Hyperkalemia Management

Introduction to Hyperkalemia

Hyperkalemia (serum potassium >5.0 mmol/L) develops due to increased potassium intake, reduced potassium excretion, or shift of potassium from intracellular to extracellular space, which is essential for proper diagnosis and management of this potentially life-threatening electrolyte disorder 1

Certain populations have increased risk for developing hyperkalemia, including advanced stages of chronic kidney disease (CKD), heart failure, resistant hypertension, diabetes mellitus, recent myocardial infarction, advanced age, and male sex, with risk increasing as eGFR decreases 2
The American College of Cardiology and other guideline societies may recommend regular monitoring and management of hyperkalemia in these high-risk populations, although specific recommendations are not provided in this article 2

Renal dysfunction, especially when eGFR <15 mL/min per 1.73 m², can lead to hyperkalemia 2
Medication-induced impaired excretion, including renin-angiotensin-aldosterone system inhibitors (RAASi), potassium-sparing diuretics, and other medications, can increase the risk of hyperkalemia 1

Hyperkalemia can lead to cardiac arrhythmias and cardiac arrest, as well as neuromuscular dysfunction, increased hospitalization rates, and increased mortality 3

Regular potassium monitoring, especially when starting or increasing doses of RAASi medications, is recommended for patients at high risk of hyperkalemia 2
Consideration of potassium binders in patients requiring RAASi therapy who develop hyperkalemia, as well as dietary counseling regarding potassium intake and careful medication reconciliation to avoid combinations that increase hyperkalemia risk, are important management strategies 2