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    Clinical Management of Hyperkalemia

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    Author
    Palmer, Biff F
    Carrero, Juan Jesus
    Clegg, Deborah J
    Colbert, Gates B
    Emmett, Michael
    Fishbane, Steven
    Hain, Debra J
    Lerma, Edgar
    Onuigbo, Macaulay
    Rastogi, Anjay
    Roger, Simon D
    Spinowitz, Bruce S
    Weir, Matthew R
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    Date
    2020-11-04
    Journal
    Mayo Clinic Proceedings
    Publisher
    Elsevier Ltd.
    Type
    Article
    Other
    
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    See at
    https://doi.org/10.1016/j.mayocp.2020.06.014
    Abstract
    Hyperkalemia is an electrolyte abnormality with potentially life-threatening consequences. Despite various guidelines, no universally accepted consensus exists on best practices for hyperkalemia monitoring, with variations in precise potassium (K+) concentration thresholds or for the management of acute or chronic hyperkalemia. Based on the available evidence, this review identifies several critical issues and unmet needs with regard to the management of hyperkalemia. Real-world studies are needed for a better understanding of the prevalence of hyperkalemia outside the clinical trial setting. There is a need to improve effective management of hyperkalemia, including classification and K+ monitoring, when to reinitiate previously discontinued renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, and when to use oral K+-binding agents. Monitoring serum K+ should be individualized; however, increased frequency of monitoring should be considered for patients with chronic kidney disease, diabetes, heart failure, or a history of hyperkalemia and for those receiving RAASi therapy. Recent clinical studies suggest that the newer K+ binders (patiromer sorbitex calcium and sodium zirconium cyclosilicate) may facilitate optimization of RAASi therapy. Enhancing the knowledge of primary care physicians and internists with respect to the safety profiles of these newer K+ binders may increase confidence in managing patients with hyperkalemia. Lastly, the availability of newer K+-binding agents requires further study to establish whether stringent dietary K+ restrictions are needed in patients receiving K+-binder therapy. Individualized monitoring of serum K+ among patients with an increased risk of hyperkalemia and the use of newer K+-binding agents may allow for optimization of RAASi therapy and more effective management of hyperkalemia.
    Rights/Terms
    Copyright © 2020 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
    Keyword
    Hyperkalemia--physiopathology
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/14122
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.mayocp.2020.06.014
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