RESUMO
AIM OF THE STUDY: The study aimed to assess the prevalence of executive function impairment among patients with chronic kidney disease (CKD) undergoing dialysis, with no subjective cognitive problems and with normal global cognition on the Mini-Mental State Examination (MMSE). We also investigated the relationship between cardiovascular risk factors and cognitive test results. RATIONALE FOR THE STUDY: Patients with CKD, including those undergoing renal replacement therapy, are at a higher risk of developing cognitive impairment (CI) than the general population. Recent research has shown CI to be a growing problem among CKD patients worldwide. Yet, it remains underdiagnosed, even though it may significantly influence the lives of patients. MATERIALS AND METHODS: In this cross-sectional, prospective study, 58 dialysis patients with no cognitive decline on the MMSE screening were assessed for executive function impairment using the Executive Clock-Drawing Task (CLOX). Moreover, past medical history, demographic data, and laboratory test results were collected. RESULTS: The mean patient age was 59.47 ± 14.98 years, and the mean duration of dialysis was 45.93 ± 48.49 months. The prevalence of executive function impairment amounted to 8.6%. Moreover, remarkably similar pattern of clock drawing was observed, with numbers written outside the clock face in the CLOX1 test. CONCLUSIONS: Executive dysfunctions in dialysis patients may manifest itself before the onset of global cognitive impairment. There appear to be a deficit in the spatial domain as well. Better education may play a protective role.
Assuntos
Disfunção Cognitiva , Insuficiência Renal Crônica , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Estudos Prospectivos , Estudos Transversais , Testes Neuropsicológicos , Diálise Renal/efeitos adversos , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapiaRESUMO
BACKGROUND: Cognitive impairment (CI) in patients with chronic kidney disease, including those treated with renal replacement therapy, is a growing problem worldwide. OBJECTIVES: The study aimed to assess the prevalence of CI and associated factors in patients undergoing peritoneal dialysis (PD). METHODS: In this cross-sectional study, 18 consecutive patients with PD therapy and 15 controls were evaluated for CI using the Addenbrooke's Cognitive Examination III (ACE III) test. RESULTS: The prevalence of CI was 33% in patients and 27% in the control group and was not statistically significant. A higher prevalence of CI was found in subjects aged ≥65 years old than in those <65 years old (p = 0.02), but only in the control group. The prevalence of CI in PD patients over and under 65 years of age did not differ statistically significantly (p = 0.12). Memory and verbal fluency were the most affected cognitive domain in PD patients with CI (p = 0.00, p = 0.04, respectively). There was a significant correlation between higher educated PD patients and the ACE III test results. The duration of dialysis did not affect the results of the cognitive screening test. CONCLUSIONS: CI is a growing problem in the course of chronic kidney disease and dialysis therapy. It seems that cognitive problems may occur in patients undergoing PD at a younger age than in the general population with particularly affected memory and verbal fluency. Higher educated patients score better on the cognitive screening test.
Assuntos
Disfunção Cognitiva , Diálise Peritoneal , Insuficiência Renal Crônica , Humanos , Idoso , Prevalência , Estudos Transversais , Diálise Renal , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Diálise Peritoneal/efeitos adversos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapiaRESUMO
INTRODUCTION: Cognitive impairment (CI) is common in end-stage kidney disease (ESKD), including kidney transplant recipients. Patients with cognitive problems may find it difficult to comply with medical recommendations after kidney transplantation (KT), which can be the cause of many complications, poorer prognosis, and increased hospitalization rates after transplantation. Additionally, some patients after KT may experience depression and anxiety, which are prevalent comorbidities in patients with ESKD. METHODS: In this single-center, cross-sectional study, we included 56 consecutive adult patients after KT. Cognitive function was assessed using the Addenbrooke Cognitive Test III (ACE III). In addition, all patients were screened for depression and anxiety using the Hospital Anxiety and Depression Scale (HADS). The impact of immunosuppressive therapy and other disease-related variables on cognitive function was also assessed. RESULTS: A total of 56 KT patients, with a mean age of 50.3 ± 11.7 years, transplanted ≤35 months ago were included in the study. The prevalence of CI was 30%. Compared with cognitively unimpaired patients, patients with CI scored significantly lower in all cognitive domains. Furthermore, better cognitive functioning after KT was significantly associated with more years of schooling. We found no significant correlation between CI and age at assessment, duration of dialysis before KT, creatinine levels, creatinine clearance, uric acid levels, hemoglobin levels, comorbid cardiovascular diseases, and immunosuppressive therapy. In addition, the prevalence of depression and anxiety in screening tests was 12.5% and 27%, respectively, and patients receiving higher daily dose of prednisone had higher HADS scores on both the depression and anxiety subscales (not statistically significant). DISCUSSION: Cognitive disorders are a relevant issue in kidney transplant recipients. There might be many factors, both before and after KT, that have a negative impact on cognition. Therefore, further research is needed to increase knowledge about the course and profile of cognitive function after KT.
