pazniak, A., Beliakouski, P., Gelovani, J. G., Gorkom, K., Almansoori, T. M., et al. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.882190 · Cited by 7 · see citing works
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BackgroundSeverino, P., D'Amato, A., Prosperi, S., Myftari, V., Francia, A. L., Önkaya, M., Notari, C., Papisca, I., Canuti, E. S., Revivo, M. Y., et al. (2022) · Nutrients · doi:10.3390/nu14163439 · Cited by 7 · see citing works
“Furthermore, it is involved in several physiological mechanisms [80], such as vascular tone and systemic blood pressure regulation, gastrointestinal motility, acid–base homeostasis, glucose, and insulin metabolism [81,82].”
BackgroundA New Understanding of Potassium's Influence Upon Human Health and Renal Physiology
McCormick, J. A., Topf, J. M., Tomacruz, I. D. V., & Grimm, P. R. (2023) · Advances in Kidney Disease and Health · doi:10.1053/j.akdh.2023.01.001 · Cited by 8 · see citing works
Usman, A., Shaikh, M. F., Dujaili, J. A., et al. (2021) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2021.03.001 · Cited by 6 · see citing works
Fifteen-minute consultation: Emergency management of children presenting with hyperkalaemia
Rubens, M., & Kanaris, C. (2021) · Archives of Disease in Childhood Education & Practice · doi:10.1136/archdischild-2021-322080 · Cited by 6 · see citing works
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Laibi, H. A., Jewad, A. M., & Salih, M. (2023) · Journal of Biomedicine and Biochemistry · doi:10.57238/jbb.2023.6532.1027 · Cited by 6 · see citing works
Hyperkalemia and blood pressure regulation
Mutig, K., & Bachmann, S. (2019) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfz218 · Cited by 6 · see citing works
Chakraborty, P., Bhattacharjee, R., Patra, S., et al. (2021) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/ijem.ijem_785_20 · Cited by 6 · see citing works
“5 mmol: mmol or >13 mmol/gram in spot sample during hypokalemia suggested inappropriate renal K+ excretion.[4,5] Tubular reabsorption of phosphate (TRP) was calculated in all patients with hypophosphatemia, and tubular maximum reabsorption of phosphate corrected for GFR (TmP/GFR) was obtained from the valid nomogram.”
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Dashputre, A. A., Gatwood, J. D., Sumida, K., et al. (2021) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2021.27.10.1403 · Cited by 6 · see citing works
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BackgroundSun, Z., Jiao, J., Lu, G., Liu, R., Li, Z. Y., Sun, Y., & Chen, Z. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1285929 · Cited by 5 · see citing works
“Contrarily, animal products have higher potassium content but lower carbohydrate content, which may lead to higher plasma potassium levels after intake, therefore, not all potassium-rich foods are likely to result in similar increases in serum potassium concentrations (6).”
BackgroundInfluentialMarshall, W. R., Curran, G. A., Traynor, J. P., et al. (2024) · Clinical Kidney Journal · doi:10.1093/ckj/sfae313 · Cited by 5 · see citing works
Strauss‐Kruger, M., Pieters, M., van Zyl, T., Gafane-Matemane, L. F., Mokwatsi, G. G., Jacobs, A., Schutte, A. E., Louw, R., & Mels, C. M. C. (2023) · Journal of Nutrition · doi:10.1016/j.tjnut.2023.12.025 · Cited by 5 · see citing works
Usman, A., Mustafa, N., Iqbal, S. P., Hasan, M. Z., Shaikh, M. F., Dujaili, J. A., & Gan, S. H. (2021) · International Journal of Clinical Practice · doi:10.1111/ijcp.14315 · Cited by 5 · see citing works
Long-term complications of primary distal renal tubular acidosis
Santos, F., & Gil‐Peña, H. (2022) · Pediatric Nephrology · doi:10.1007/s00467-022-05546-w · Cited by 5 · see citing works
Hirose, R., Tsurutani, Y., Nakatsue, T., et al. (2023) · Internal Medicine · doi:10.2169/internalmedicine.1931-23 · Cited by 5 · see citing works
“Excessive carbohydrate intake causes hyperinsulinemia, which results in an intracellular shift of serum potassium, leading to hypokalemia (25).”
BackgroundUsman, A., Mustafa, N., Dujaili, J. A., et al. (2020) · Polskie Archiwum Medycyny Wewnętrznej · doi:10.20452/pamw.15634 · Cited by 5 · see citing works
“At first, it hinders influx of serum-potassium (SK) from extracellular (ECF) to intracellular (ICF) compartment triggering hyperkalemia [2].”
