Updates in hyperkalemia: Outcomes and therapeutic strategies
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Hyperkalemia is a frequent clinical abnormality in patients with chronic kidney disease, and it is associated with higher risk of mortality and malignant arrhythmias. Severe hyperkalemia is a medical emergency, which requires immediate therapies, followed by interventions aimed at preventing its recurrence. Current treatment paradigms for chronic hyperkalemia management are focused on eliminating predisposing factors, such as high potassium intake in diets or supplements, and the use of medications known to raise potassium level. Among the latter, inhibitors of the renin-angiotensin aldosterone system are some of the most commonly involved medications, and their discontinuation is often the first step taken by clinicians to prevent the recurrence of hyperkalemia. While this strategy is usually successful, it also deprives patients of the recognized benefits of this class, such as their renoprotective effects. The development of novel potassium binders has ushered in a new era of hyperkalemia management, with a focus on chronic therapy while maintaining the use of beneficial, but hyperkalemia-inducing medications such as renin-angiotensin aldosterone system inhibitors. This review article examines the incidence and clinical consequences of hyperkalemia, and its various treatment options, with special emphasis on novel therapeutic agents and the potential benefits of their application.
KeywordsSerum potassium Hyperkalemia Chronic kidney disease Mortality Glomerular filtration rate Renin-angiotensin-aldosterone system
Dr. Kovesdy is an employee of the US Department of Veterans Affairs. Opinions expressed in this paper are those of the author’s and do not represent the opinion of the US Department of Veterans Affairs.
Conflicts of interest
Dr. Kovesdy received consultant fees from Relypsa (manufacturer of Patiromer) and ZS Pharma (manufacturer of zirconium cyclosilicate).
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