Hyperkalemia - clinical significance, treatment approaches


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Hyperkalemia, as an electrolyte disorder, is common among patients with ckd, diabetes mellitus, heart failure, patients using angiotensin-aldosterone system inhibitors and non-steroidal anti-inflammatory drugs. Various studies have shown that in patients with cardiovascular disease and/or ckd, hyperkalemia is a significant risk factor for all-cause mortality. Currently available therapeutic interventions to treat chronic hyperkalemia include potassium restriction in the diet, active use of diuretic therapy, correction of acidosis and administration of sodium or calcium polystyrenesulfonate. Potassium binding resins remain the only drugs currently available in everyday clinical practice. despite the seriousness of the problem of hyperkalemia, there are still not enough clinical studies on the effective and safe treatment of this pathology.

Full Text

Restricted Access

About the authors

Evgeniy V. Shutov

SBHCI "City Clinical Hospital n.a. S.P. Botkin of the Moscow Healthcare Department”; FSBEI FPE "Russian Medical Academy of Continuous Professional Education" of the Ministry of Health of the Russian Federation

Email: shutov_e_v@mail.ru
Doctor of Medical Sciences, Head of the Department of Nephrology № 12; Professor at the Department of Nephrology and Hemodialysis Moscow, Russia

References

  1. Hiatt N., Katayanagi T., Miller A. Cardiac sensitivity to hyperkalemia in adrenalectomizeddogs. Proc. Soc. Exp. Biol. Med. 1975;149:168-71.
  2. Coulter D.B., Swenson M.J. Effects of potassium intoxication on porcine electrocardiograms. Am. J. Vet. Res. 1970;31:2001-11.
  3. Fisch C. Relation of electrolyte disturbances to cardiac arrhythmias. Circulation. 1973;47:408-19.
  4. El-Sherif N., Turitto G. Electrolyte disorders and arrhythmogenesis. Cardiol. J. 2011;18:233-45.
  5. Surawicz B. Relationship between electrocardiogram and electrolytes. Am. Heart J. 1967;73:814-34.
  6. Lee S.H., Kim K.J., Chang C.H., Heo S.B. Cardiac arrest from acute hyperkalemia during liver surgery - A case report. Korean J. Anesthesiol. 2010;59(l):124-27. doi: 10.4097/kjae.2010.59.S.S124.
  7. Wiltrout C. Hyperkalemia, bradycardia, and cardiac arrest during percutaneous declotting of an arteriovenous graft. Semin. Intervent. Radiol. 2010;27:241-44. doi: 10.1055/s-0030-1253520.
  8. Huggins R.M., Kennedy W.K., Melroy M.J., Tollerton D.G. Cardiac arrest from succinylcholine-induced hyperkalemia. Am. J. Health Syst. Pharm. 2003;60:694-97.
  9. Acker C.G., Johnson J.P, Palevsky PM., Greenberg A. Hyperkalemia in hospitalized patients: Causes, adequacy of treatment, and results of an attempt to improve physician compliance with published therapy guidelines. Arch. Intern. Med. 1998;158:917-24.
  10. Montague B.T., Ouellette J.R., Buller G.K. Retrospective review of the frequency of ECG changes in hyperkalemia. Clin. J. Am. Soc. Nephrol. 2008;3:324-30.
  11. Green D., Green H.D., New D.I., Kalra P.A. The clinical significance of hyperkalaemia-associated repolarization abnormalities in end-stage renal disease. Nephrol. Dial. Transplant. 2013;28:99-105. doi: 10.1093/ndt/gfs129
  12. Khattak H.K., Khalid S., Manzoor K., Stein P.K. Recurrent life-threatening hyperkalemia without typical electrocardiographic changes. J. Electrocardiol. 2014;47:95-97. doi: 10.1016/j.jelectrocard.2013.07.012.
  13. Yu A.S. Atypical electrocardiographic changes in severe hyperkalemia. Am. J. Cardiol. 1996;77:906-8.
  14. Martinez-Vea A., Bardaji A, Garcia C., Oliver J.A. Severe hyperkalemia with minimal electrocardiographic manifestations: A report of seven cases. J. Electrocardiol. 1999;32:45-9.
  15. Szerlip H.M., Weiss J., Singer I. Profound hyperkalemia without electrocardiographic manifestations. Am. J. Kidney Dis. 1986;7:461-65.
