Hyperkalemia Causes and Risk Factors
Major Causes of Hyperkalemia
- Hyperkalemia is primarily caused by impaired renal excretion, excessive intake, or shift of potassium from intracellular to extracellular space, with serum potassium >5.0 mmol/L being the defining characteristic 1, 2
- Chronic kidney disease (CKD), especially when eGFR <15 mL/min/1.73 m², is a primary cause of hyperkalemia due to reduced potassium filtration 2, 3
- Urinary obstruction is a cause of hyperkalemia 4
- The European Heart Journal recommends considering renin-angiotensin-aldosterone system inhibitors (RAASi), including ACE inhibitors 1, angiotensin receptor blockers (ARBs) 5, mineralocorticoid receptor antagonists (e.g., spironolactone) 6, and direct renin inhibitors (aliskiren) 1, 6, 5, as potential causes of hyperkalemia
- Potassium-sparing diuretics (e.g., triamterene, amiloride) 5, NSAIDs (non-steroidal anti-inflammatory drugs) 5, and beta-blockers 5 can also contribute to hyperkalemia
- Excessive dietary potassium consumption 4 and potassium supplements 5 are additional causes of hyperkalemia
- Acidosis (causes potassium to move out of cells) 4, rhabdomyolysis (muscle breakdown releasing intracellular potassium) 4, and hemolysis (red blood cell destruction, e.g., from blood transfusions) 4 can lead to transcellular shifts and hyperkalemia
- Tumor lysis syndrome (rapid breakdown of malignant cells) 7, 8 is another cause of hyperkalemia
Risk Factors for Hyperkalemia
- Advanced CKD (especially eGFR <45 mL/min/1.73 m²) 2, 3, diabetes mellitus 2, heart failure 2, and advanced age 2 are risk factors for hyperkalemia
- Combination of multiple potassium-altering medications 2, 5 and male gender (slightly higher risk) 2 also increase the risk of hyperkalemia