Assuntos
Disfunção Cognitiva , Falência Renal Crônica , Transplante de Rim , Adulto , Humanos , Pessoa de Meia-Idade , Transplante de Rim/efeitos adversos , Diálise Renal , Estudos Transversais , Creatinina , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Falência Renal Crônica/terapia , Ansiedade/psicologia , Transplantados/psicologiaRESUMO
Patients with chronic kidney disease (CKD) are at risk of progression to end-stage renal disease and high cardiovascular mortality. Data from other populations and animal experiments suggests that angiotensin-neprilysin inhibition may be superior to renin-angiotensin-aldosterone system inhibition in reducing the risk of cardiovascular mortality and retarding the progression of CKD. The review summarizes the existing evidence on the potential benefits of angiotensin-neprilysin inhibitor (ARNi) in CKD.
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Insuficiência Cardíaca , Insuficiência Renal Crônica , Aminobutiratos , Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Angiotensinas , Animais , Humanos , Neprilisina , Insuficiência Renal Crônica/tratamento farmacológico , Sistema Renina-Angiotensina , TetrazóisRESUMO
Patients with chronic kidney disease are immunocompromised and deterioration of kidney function builds up the defect of the cellular and humoral immunity. This makes the patients prone to severe life-threatening infections, and results in less effective vaccination. In addition, frequent hospitalizations, immunosuppressive therapy and renal replacement therapy are important risk factors for infection. The review presents recommendations and the evidence for the efficacy of vaccination in different populations of patients with kidney disease.
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Insuficiência Renal Crônica/fisiopatologia , Vacinação/estatística & dados numéricos , Vacinas Atenuadas/uso terapêutico , Vacinas contra Hepatite B/uso terapêutico , Humanos , Vacinas contra Influenza/uso terapêutico , Vacinas contra Papillomavirus/uso terapêutico , Vacinas Pneumocócicas/uso terapêutico , Insuficiência Renal Crônica/terapia , Fatores de RiscoRESUMO
Hypertension is the most common chronic cardiovascular condition, with an increasing prevalence all over the world. Patients with refractory hypertension are the group most at risk for adverse cardiovascular events, but also present a particular diagnostic and therapeutic challenge. The present article reviews the mechanisms of development of resistant hypertension and the possibilities of pharmacological treatment and interventional approaches.
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Anti-Hipertensivos/uso terapêutico , Resistência a Medicamentos , Hipertensão/tratamento farmacológico , Doenças Cardiovasculares/prevenção & controle , Humanos , Hipertensão/prevenção & controle , Prognóstico , Medição de RiscoRESUMO
Hyperkalemia is a medical emergency that requires immediate therapy, followed by interventions aimed at preventing its recurrence. Hyperkalemia occurs especially frequently in patients with chronic kidney disease (CKD), in part because of impaired kidney function and in part due to coexisting comorbidities such as diabetes or heart failure and the medications used to treat them, first of all the inhibitors of renin-angiotensin-aldosterone system (RAASi). Both acute and chronic management of hyperkalemia are equally important, though, with currently available therapeutic possibilities, the effective restoration of potassium homeostasis are in fact limited to the correction of its triggers. The emergence of new medications (patiromer and ZS-9) could lead to a therapeutic paradigm shift from intermittent treatment of incidentally discovered hyperkalemia toward preventive measures preventing fluctuations in serum potassium levels and enabling the continuation of beneficial, but hyperkalemia inducing agents.