BackgroundInfluentialUehara, A., Mok, Y., Matsushita, K., Lutsey, P. L., & Ishigami, J. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaf120 · Cited by 4 · see citing works
The impact of serum potassium ion variability on 28-day mortality in ICU patients
Zhang, Y., Liang, S., & Wen, H. (2024) · PLoS ONE · doi:10.1371/journal.pone.0310046 · Cited by 4 · see citing works
Pérez‐Juárez, C. M., García-Ortíz, J. D., González-Martínez, D. W., Flores‐Gallegos, A. C., Requena, M. C., Galindo, A. S., Ascacio-Valdés, J. A., & Rodrı́guez-Herrera, R. (2024) · Food and Humanity · doi:10.1016/j.foohum.2024.100479 · Cited by 4 · see citing works
Cai, A., Zhang, T., Gao, K., et al. (2025) · Frontiers in Medicine · doi:10.3389/fmed.2025.1582894 · Cited by 4 · see citing works
“Insulin resistance in diabetic patients can reduce cellular potassium uptake, while sepsis-induced AKI may impair potassium excretion (25, 26).”
Ma, Y., Ding, Y.-F., Yang, L.-H., et al. (2026) · Electrochimica Acta · doi:10.1016/j.electacta.2026.148137 · Cited by 4 · see citing works
Walter, C., Rafael, C., Genna, A., Baron, S., & Crambert, G. (2021) · Scientific Reports · doi:10.1038/s41598-021-81388-0 · Cited by 4 · see citing works
The Effects of Magnesium Coadminstration During Treatment of Hypokalemia in the Emergency Department
Tuttle, A., Fitter, S., Hua, H., et al. (2022) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2022.06.007 · Cited by 4 · see citing works
Gerard, R., Sauvestre, C., Barat, P., et al. (2024) · Archives de Pédiatrie · doi:10.1016/j.arcped.2023.10.007 · Cited by 4 · see citing works
Li, F., Wang, T., Wang, L., et al. (2025) · Science Progress · doi:10.1177/00368504251314081 · Cited by 4 · see citing works
Xiao, X., Erukainure, O. L., Guo, Y., Msomi, N. Z., Chu, M., & Islam, M. S. (2025) · Food Bioscience · doi:10.1016/j.fbio.2025.107011 · Cited by 4 · see citing works
Polymyxin Acute Kidney Injury: a case of severe tubulopathy
Goldin, L. A. D. M., Silva, L. N., da Silva, T. F., et al. (2021) · Brazilian Journal of Nephrology · doi:10.1590/2175-8239-jbn-2019-0191 · Cited by 4 · see citing works
Romero-González, G. A., Bover, J., Arrieta, J., Salera, D., Troya, M. I., Graterol, F., Ureña, P., Cozzolino, M. G., Lullo, L. D., Cippà, P. E., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11143970 · Cited by 4 · see citing works
“The electrical and chemical gradients determining the K+ flow into the urine are influenced by plasma K+ concentration, mineralocorticoid activity, distal sodium delivery, and tubular fluid flow rate (which is decreased in HF), among other factors [20].”
BackgroundInfluentialTian, R., Li, R., & Zhou, X. (2023) · Medicina · doi:10.3390/medicina59020353 · Cited by 4 · see citing works
“Insulin is the most efficient rapid-action treatment to shift potassium; the primary shifting mechanism of insulin is by binding with glucose transporter 4 receptor on skeletal muscles, thus activating sodium–potassium adenosine triphosphatase (ATPase) to achieve potassium homeostasis control [40].”
BackgroundStadt, M. M., & Layton, A. T. (2024) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00283.2023 · Cited by 4 · see citing works
Chukwuedozie, V. C., Garg, T., Chaudhry, H. A., Shawl, S. H., Mishra, P., Adaralegbe, N. J., & Khan, A. (2022) · Cureus · doi:10.7759/cureus.27695 · Cited by 4 · see citing works
- Authors
- Palmer, B. F., & Clegg, D. J.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- Cedars-Sinai Medical Center (US)
- Corresponding author
- Palmer, Biff F.
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2019-11
- Volume
- 74
- Issue
- 5
- Pages
- 682-695
- ISSN
- 0272-6386 (ISSN-L)
- OpenAlex
- W2949599907
- Cited by
- 215
- References
- 0
- Citations by year
- 2026: 32 · 2025: 30 · 2024: 29 · 2023: 39 · 2022: 28 · 2021: 29 · 2020: 22 · 2019: 6
- FWCI
- 15.53
- Type
- journal article
- Language
- en
- Update notices
- erratum (2022-11-01)
- Open access
- closed
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Potassium and Related Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Ion Transport and Channel Regulation
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Keywords
- potassium homeostasis, total body potassium, potassium distribution, renal potassium excretion, insulin, hyperkalemia, hypokalemia, potassium disorders
- MeSH terms
- Curriculum, Education, Medical, Homeostasis, Humans, Hyperkalemia, Kidney, Kidney Failure, Chronic, Nephrology, Potassium
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