  16. Fordjour K.N., Walton T., Doran J.J. Management of hyperkalemia in hospitalized patients. Am. J. Med. Sci. 2014;347:93-100. Doi: 10.1097/ MAJ.0b013e318279b105.
  17. Dreyfuss D., Jondeau G., Couturier R., Rahmani J., Assayag P., Coste F. Tall T waves during metabolic acidosis without hyperkalemia: A prospective study. Crit. Care Med. 1989;17:404-8.
  18. Huwez F.U., Pringle S.D., Macfarlane P.W. Variable patterns of ST-T abnormalities in patients with left ventricular hypertrophy and normal coronary arteries. Br. Heart J. 1992;67:304-7.
  19. Brady W.J., Chan T.C. Electrocardiographic manifestations: Benign early repolarization. J. Emerg. Med. 1999;17:473-78.
  20. Somers M.P., Brady W.J., Perron A.D., Mattu A. The prominent T wave: Electrocardiographic differential diagnosis. Am. J. Emerg. Med. 2002;20: 243-51. doi: 10.1053/ajem.2002.32630.
  21. An J.N., Lee J.P., Jeon H.J., Kim D.H., Oh Y.K., Kim Y.S., Lim C.S. Severe hyperkalemia requiring hospitalization: Predictors of mortality. Crit. Care. 2012;16:R225. doi: 10.1186/cc11872.
  22. McMahon G.M., Mendu M.L., Gibbons F.K., Christopher K.B. Association between hyperkalemia at critical care initiation and mortality. Intensive Care Med. 2012;38:1834-42. doi: 10.1007/s00134-012-2636-7.
  23. Khanagavi J., Gupta T., Aronow W.S., Shah T., Garg J., Ahn C., Sule S., Peterson S. Hyperkalemia among hospitalized patients and association between duration of hyperkalemia and outcomes. Arch. Med. Sci. 2014;10:251-57. doi: 10.5114/aoms.2014.42577.
  24. Einhorn L.M., Zhan M., Hsu V.D., Walker L.D., Moen M.F., Seliger S.L., Weir M.R., Fink J.C. The frequency of hyperkalemia and its significance in chronic kidney disease. Arch. Intern. Med. 2009;169:1156-62. Doi: 10.1001/ archinternmed.2009.132.
  25. Iseki K., Uehara H., Nishime K., Tokuyama K., Yoshihara K., Kinjo K., Shiohira Y., Fukiyama K. Impact of the initial levels of laboratory variables on survival in chronic dialysis patients. Am. J. Kidney Dis. 1996;28:541-48.
  26. Brunelli S.M., Du Mond C., Oestreicher N., Rakov V., Spiegel D.M. Serum potassium and short-term clinical outcomes among hemodialysis patients: Impact of the long interdialytic interval. Am. J. Kidney Dis. 2017;70:21-9. doi: 10.1053/j.ajkd.2016.10.024.
  27. Genovesi S., Valsecchi M.G., Rossi E., Pogliani D., Acquistapace I. Sudden death and associated factors in a historical cohort of chronic hemodialysis patients. Nephrol. Dial. Transplant. 2009;24:2529-36.
  28. Karnik J.A., Young B.S., Lew N.L., Herget M., Dubinsky C., Lazarus J.M., Chertow G.M. Cardiac arrest and sudden death in dialysis units. Kidney Int. 2001;60(1):350-57.
  29. Pun PH., Lehrich R.W., Honeycutt E.F., Herzog C.A., Middleton J.P. Modifiable risk factors associated with sudden cardiac arrest within hemodialysis clinics. Kidney Int. 2011;79(2):218-27. doi: 10.1038/ki.2010.315.
  30. Morrison G., Michelson E.L., Brown S., Morganroth J. Mechanism and prevention of cardiac arrhythmias in chronic hemodialysis patients. Kidney Int. 1980;17:811-19.
  31. Lorincz I., Maytus J., Zilahi Z., Kun C., Karanyi Z., Kakuk G. QT dispersion in patients with end-stage renal failure and during hemodialysis. J. Am. Soc. Nephrol 1999;10:1297-302.
  32. Cupisti A., Galetta F., Caprioli R., Morelli E., Tintori G.C., Franzoni F., Lippi A, Meola M., Rindi P., Barsotti G. Potassium removal increases the QTc interval dispersion during hemodialysis. Nephron. 1999;82:122-26.
  33. Morris S., Galiatsou E., Stewart G.A., Rodger R.S., Jardine A.G. QT dispersion before and after hemodialysis. J. Am. Soc. Nephrol. 1999;10:160-63.
  34. Buemi M., Aloisi E., Coppolino G., Loddo S., Crasci E., Aloise C., Barilla A., Cosentini V., Nostro L., Caccamo C., Floccari F., Romeo A., Frisina N., Teti D. The effect of two different protocols of potassium haemodiafiltration on QT dispersion. Nephrol. Dial. Transplant. 2005;20:1148-54.
