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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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“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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Chun, K., Lee, C. J., Shin, D.-H., Jeong, J., Kim, J. H., Ryu, J., Lee, H., Choi, S., Lee, E. M., Choi, J. H., et al. (2026) · Hypertension Research · doi:10.1038/s41440-026-02773-8
“In contrast, amiloride, by targeting epithelial sodium channels in the distal nephron, is less speci fi c and less likely to be effective at of fl oading sodium irrespective of whether the sodium status is driven by excess aldosterone [19].”
Androglobin contributes to adaptive renal responses during dietary potassium loadingPreprint
Correia, M., Maric, D., Winter, D. V., Jeandel, M., Osterhof, C., Derivaz, O., Clerc, A., Back, F., Odermatt, A., Hoogewijs, D., et al. (2026) · Research Square · doi:10.21203/rs.3.rs-10743170/v1
Diagnosis and management of acute hyperkalaemia
Rech, M. A., Zimmerman, D. E., Ray, L. C., Desai, D., Hoffman, J. W., & Howington, G. T. (2026) · BMJ · doi:10.1136/bmj-2026-100287
“24 Several hormonal mechanisms are involved in potassium balance.”
Common electrolyte disorders for the internist
Colbert, G. B., Shah, A., Rodriguez, S. T., & Lerma, E. V. (2026) · Disease-a-Month · doi:10.1016/j.disamonth.2026.102209
Dietary Salt Intake and Hypertension in Chronic Kidney Disease
Bae, E. (2026) · Electrolytes & Blood Pressure · doi:10.5049/ebp.2026.24.e10
Sadeghi, M., Sattar, F., Karami, M., Talaei, M., Roohafza, H., Tehrani, S. F., Shirvani, E., Mansouri, M. H., Taheri, M., & Sarrafzadegan, N. (2026) · International Journal of Preventive Medicine · doi:10.4103/ijpvm.ijpvm_303_25
“[5] Numerous studies have established a clear relationship between dietary sodium and potassium intake and blood pressure regulation.”
Potassium Timing and Outcomes in Elective GI Tumor Surgery: A Propensity Score AnalysisPreprint
Wang, Q., Zhao, B., Wu, Q., Huang, F., 熊秋菊, & Liu, D. (2026) · Research Square · doi:10.21203/rs.3.rs-10506987/v1
Zhang, J., Zhang, W., Zeng, B., et al. (2026) · Brain and Behavior · doi:10.1002/brb3.71626
“Potassium plays a crucial role in maintaining cellular function and electrical stability in the heart and muscles (Palmer and Clegg 2019 ).”
Aldosterone Synthase Inhibitors: Emerging Therapeutic Strategies in Resistant Hypertension
Pradhan, A. K., Bhandari, M., Singh, A. K., Vishwakarma, P., Mahajan, K., Perrone, M. A., & Batta, A. (2026) · Life · doi:10.3390/life16091495
“…excretion through MR-mediated upregulation of luminal potassium channels [ROMK] in the collecting duct, and suppression of aldosterone biosynthesis by CYP11B2 inhibition reduces this kaliuretic drive, resulting in potassium retention proportional to the degree of aldosterone suppression [111].”
Mahmud, F., Bello, A., Kumar, A., et al. (2026) · SSRN Electronic Journal · doi:10.2139/ssrn.7472308
Kant, S., & William, J. H. (2026) · Advances in Kidney Disease and Health · doi:10.1053/j.akdh.2026.07.002
Zhang, C., Yang, Q., Tian, D., Zhu, J., Xie, J., Tian, G., Zhao, J., Du, H., Zhao, W., Han, Z., et al. (2026) · Genes & Diseases · doi:10.1016/j.gendis.2026.102506
Metadata
- 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 › Nephrology › 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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