Maintaining K⁺ balance on the low-Na⁺, high-K⁺ diet

A low-Na⁺, high-K⁺ diet (LNaHK) is considered a healthier alternative to the "Western" high-Na⁺ diet. Because the mechanism for K⁺ secretion involves Na⁺ reabsorptive exchange for secreted K⁺ in the distal nephron, it is not understood how K⁺ is eliminated with such low Na⁺ intake. Animals on a LNaHK diet produce an alkaline load, high urinary flows, and markedly elevated plasma ANG II and aldosterone levels to maintain their K⁺ balance. Recent studies have revealed a potential mechanism involving the actions of alkalosis, urinary flow, elevated ANG II, and aldosterone on two types of K⁺ channels, renal outer medullary K⁺ and large-conductance K⁺ channels, located in principal and intercalated cells. Here, we review these recent advances.