Assuntos
Hiperpotassemia/tratamento farmacológico , Hiperpotassemia/etiologia , Polímeros/uso terapêutico , Insuficiência Renal Crônica/complicações , Silicatos/uso terapêutico , HumanosRESUMO
Optimal blood pressure control is a key measure in slowing the progression of kidney disease and reducing the cardiovascular risk in patients with chronic kidney disease, although the target BP remain controversial. The SPRINT (Systolic Blood Pressure Intervention Trial) demonstrated that intensive treatment of hypertension brings a spectacular reduction in the risk of major cardiovascular events and all-cause mortality in older non-diabetic patients at high cardiovascular risk and chronic kidney disease and mild proteinuria.
Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Insuficiência Renal Crônica/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
A close relationship between renal dysfunction and heart failure has been demonstrated with a huge impact on the patients outcomes. To describe the relationship, the term cardio-renal syndrome (CRS) has been increasingly used in recent years. Medical management of patients with CRS remains tremendously challenging. The integration of cardiology and nephrology communities providing with a more holistic and complete clinical presentation of patients seems to be a necessary strategy to treat this vulnerable population.
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Síndrome Cardiorrenal/diagnóstico , Síndrome Cardiorrenal/terapia , Cardiologia/normas , Comunicação Interdisciplinar , Nefrologia/normas , Hemodiafiltração/normas , Humanos , Monitorização Fisiológica , Guias de Prática Clínica como AssuntoRESUMO
Acute kidney injury (AKI) is a common postoperative complication of cardiac surgery and the second most common cause of this syndrome in the intensive care units. The etiology is multifactorial and related to the surgery itself, as well as to intra- and postoperative management. To date, there is scarce evidence supporting specific measures to prevent AKI in this clinical situation, and whether the patients may benefit from early institution of some pharmacologic agents or early renal replacement therapy initiation. Further studies are essential to determine how to optimize cardiac surgical procedures and intra- and postoperative management.
Assuntos
Injúria Renal Aguda/etiologia , Injúria Renal Aguda/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Humanos , Unidades de Terapia Intensiva , Terapia de Substituição Renal/efeitos adversos , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Data on the potent pleiotropic extraskeletal effects of vitamin D have renewed interest in its use in selected populations, including patients with chronic kidney disease, but the available data are still insufficient to make recommendations. This study assessed the long-term effect of small cholecalciferol doses on serum vitamin D, parathormone (PTH), and bone mineral density (BMD) in hemodialysis patients. MATERIAL/METHODS: Nineteen patients with serum 25(OH)D <20 ng/mL were randomized into cholecalciferol (2000 IU 3×/week) and no-treatment groups, then observed for 1 year. Patients with hypercalcemia, hyperphosphatemia, and receiving vitamin D/calcimimetics were excluded. Serum 25(OH)D, 1,25(OH)2D, PTH, and alkaline phosphatase activity were examined every 2 months and BMD was measured before and after the study. RESULTS: We observed normalization of serum 25(OH)D with an increase in medians from 11.3 to 44.9 ng/mL (P=0.02) in the cholecalciferol group and no change in the controls (P<0.001). Simultaneously, median serum 1,25(OH)2D increased from 18.2 to 43.1 pmol/L (P=0.02) in the cholecalciferol group and from 10.6 to 21.2 pmol/L (P=0.02) in controls (P=0.013). The treatment was associated with a small increase in serum calcium, but serum phosphate, PTH, alkaline phosphatase, and BMD remained unchanged in both groups. CONCLUSIONS: Oral cholecalciferol at a dose of 2000 IU/3×/week is an effective and safe way to treat vitamin D deficiency in hemodialysis patients, leading to a significant increase in serum 1,25(OH)2D. However, it was insufficient to suppress the activity of parathyroid glands or to significantly change BMD.