  35. Rombola G., Colussi G., De Ferrari M.E., Frontini A., Minetti L. Cardiac arrhythmias and electrolyte changes during haemodialysis. Nephrol. Dial. Transplant. 1992;7:318-22.
  36. Butkus D.E., Alfrey A.C., Miller N.L. Tissue potassium in chronic dialysis patients. Nephron. 1974;13:314-24.
  37. Johny K.V, Lawrence J.R., O’Halloran M.W., Wellby M.L., Worthley B.W. Studies on total body, serum and erythrocyte potassium in patients on maintenance haemodialysis. The value of erythrocyte potassium as a measure of body potassium. Nephron. 1970;7:230-40.
  38. Cohen J.D., Neaton J.D., Preineas R.J., Daniels K.A., the Multiple Risk Factor Intervention Trial Research Group Diuretics, serum potassium and ventricular arrhythmia in the multiple risk factor intervention trial. JAMA. 1982;60:548-54.
  39. Goyal A., Spertus J.A., Gosch K., Venkitachalam L., Jones P.G., Van den Berghe G., Kosiborod M. Serum potassium levels and mortality in acute myocardial nfarction. JAMA. 2012;307:157-64.
  40. Grodzinsky A., Goyal A., Gosch K., McCullough P.A., Fonarow G.C., Mebazaa A, Masoudi F.A., Spertus J.A., Palmer B.F., Kosiborod M. Prevalence and prognosis of hyperkalemia in patients with acute myocardial Infarction. Am. J. Med. 2016;129:858-65. doi: 10.1016/j.amjmed.2016.03.008.
  41. Korgaonkar S., Tilea A., Gillespie B.W., Kiser M., Eisele G., Finkelstein F., Kotanko P., Pitt B., Saran R. Serum potassium and outcomes in CKD: Insights from the RRI-CKD cohort study. Clin. J. Am. Soc. Nephrol 2010;5:762-69. doi: 10.2215/CJN.05850809.
  42. Foley R.N., Curtis B.M., Randell E.W., Parfrey PS. Left ventricular hypertrophy in new hemodialysis patients without symptomatic cardiac disease. Clin. J. Am. Soc. Nephrol. 2010;5:805-13. doi: 10.2215/CJN.07761109.
  43. Bansal N., Keane M., Delafontaine P., Dries D., Foster E., Gadegbeku C.A., Go A.S., Hamm L.L., Kusek J.W., Ojo A.O., Rahman M., Tao K., Wright J.T., Xie D., Hsu C.Y.; CRIC Study Investigators. A longitudinal study of left ventricular function and structure from CKD to ESRD: The CRIC study. Clin. J. Am. Soc. Nephrol. 2013;8:355-62. doi: 10.2215/CJN.06020612.
  44. Bansal N., Fan D., Hsu C.Y., Ordonez J.D., Go A.S. Incident atrial fibrillation and risk of death in adults with chronic kidney disease. J. Am. Heart Assoc. 2014;3:e001303. doi: 10.1161/JAHA.114.001303.
  45. Soliman E.Z., PrineasR.J., Go A.S., Xie D., Lash J.P, Rahman M., Ojo A., Teal V.L., Jensvold N.G., Robinson N.L., Dries D.L., Bazzano L., Mohler E.R., Wright J.T., Feldman H.I; Chronic Renal Insufficiency Cohort (CRIC) Study Group. Chronic kidney disease and prevalent atrial fibrillation: The Chronic Renal Insufficiency Cohort (CRIC). Am. Heart J. 2010;159:1102-107. doi: 10.1016/j.ahj.2010.03.027.
  46. Drawz P.E., Babineau D.C., Brecklin C., He J., Kallem R.R., Soliman E.Z., Xie D., Appleby D., Anderson A.H., Rahman M.; CRIC Study Investigators. Heart rate variability is a predictor of mortality in chronic kidney disease: A report from the CRIC Study. Am. J. Nephrol. 2013;38:517-28. doi: 10.1159/000357200.
  47. Harnett J.D., Foley R.N., Kent G.M., Barre P.E., Murray D., Parfrey PS. Congestive heart failure in dialysis patients: Prevalence, incidence, prognosis and risk factors. Kidney Int. 1995;47(3):884-90. doi: 10.1038/ki.1995.132
  48. Rizk D.V., Gutierrez O., Levitan E.B., McClellan W.M., Safford M., Soliman E.Z., Warnock D.G., Muntner P. Prevalence and prognosis of unrecognized myocardial infarctions in chronic kidney disease. Nephrol. Dial. Transplant. 2012;27:3482-88. doi: 10.1038/ki.1995.132.
