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  • Cardio Renal Hyperkalemia - English

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    shaheershayanqazi
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    This document provides guidance on managing acute versus chronic hyperkalemia. It defines the different types and recommends evaluating estimated GFR and bicarbonate levels. For chronic hyperkalemia, it recommends reviewing medications, dietary approaches, and diuretics. Management depends on potassium level, ranging from maintaining renin-angiotensin-aldosterone system inhibitors for mild cases to withholding them for severe cases above 6.0 mmol/L. Pseudo-hyperkalemia can result from sample handling and requires retesting.

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    Cardio-Renal-Hyperkalemia_English

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    This document provides guidance on managing acute versus chronic hyperkalemia. It defines the different types and recommends evaluating estimated GFR and bicarbonate levels. For chronic hyperkalemia, it recommends reviewing medications, dietary approaches, and diuretics. Management depends on potassium level, ranging from maintaining renin-angiotensin-aldosterone system inhibitors for mild cases to withholding them for severe cases above 6.0 mmol/L. Pseudo-hyperkalemia can result from sample handling and requires retesting.

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    © All Rights Reserved
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    14 views2 pages

    Cardio Renal Hyperkalemia - English

    Uploaded by

    shaheershayanqazi
    This document provides guidance on managing acute versus chronic hyperkalemia. It defines the different types and recommends evaluating estimated GFR and bicarbonate levels. For chronic hyperkalemia, it recommends reviewing medications, dietary approaches, and diuretics. Management depends on potassium level, ranging from maintaining renin-angiotensin-aldosterone system inhibitors for mild cases to withholding them for severe cases above 6.0 mmol/L. Pseudo-hyperkalemia can result from sample handling and requires retesting.

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    © All Rights Reserved
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    of 2

    To define whether patient is in:

    Acute hyperkalemia^
    Chronic hyperkalemia*
    Pseudo-hyperkalemia+
    eGFR and bicarbonate should also be closely monitored in all hyperkalemia situations
    Pseudo-hyperkalemia

    Management
    • Pseudo-hyperkalemia is typically
    Acute hyperkalemia Chronic hyperkalemia defined as a difference of >0.3-
    0.4 mmol/L between serum and
    plasma K+.
    • Serum K+ measurement should
    be immediately repeated.
    Refer to the Mild • Ensure blood is sampled
    Moderate Severe
    KDIGO acute K+ (5.0-5.5) (>5.5-6.0) (>6.0) appropriately/or eventually taken
    management as arterial sample.
    algorithm (See page 2 for more details on chronic • In case of hemolysis, to consider
    recommendations hyperkalemia) whether this occurred In the
    sample or in the body.

    ^Acute hyperkalemia is defined where a potassium concentration above the upper limit of normal, is not known to be explained
    by a chronic cause.
    *Chronic hyperkalemia is defined where a potassium concentration above the upper limit of normal, is likely to be explained by a
    chronic cause (e.g. chronic kidney disease, heart failure, induced by regular medication/supplements), and K+ > 5.0mmol/L from
    repetitive measurements over a 3 month period.
    +Pseudo-hyperkalemia is defined where there is a falsely elevated serum potassium concentration, which can occur due to
    mechanical trauma, prolonged tourniquet use (>1 minute) or fist clenching during the process of blood drawing, and through
    blood clotting, centrifugation, elevated white blood cell count, or thrombocytosis.

    Infographic design by Priti Meena M.D, FASN, @Priti899 ; Infographic content by Henry H.L. Wu, MBChB, PGCert, @hhlwu and Amina Rahkisheva, M.D., PhD
    Chronic hyperkalemia Management

    Mild (5.0-5.5) Moderate (>5.5-6.0) Severe (>6.0)

    Important measures to manage hyperkalemia

    • Review K+ inducing medications • Review K+ inducing medications and eliminate K+ supplements.


    and eliminate K+ supplements. • See more information on dietary approaches to hyperkalemia in this tool.
    • See information on dietary • Consider loop diuretics if not prescribed for patients with volume
    approaches to hyperkalemia in overload, increase loop diuretic dose if already previously prescribed
    this tool.
    • Correct acidosis if present.

    RAASi-specific management
    • If on RAASi, aim to maintain RAASi • Consider K+ binder initiation if • Need to reduce K+ to <5.0.
    dose and monitor K+ levels. available to avoid dose reduction.
    • Withhold RAASi and evaluate eGFR,
    • Do not start RAASi if not already • If on RAASi, and K+ binder not bicarbonate and K+ to determine
    prescribed when serum K+ available, reduce RAASi dose and whether RAASi could be restarted.
    >5.0mmol/L. monitor K+ levels.
    • Consider K+ binder initiation if
    • If indication is for heart failure, available to facilitate RAASi
    consider switch to ARNi from RAASi reinitiation.
    if available.

    Additional management in a specific case-to-case basis


    • To consider the prescription of SGLT2 inhibitors for patients with eGFR > 25 mL/min/1.73m2

    ARNi: Angiotensin receptor II blocker-neprilysin inhibitor; ECG: Electrocardiogram; eGFR: Estimated Glomerular Filtration Rate; K+: Potassium;
    KDIGO: Kidney Disease Improving Global Outcomes; MRA: Mineralocorticoid Receptor Antagonists; RAASi: Renin-angiotensin-aldosterone system
    inhibitors; SGLT2: Sodium-glucose Cotransporter-2
    For funding and support information, see: https://www.theisn.org/initiatives/toolkits/raasi-toolkit/#Support

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