Hyperkalemia (high potassium) is a medical disorder in which the blood contains too much potassium. CHRONIC KIDNEY DISEASE causes Hyperkalemia is a common electrolyte disorder that occurs most commonly in people with impaired kidney function, with end-stage renal illness having the highest frequency (ESRD).

High blood potassium levels or rapid elevations can induce sudden cardiac death. Severe hyperkalemia is a medical emergency. Aside from a reduction in potassium excretion by the kidneys (as observed in chronic kidney disease (CKD) or end-stage renal disease (ESRD) and sometimes exacerbated by drugs such as renin-angiotensin-aldosterone system (RAAS) inhibitors), an improper shift between the intracellular and extracellular space, as well as increased dietary potassium consumption, might worsen hyperkalemia.

  • Chronic and acute hyperkalemia are the two types of hyperkalemia.
  • Acute hyperkalemia is a single episode that can last from hours to days and need immediate medical attention. 
  • Chronic hyperkalemia develops gradually over weeks to months, maybe permanent or recurrent, and needs regular outpatient care.

How common is hyperkalemia?

  • Although the real incidence and frequency of hyperkalemia are unknown, it is believed to be between 2-3 percent in the general population and 1 percent to 10% in hospitalized patients. 
  • It is thought to be 2 to 3 times more common among those with chronic renal disease, heart failure, diabetes mellitus, and those using blood pressure medications termed renin-angiotensin-aldosterone system inhibitors (RAAS).
  • It develops in more than half of pre-dialysis CKD patients.

When are potassium levels said to be high?

  • Potassium imbalance is indicated by a blood potassium level of >5.0. To signify severity, subjective criteria are utilized, such as mild (>5.0), moderate (>5.5), and severe (>6.0). 
  • The severity of clinical findings is measured by the speed with which symptoms occur, the extent of the severity, and the progression of clinical findings.

Signs of Elevated Potassium Levels

  • If symptoms do appear, they are frequently vague and include heart palpitations,
  • nausea,
  • weakness, and paresthesia.
  • Paresthesia is a tingling, numbing, or burning feeling that commonly occurs in the hands, feet, arms, or legs.

Diagnosed Hyperkalemia

  • The diagnosis includes an evaluation of kidney and heart function, as well as blood tests and an electrocardiogram (ECG) to see if the hyperkalemia has to be treated right away. An ECG is a test that looks for issues with the heart’s electrical activity.
  • The more rapidly serum potassium levels rise, and the more evidence of toxicity emerges, the more vigorous the therapy must be.

Hyperkalemia Treated/Managed

  • The patient’s clinical presentation, the speed with which the illness progressed, the degree of hyperkalemia, and the presence or absence of ECG abnormalities all influence the therapy options.
  • Stabilizing heart function, shifting potassium to the intracellular space [using a combination of IV insulin plus glucose (to offset hypoglycemia), albuterol, and sodium bicarbonate], and removing potassium with potassium binders, diuretics, or dialysis are all part of the treatment for acute hyperkalemia.
  • Confirmation, enhanced laboratory surveillance, dietary review and counseling, a review of medicines (prescription, over-the-counter, and herbal), and, if needed, a potassium-lowering drug and/or a diuretic are all required in the treatment of persistent hyperkalemia. 

Recently, new potassium-lowering drugs have been developed:

  • Patiromer binds potassium in the gastrointestinal system and was authorized by the FDA in October 2015. (primarily in the colon).
  • With its delayed beginning of the effect, it should not be utilized as an emergency therapy for life-threatening hyperkalemia. It’s a dry powder that is combined with water and swallows.
  • The FDA is now reviewing sodium zirconium cyclosilicate (ZS-9), which binds potassium in the gastrointestinal system. In individuals with hyperkalemia, it has been tested in three double-blind, placebo-controlled studies and one continuing 12-month open-label clinical research, totaling over 1,600 participants. It comes as a powder to be combined with water and swallowed.
  • Both patiromer and ZS-9 have been shown in published research to safely and efficiently lower potassium levels in individuals with a variety of underlying illnesses, including heart failure and chronic renal disease.

Drug-induced Hyperkalemia-Work

  • It can be caused by dietary variables (high-potassium meals, additives, and/or salt replacements) as well as concomitant disorders (e.g., CKD, heart failure. Drug-induced hyperkalemia, on the other hand, is the most prevalent cause of high potassium in routine medical treatment.
  • In 35-75 percent of hospitalized patients with hyperkalemia, prescription and non-prescription medicines have been recognized as the primary contributory cause.
  • In a study of 168 individuals with severe hyperkalemia discovered during or after hospital admission, 60% were taking at least one medicine known to induce or exacerbate hyperkalemia.
  • It was shown to be the cause of mortality in 10% of these instances.
  • Drugs that affect the renin-angiotensin-aldosterone system (RAAS), such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers, are the most prevalent cause of hyperkalemia (ARBs).
  • It can also be caused by potassium-sparing diuretics, beta-blockers, NSAIDs, calcineurin inhibitors, potassium-based salt replacements, potassium dietary supplements, heparin, trimethoprim (an antibiotic), and other medications.
  • The use of RAAS inhibitors to slow the course of CKD is a common treatment. In individuals with heart failure, RAAS inhibitors have also been found to minimize sickness and mortality. However, to control potassium levels, they are frequently stopped or under-prescribed, which may reduce or eliminate their potential morbidity and mortality benefit.
  • The development of two novel potassium binders, sodium zirconium cyclosilicate (ZS-9) and patiromer, may allow RAAS treatment to be used more liberally, even in hyperkalemic patients. This may lead to better results in people with cardiovascular and renal illnesses.
  • Under normal circumstances, the kidneys eliminate 90% of the potassium eaten daily, with faeces excreting the remaining 10%.
  • Because of the impact of renal failure on potassium homeostasis, people with chronic kidney disease (CKD) have a higher risk of hyperkalemia.
  • In individuals with CKD, an episode of hyperkalemia increases the risk of death within one day after the occurrence.
  • With a reported prevalence of 44 percent to 73 percent among kidney transplant recipients who undergo immunosuppressive medication with calcineurin inhibitors (cyclosporine or tacrolimus), hyperkalemia is also frequent. 
  • The use of angiotensin-converting enzyme inhibitors (ACE inhibitors) like Captopril, Enalapril, Lisinopril, Ramipril, and angiotensin-converting enzyme receptor blockers (ARBs) like Olmesartan, losartan, valsartan, telmisartan, to delay the course of chronic allograft nephropathy increases the risk.

Hyperkalemia Prevention| chronic kidney disease

A low-potassium diet is an ideal method to safeguard health if you’ve experienced hyperkalemia or are at risk for it. Certain high-potassium foods, such as: may need to be reduced or eliminated.

  • Asparagus.
  • Avocados.
  • Bananas.
  • Oranges and grapefruit, for example, are citrus fruits and juices.
  • Spinach that has been cooked.
  • Honeydew and cantaloupe are examples of melons.
  • Nectarines.
  • Potatoes.
  • Prunes, raisins, and other dried fruits are examples of this.
  • Winter squash and pumpkin
  • Potassium-fortified salt replacements.

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