Modest dietary K+ restriction provokes insulin resistance of cellular K+ uptake and phosphorylation of renal outer medulla K+ channel without fall in plasma K+ concentration

Extracellular K⁺ concentration (K⁺]) is closely regulated by the concerted regulatory responses of kidney and muscle. In this study, we aimed to define the responses activated when dietary K⁺ was moderately reduced from a control diet (1.0% K⁺) to a 0.33% K⁺ diet for 15 days. Although body weight and baseline plasma K⁺] (4.0 mM) were not reduced in the 0.33% K⁺ group, regulatory responses to conserve plasma K⁺] were evident in both muscle and kidney. Insulin-stimulated clearance of K⁺ from the plasma was estimated in vivo in conscious rats with the use of tail venous and arterial cannulas. During infusion of insulin·(50 mU·kg^–1·min^–1), plasma K⁺] level fell to 3.2 ± 0.1 mM in the 1.0% K⁺ diet group and to only 3.47 ± 0.07 mM in the 0.33% K⁺ diet group (P < 0.01) with no reduction in urinary K⁺ excretion, which is evidence of insulin resistance to cellular K⁺ uptake. Insulin-stimulated cellular K⁺ uptake was quantitated by measuring the K⁺ infusion rate necessary to clamp plasma K⁺ at baseline (in µmol·kg^–1·min^–1) during 5 mU of insulin·kg^–1·min^–1 infusion: 9.7 ± 1.5 in 1% K⁺ diet was blunted to 5.2 ± 1.7 in the 0.33% K⁺ diet group (P < 0.001). Muscle K⁺] and Na⁺-K⁺-ATPase activity and abundance were unchanged during the 0.33% K⁺ diet. Renal excretion, which was measured overnight in metabolic cages, was reduced by 80%, from 117.6 ± 10.5 µmol/h/animal (1% K⁺ diet) to 24.2 ± 1.7 µmol/h/animal (0.33% K⁺ diet) (P < 0.001). There was no significant change in total abundance of key renal K⁺ transporters, but 50% increases in both renal PTK cSrc abundance and ROMK phosphorylation in the 0.33% K⁺ vs. 1% K⁺ diet group, previously established to be associated with internalization of ROMK. These results indicate that plasma K⁺] can be maintained during modest K⁺ restriction due to a decrease in insulin-stimulated cellular K⁺ uptake as well as renal K⁺ conservation mediated by inactivation of ROMK, both without a detectable change in plasma K⁺]. The error signals inciting and maintaining these responses remain to be identified. potassium homeostasis; Na⁺-K⁺-ATPase; H⁺-K⁺-ATPase; protein tyrosine kinase; cSrc