Low Na, High K Diet and the Role of Aldosterone in BK-Mediated K Excretion

A low Na, high K diet (LNaHK) is associated with a low rate of cardiovascular (CV) disease in many societies. Part of the benefit of LNaHK relies on its diuretic effects; however, the role of aldosterone (aldo) in the diuresis is not understood. LNaHK mice exhibit an increase in renal K secretion that is dependent on the large, Ca-activated K channel, (BK-alpha with accessory BK-beta 4; BK-alpha/beta 4). We hypothesized that aldo causes an osmotic diuresis by increasing BK-alpha/beta-mediated K secretion in LNaHK mice. We found that the plasma aldo concentration (P[aldo]) was elevated by 10-fold in LNaHK mice compared with control diet (Con) mice. We subjected LNaHK mice to either sham surgery (sham), adrenalectomy (ADX) with low aldo replacement (ADX-LA), or ADX with high aldo replacement (ADX-HA). Compared to sham, the urinary flow, K excretion rate, transtubular K gradient (TTKG), and BK-alpha and BK-beta 4 expressions, were decreased in ADX-LA, but not different in ADX-HA. BK-beta 4 knockout (beta 4KO) and WT mice exhibited similar K clearance and TTKG in the ADX-LA groups; however, in sham and ADX-HA, the K clearance and TTKG of beta 4KO were less than WT. In response to amiloride treatment, the osmolar clearance was increased in WT Con, decreased in WT LNaHK, and unchanged in beta 4KO LNaHK. These data show that the high P[aldo] of LNaHK mice is necessary to generate a high rate of BK-alpha/beta 4-mediated K secretion, which creates an osmotic diuresis that may contribute to a reduction in CV disease.