Acute Kidney Injury and Hyperkalemia Management

Renal Function and Hyperkalemia

The American Journal of Kidney Diseases recommends that a creatinine spike to 275 µmol/L with eGFR dropping to 20 mL/min/1.73m² represents Stage 3 AKI, which subsequently recovered to near-baseline levels 1
The Journal of the American College of Cardiology suggests that the combination of diabetes, reduced renal function, and RAAS inhibitors dramatically increases hyperkalemia risk, and recommends avoiding the combination of ACE inhibitors, ARBs, and aldosterone antagonists 5
The American Journal of Kidney Diseases states that at eGFR <60 mL/min/1.73m², patients are at significantly increased risk for hyperkalemia, particularly with RAAS inhibitors, and recommends monitoring potassium levels closely 2
The European Heart Journal indicates that a patient's baseline eGFR 33-45 mL/min/1.73m² places them at Stage 3b CKD, requiring monitoring every 3 months 4

The Journal of the American College of Cardiology recommends immediately reviewing for ACE inhibitors, ARBs, aldosterone antagonists, NSAIDs, or potassium-sparing diuretics that could have precipitated both the AKI and hyperkalemia 5
The American Journal of Kidney Diseases suggests discontinuing any ARB or ACE inhibitor temporarily until potassium stabilizes <5.0 mmol/L, and stopping all NSAIDs, potassium supplements, and potassium-sparing diuretics 2
The Journal of Hepatology recommends evaluating for volume depletion, hypotension, sepsis, or nephrotoxic exposures that caused the creatinine spike to 275 µmol/L 1

The American Journal of Kidney Diseases states that the recent doubling of GGT from 113→210 U/L is the most concerning new finding, and recommends obtaining a hepatic function panel including AST, ALT, alkaline phosphatase, GGT, and bilirubin 6
The Journal of Hepatology suggests that the combination of fluctuating renal function and rising GGT raises concern for hepatorenal physiology, though the rapid renal recovery argues against hepatorenal syndrome 1

The American Journal of Kidney Diseases recommends rechecking creatinine, eGFR, and potassium within 3 days, then at 7 days, and obtaining a hepatic function panel including AST, ALT, alkaline phosphatase, GGT, and bilirubin 6
The Journal of the American College of Cardiology suggests providing dietary counseling to limit high-potassium foods, and avoiding sodium polystyrene sulfonate (Kayexalate) in patients due to GI adverse event risk 5