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Updates on medical management of hyperkalemia

Lopes, Marcelo B.a; Rocha, Paulo N.b; Pecoits-Filho, Robertoa,c

Current Opinion in Nephrology and Hypertension: September 2019 - Volume 28 - Issue 5 - p 417–423
doi: 10.1097/MNH.0000000000000530
PHARMACOLOGY AND THERAPEUTICS: Edited by Sankar D. Navaneethan

Purpose of review Hyperkalemia is a potentially fatal electrolyte disorder, more commonly present when the potassium excretion capacity is imparied. Hyperkalemia can lead to adverse outcomes, especially due to severe cardiac arrhythmias. It can also impair the cardiovascular effects of renin–angiotensin–aldosterone system inhibitors (RAASis) and potassium rich diets, as hyperkalemia frequently leads to their discontinuation.

Recent findings Potassium is a predictor of mortality and should be monitored closely for patients who are at risk for hyperkalemia. Acute hyperkalemia protocols have been revised and updated. Randomized trials have shown that the new anti-hyperkalemic agents (patiromer and zirconium cyclosilicate) are effective hyperkalemia treatment options. The use of anti-hyperkalemic agents may allow for a less restrictive potassium diet and lower RAASi discontinuation rates.

Summary Hyperkalemia should be monitored closely for high-risk patients, as it is associated with adverse outcomes. New therapies have demonstrated effective control, offering hope for potential use in patients that would benefit from diet or medications associated with an increase in serum potassium, indicating that the use of hyperkalemic agents can be associated with better outcomes.

aArbor Research Collaborative for Health, Ann Arbor, Michigan, USA

bDepartment of Internal Medicine and Diagnostic Support, Medical School of Bahia, Federal University of Bahia, Salvador

cSchool of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil

Correspondence to Roberto Pecoits-Filho, MD, PhD, FASN, FACP, Senior Research Scientist, Arbor Research Collaborative for Health, 340 East Huron Street, Suite 300, Ann Arbor, MI 48104, USA. Tel: +1 734 665 4108/+1 734 369 9374; e-mail:

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