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.

中文翻译：

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盐皮质激素受体拮抗剂治疗的原发性醛固酮增多症的盐摄入量：是敌人还是盟友？

轻度高钾血症是盐皮质激素受体拮抗剂（MRA）治疗原发性醛固酮增多症（PA）患者的常见副作用，通过减少盐摄入量的指示可使其恶化。我们的目标是评估盐消耗对相对盐分受限的MRA治疗的高钾PA患者的血钾水平以及平均，平均最小和最大最大收缩压和舒张压（BP）的影响。连续招募了17名66.3±8.37岁的轻度高钾MRA治疗的PA患者。评估了体重指数（BMI）和血压，并测量了血清和24小时尿钠和钾水平，血浆肾素和血清醛固酮，而患者则遵循相对限盐饮食，在控制性补充盐分1个月后（通常为限盐饮食加4 g盐/天），并在6个月后按指示免费食用盐分食用。另外在另外两个患者组（血压正常的受试者和正常血MRA治疗的PA患者）中评估了基线盐的消耗。一个月的受控盐补充（24小时尿钠（中位数，最小值，最大值）：195.2（120.30–275.20）vs 110.13（34.30–139.20）mEq /天，p  <0.001）导致kaliuresis增加（62.25（40.69–97.0）vs 54.0（23.28–79.60）mEq / day，p  = 0.001）和血清钾减少（5.2（5–5.70）vs 4.6（3.8–5.1） mEq / L，p  <0.001），而血清钠（139（133-141）vs 1 39（135-144）mEq / L）和平均收缩压（130（105-141 vs. 130（106-141）mmHg）舒张压（76（53–85）vs 75（53–84）mmHg）的血压保持稳定，游离盐摄入6个月后这些发现没有改变； BMI保持恒定，而盐补充后血浆肾素和血清醛固酮下降。食盐可以缓解相对盐限制的PA患者MRA引起的高钾血症，而不会影响BP或BMI。