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Urea Excretion Rate as a Contributor to Trimethoprim-induced Hyperkalemia
- Heino Velazquez, PhD;
- David H. Ellison, MD; and
- Mark A. Perazella, MD
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IN RESPONSE:
In a recent study [1], we showed that trimethoprim inhibits potassium secretion and blocks sodium channels in the renal distal tubule and that half of the patients with AIDS who were treated with trimethoprim developed hyperkalemia (plasma potassium >5.0). We attributed this finding to a decrease in renal potassium excretion caused by trimethoprim.
Drs. Schreiber and Halperin propose another possible reason, namely a low volume delivery (low osmolar delivery, specifically urea) to the distal tubule. Tubule fluid flow rate is an important determinant of potassium secretion [2] and limiting distal solute delivery can decrease potassium secretion. We do not have data on urea excretion or volume status of the patients in our study sample, but we agree that this possibility should be studied further.
Heino Velazquez, PhD
David H. Ellison, MD
Mark A. Perazella, MD
Yale University School of Medicine; New Haven, CT 06520-8029
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
