{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:33:53Z","timestamp":1768570433570,"version":"3.49.0"},"reference-count":71,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2022,7,8]],"date-time":"2022-07-08T00:00:00Z","timestamp":1657238400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Hyperkalaemia (HK) is one of the most common electrolyte disorders and a frequent reason for nephrological consultations. High serum potassium (K+) levels are associated with elevated morbidity and mortality, mainly due to life-threatening arrhythmias. In the majority of cases, HK is associated with chronic kidney disease (CKD), or with the use of renin\u2013angiotensin\u2013aldosterone system inhibitors (RAASis) and\/or mineral corticoid antagonists (MRAs). These drugs represent the mainstays of treatment in CKD, HF, diabetes, hypertension, and even glomerular diseases, in consideration of their beneficial effect on hard outcomes related to cardiovascular events and CKD progression. However, experiences in relation to the Randomised Aldactone Evaluation Study (RALES) cast a long shadow that extends to the present day, since the increased risk for HK remains a major concern. In this article, we summarise the physiology of K+ homeostasis, and we review the effects of dietary K+ on blood pressure and cardiovascular risk in the general population and in patients with early CKD, who are often not aware of this disease. We conclude with a note of caution regarding the recent publication of the SSaSS trial and the use of salt substitutes, particularly in patients with a limited capacity to increase K+ secretion in response to an exogenous load, particularly in the context of \u201coccult\u201d CKD, HF, and in patients taking RAASis and\/or MRAs.<\/jats:p>","DOI":"10.3390\/jcm11143970","type":"journal-article","created":{"date-parts":[[2022,7,8]],"date-time":"2022-07-08T11:37:08Z","timestamp":1657280228000},"page":"3970","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The \u201cFIFTY SHADOWS\u201d of the RALES Trial: Lessons about the Potential Risk of Dietary Potassium Supplementation in Patients with Chronic Kidney Disease"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7481-3678","authenticated-orcid":false,"given":"Gregorio","family":"Romero-Gonz\u00e1lez","sequence":"first","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain"},{"name":"REMAR-IGTP Group, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, 08916 Barcelona, Spain"},{"name":"International Renal Research Institute of Vicenza, 36100 Vicenza, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordi","family":"Bover","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain"},{"name":"REMAR-IGTP Group, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, 08916 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5654-7895","authenticated-orcid":false,"given":"Javier","family":"Arrieta","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Basurto, 48013 Bilbao, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6683-4583","authenticated-orcid":false,"given":"Davide","family":"Salera","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maribel","family":"Troya","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fredzzia","family":"Graterol","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6757-1906","authenticated-orcid":false,"given":"Pablo","family":"Ure\u00f1a-Torres","sequence":"additional","affiliation":[{"name":"AURA Nord Saint Ouen Dialysis Service, 93400 Saint Ouen, France"},{"name":"Service d\u2019Explorations Fonctionnelles R\u00e9nales, H\u00f4pital Necker, Universit\u00e9 Paris V, Ren\u00e9 Descartes, 75006 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8494-6252","authenticated-orcid":false,"given":"Mario","family":"Cozzolino","sequence":"additional","affiliation":[{"name":"Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Di Lullo","sequence":"additional","affiliation":[{"name":"Nephrology Department, Parodi-Delfino Hospital, 00034 Colleferro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pietro E.","family":"Cipp\u00e0","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Urrutia","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"Pa\u00fal-Martinez","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5330-9971","authenticated-orcid":false,"given":"Ram\u00f3n","family":"Boixeda","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Matar\u00f3 Hospital, 08304 Matar\u00f3, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1134-9051","authenticated-orcid":false,"given":"Jos\u00e9 Luis","family":"G\u00f3rriz","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Cl\u00ednico University Hospital, INCLIVA, Universitat de Val\u00e8ncia, 46010 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordi","family":"Ara","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antoni","family":"Bay\u00e9s-Gen\u00eds","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol (HGTiP), 08916 Badalona, Spain"},{"name":"CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7830-1645","authenticated-orcid":false,"given":"Antonio","family":"Bellasi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Ronco","sequence":"additional","affiliation":[{"name":"International Renal Research Institute of Vicenza, 36100 Vicenza, Italy"},{"name":"Department of Nephrology, DIMED\u2013University of Padova, 35122 Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.kisu.2016.01.002","article-title":"Epidemiology of hyperkalemia: An update","volume":"6","author":"Kovesdy","year":"2016","journal-title":"Kidney Int. 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