Assuntos
Colecalciferol/administração & dosagem , Colecalciferol/farmacologia , Diálise Renal , Idoso , Osso e Ossos/efeitos dos fármacos , Calcifediol/sangue , Calcitriol/sangue , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Fatores de TempoRESUMO
The integrated renal replacement therapy (RRT) concept assumes that all its methods: kidney transplantation (Tx), hemodialysis (HD) and peritoneal dialysis (PD) can be applied in a complementary manner, according to the clinical situation of the particular patient and his preferences. Besides the integration of treatments this concept also emphasizes timely patient referral, predialysis education and timely start of RRT.
Assuntos
Falência Renal Crônica/terapia , Transplante de Rim , Diálise Peritoneal , Diálise Renal , Terapia Combinada/métodos , HumanosRESUMO
In this paper the main therapeutic goals in chronic kidney disease (CKD) are summarized, together with the methods of its early detection, the main rules of nephro- and cardioprotection, as well as the prevention of the other complications.
Assuntos
Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Substâncias Protetoras/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Anemia/tratamento farmacológico , Anemia/etiologia , Diagnóstico Precoce , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Falência Renal Crônica/complicações , Masculino , Desnutrição/etiologia , Desnutrição/prevenção & controle , Pessoa de Meia-Idade , Proteinúria/tratamento farmacológico , Proteinúria/etiologia , Prevenção SecundáriaRESUMO
Living kidney transplantation is considered as preferred, and sometimes the only possible, treatment option for improving survival and quality of life of patients with end-stage kidney disease. The main obstacle in the development of transplantation is shortage of organs, but in certain regions of the world also organizational, legislative and economic limitations. The paper some data on the kidney transplantation from living donors in Poland, Europe and the world are presented.
Assuntos
Falência Renal Crônica/terapia , Transplante de Rim/estatística & dados numéricos , Doadores Vivos/estatística & dados numéricos , Saúde Global , Humanos , PolôniaRESUMO
There is a substantial evidence that late referral for renal replacement therapy leads to poor outcomes for patients with advanced chronic kidney disease, with many complications, prolonged hospital stays and rehabilitation, and increased mortality. However, in many services worldwide, a lot of patients still do not begin dialysis treatment electively despite prior nephrology care. The predialysis education in addition to standard nephrology follow-up enhances the probability of planned dialysis start and may improve dialysis patient outcomes.
Assuntos
Falência Renal Crônica/terapia , Educação de Pacientes como Assunto , Diálise Renal , Diagnóstico Precoce , Humanos , Falência Renal Crônica/diagnóstico , Encaminhamento e Consulta/organização & administração , Resultado do TratamentoRESUMO
BACKGROUND: Pre-transplantation dialysis duration and modality may affect patients' long-term (mortality and graft failure) and short-term (delayed graft function) outcomes after kidney transplantation. We aimed to assess the impact of the method and duration of dialysis therapy on the graft function in the first 6 months post-transplant. METHODS: The analysis included 122 kidney transplant patients (109 from a deceased donor and 13 from a living donor). Before transplantation, 91 were on hemodialysis (HD), 19 were on peritoneal dialysis (PD), and 9 received preemptive transplants. The incidence of delayed graft function (DGF) and creatinine levels at discharge and 6 months after transplantation were assessed. RESULTS: PD and HD patients did not differ in age, number of mismatches, and cold ischemia time (CIT), but they had a significantly shorter dialysis vintage (18.3 ± 25.7 vs 39.6 ± 34.3 months, P = .01) and a lower incidence of DGF (5% vs 37%, P = .006). The duration of hospitalization and creatinine concentration at discharge and after 6 months were similar. Preemptively transplanted patients had a significantly shorter CIT (ND vs DO - 576 ± 362 vs 1113 ± 574, P = .01; ND vs HD - 576 ± 362 vs 1025 ± 585 minutes, P = .01). DGF did not occur in any of the patients transplanted preemptively. They had slightly shorter hospitalization times and, compared to HD, better graft function at discharge. After 6 months, creatinine levels were comparable to HD and PD. Patients dialyzed for less than 12 months, regardless of the method, had a lower incidence of DGF. CONCLUSIONS: Peritoneal dialysis and a short duration of pre-transplant dialysis may improve the early results of kidney transplantation.
Assuntos
Função Retardada do Enxerto , Transplante de Rim , Diálise Renal , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Resultado do Tratamento , Função Retardada do Enxerto/etiologia , Função Retardada do Enxerto/epidemiologia , Fatores de Tempo , Creatinina/sangue , Diálise Peritoneal , Sobrevivência de EnxertoRESUMO
INTRODUCTION: Iron metabolism disorders and anemia are one of the main complications of end-stage renal disease that may affect the evaluation process for kidney transplantation. The study aimed to assess the iron metabolism in hemodialysis patients in relation to waiting list status. STUDY METHOD: The study included 5068 hemodialysis patients, including those on the active waiting list (N = 449) and those who were not eligible for the waitlist (N = 4619). Demographic and biochemical data, Charlson's comorbidity index, duration of hemodialysis therapy and, respectively, hemoglobin, ferritin, and transferrin saturation levels were compared in both groups of patients. RESULTS: Patients on the active waiting list were significantly younger -53.2 vs 67.2 years (P < .001), with a lower Charlson comorbidity index score: 3.33 vs 4.42 (P < .001). The duration of hemodialysis therapy was similar: 66.0 vs 63.2 months (P = .416), the incidence of anemia according to World Health Organization (90.6%, vs 91.2%) and KDIGO (72.4% vs 70.4%). The degree of anemia correction in terms of hemoglobin concentration and transferrin saturation was comparable in both groups and amounted to an average of 10.9 g/dL (P = .349) for hemoglobin concentration and 32.7% vs 33.4% (P = .513) for transferrin saturation. However, there was a statistically significant difference in ferritin concentration: 554 ug/L vs 733 ug/L (P = .001). CONCLUSIONS: Patients on the active list have significantly lower ferritin levels despite similar duration of hemodialysis treatment and comparable hemoglobin values. This may be due to lower inflammation, and less frequent blood transfusions, and lead to a lower risk of immunization and an increased chance of potential kidney transplantation.
Assuntos
Anemia , Ferro , Falência Renal Crônica , Transplante de Rim , Diálise Renal , Listas de Espera , Humanos , Transplante de Rim/efeitos adversos , Pessoa de Meia-Idade , Feminino , Masculino , Anemia/sangue , Anemia/etiologia , Idoso , Falência Renal Crônica/terapia , Falência Renal Crônica/cirurgia , Falência Renal Crônica/complicações , Ferro/sangue , Ferritinas/sangue , Hemoglobinas/metabolismo , Hemoglobinas/análise , Transferrina/análise , Transferrina/metabolismo , AdultoRESUMO
Hematopoietic stem cell transplant (HSCT) is the treatment of choice in various hematologic diseases, and kidney transplantation (KTx) is the best therapy for end-stage kidney disease. Chronic kidney disease (CKD) occurs relatively often after both types of transplantations. Anemia after both HSCT and KTx may be due to CKD and other reasons. This study aimed to assess the prevalence of anemia to CKD in 156 prevalent patients after HSCT and 80 after KTx. According to the World Health Organization's definition (hemoglobin <13 g/dL for men and <12 g/dL for women), the prevalence of anemia in the studied cohort after HSCT was 13% in women and 35% in men and for those after KTx, it was29% in men and 11%. Anemia in KTx was found in 46% of patients, whereas CKD was present in 53%. After HSCT, anemia was associated with CKD in 56% of women and 17% of men. In KTx, anemia and CKD was diagnosed in 21% of patients. Patients with anemia after KTx had significantly lower glomerular filtration rate (GFR), hemoglobin, and significantly higher creatinine levels. Age was related to the estimated GFR (eGFR; r = -0.39, P < .001) in patients who underwent HSCT and had anemia. In patients without anemia, age was negatively related to eGFR (r = -0.56, P < .001) and the hemoglobin-to-platelet count (r = 0.62, P < .001). In KTx, hemoglobin was related to eGFR (r = 0.35, P < .001), and age was related to eGFR (r = -0.20, P < .05). The type of induction therapy immunosuppressive regimen (anti-thymocyte globulin vs basiliximab vs no induction) did not affect the prevalence of anemia in the KTx population studied. Anemia is relatively common in CKD after HSCT. In both CKD and coexistent anemia, nephrology referral is to be considered to optimize therapy, including nephroprotection.
Assuntos
Anemia , Taxa de Filtração Glomerular , Transplante de Rim , Humanos , Anemia/epidemiologia , Anemia/etiologia , Masculino , Feminino , Transplante de Rim/efeitos adversos , Pessoa de Meia-Idade , Adulto , Prevalência , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapiaRESUMO
INTRODUCTION: Cognitive impairment (CI) is common in both end-stage kidney disease (ESKD) and alcohol-related liver cirrhosis. The aim of this study was to assess the prevalence and patterns of CI in patients awaiting kidney and liver transplantation, and to identify its determinants. METHODS: In this cross-sectional, prospective study, 31 consecutive patients with ESKD and 31 consecutive patients with alcohol-related liver cirrhosis, all currently on transplant waiting lists, were screened for cognitive decline using the Addenbrooke's Cognitive Examination. Medical history, demographics, and laboratory test results were also collected. RESULTS: The prevalence of CI among patients with ESKD and alcohol-related liver cirrhosis was 26% and 90%, respectively. In both groups, memory was the most affected cognitive domain, along with verbal fluency in patients with ESKD, and visuospatial abilities in patients with alcoholic cirrhosis. The most statistically significant increase in the prevalence of CI was found in patients with lower educational attainment, in both alcohol-related liver cirrhosis and ESKD populations as well as in older patients with alcoholic cirrhosis. Furthermore, better cognitive functioning in ESKD patients was associated with higher levels of total lymphocyte count and alanine transaminase (ALT), and in alcohol-related liver cirrhosis patients with higher levels of ALT and aspartate transaminase. A nonsignificant trend toward lower memory domain scores was also observed with increasing ammonia levels and increasing severity of liver disease (higher Child-Pugh scores). Finally, suboptimal performance on the screening test was correlated with the severity of liver disease as assessed by the Model for End-Stage Liver Disease Sodium (MELD-Na), but not at the statistically significant level. CONCLUSIONS: The prevalence of CI, especially in patients with alcohol-related liver cirrhosis, is high and can be a significant clinical problem, negatively affecting the transplantation process. Routine screening tests in this group would contribute to the implementation of appropriate management, such as rehabilitation program or psychosocial treatments and facilitate the provision of specialized health care.
Assuntos
Disfunção Cognitiva , Falência Renal Crônica , Transplante de Rim , Transplante de Fígado , Listas de Espera , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Transversais , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/epidemiologia , Estudos Prospectivos , Prevalência , Falência Renal Crônica/epidemiologia , Cirrose Hepática Alcoólica/epidemiologia , Cirrose Hepática Alcoólica/complicações , Adulto , Idoso , Testes NeuropsicológicosRESUMO
Potassium is a main cation in the intracellular compartment, with nearly 80% of stores being present in muscles, liver, bone and red blood cells. Intracellular potassium concentration is about 140-150 mmol/l in contrast to more than 30 times lower extracellular levels (3.5-5.0 mmol/l).This transmembrane gradient is crucial for maintenance of the membrane resting potential and neuro-muscularfunctioning, including the heart. In this review the physiological regulation of potassium balance is shortly reviewed to set a background for understanding its disorders.