  49. Lorincz I., Matyus J., Zilahi Z., Kun C., Karanyi Z., Kakuk G. QT dispersion in patients with end-stage renal failure and during hemodialysis. J. Am. Soc. Nephrol. 1999;10:1297-302.
  50. Sise M.E., Courtwright A.M., Channick R.N. Pulmonary hypertension in patients with chronic and end-stage kidney disease. Kidney Int. 2013;84: 682-92. doi: 10.1038/ki.2013.186.
  51. Kim S.C., Chang H.J., Kim M.G., Jo S.K., Cho W.Y., Kim H.K. Relationship between pulmonary hypertension, peripheral vascular calcification, and major cardiovascular events in dialysis patients. Kidney Res. Clin. Pract. 2015;34:28-34. doi: 10.1016/j.krcp.2015.01.003.
  52. Fenton F., Smally A.J., Laut J. Hyperkalemia and digoxin toxicity in a patient with kidney failure. Ann. Emerg. Med. 1996;28:440-41.
  53. Turgutalp K., Bardak S., Helvaci I., IggUzar G., Payas E., Demir S., Kiykim A. Community-acquired hyperkalemia in elderly patients: Risk factors and clinical outcomes. Ren. Fail. 2016;38:1405-12. doi: 10.1080/0886022X.2016.1216714.
  54. Loutradis C., Tolika P., Skodra A., Avdelidou A., Sarafidis P.A. Prevalence of hyperkalemia in diabetic and non-diabetic patients with chronic kidney disease: A Nested Case-Control study. Am. J. Nephrol. 2015;42:351-60. doi: 10.1159/000442393.
  55. Agarwal R., Sinha A.D., Pappas M.K., Abraham T.N., Tegegne G.G. Hypertension in hemodialysis patients treated with atenolol or lisinopril: A randomized controlled trial. Nephrol. Dial. Transplant. 2014;29:672-81. doi: 10.1093/ndt/gft515.
  56. Hayes J., Kalantar-Zadeh K., Lu J.L. Association of hypo- and hyperkalemia with disease progression and mortality in males with chronic kidney disease: the role of race. Nephron. Clin. Pract. 2012;120:c8-c16. doi: 10.1159/000329511.
  57. Kovesdy C.P., Regidor D.L., Mehrotra R. Serum and dialysate potassium concentrations and survival in hemodialysis patients. Clin. J. Am. Soc. Nephrol. 2007;2:999-1007. doi: 10.2215/CJN.04451206.
  58. Pitt B., Collins A.J., Reaven N. Effect of cardiovascular comorbidities on the mortality risk associated with serum potassium. Circulation. 2014;130(2):A13320-A13320.
  59. Torlen K., Kalantar-Zadeh K., Molnar M.Z. Serum potassium and cause-specific mortality in a large peritoneal dialysis cohort. Clin. J. Am. Soc. Nephrol. 2012;7:1272-84. doi: 10.2215/CJN.00960112.
  60. Herzog C.A., Mangrum J.M., Passman R. Sudden cardiac death and dialysis patients. Semin. Dial. 2008;21(4):300-7.
  61. Foley R.N., Gilbertson D.T., Murray T., Collins A.J. Long interdialytic interval and mortality among patients receiving hemodialysis. N. Engl. J. Med. 2011;365(12):1099-107. doi: 10.1056/NEJMoa1103313.
  62. Bleyer A.J., Hartman J., Brannon P.C., Reeves-Daniel A., Satko S.G., Russell G. Characteristics of sudden death in hemodialysis patients. Kidney Int. 2006;69(12):2268-73. doi: 10.1038/sj.ki.5000446.
  63. Perazella M.A., Mahnensmith R.L. Hyperkalemia in the elderly: drugs exacerbate impaired potassium homeostasis. J. Gen. Intern. Med. 1997;12(10):646-56.
  64. Salem M.M., Rosa R.M., Batlle D.C. Extrarenal potassium tolerance in chronic renal failure: Implicationsfor the treatment of acute hyperkalemia. Am. J. Kidney Dis. 1991;18:421-40.
  65. Muto S., Sebata K., Watanabe H., Shoji F., Yamamoto Y., Ohashi M., Yamada T., Matsumoto H., Mukouyama T., Yonekura T., Namiki S., Kusano E. Effect of oral glucose administration on serum potassium concentration in hemodialysis patients. Am. J. Kidney Dis. 2005;46:697-705.
  66. Sica D.A. Diuretic use in renal disease. Nat. Rev. Nephrol. 2011;8:100-9. doi: 10.1038/nrneph.2011.175.
  67. DeFronzo R.A. Hyperkalemia and hyporeninemic hypoaldosteronism. Kidney Int. 1980;17:118-34.
  68. Kamel K.S., Ethier J.H., Quaggin S., Levin A., Albert S., Carlisle E.J., Halperin M.L. Studies to determine the basis for hyperkalemia in recipients of a renal transplant who are treated with cyclosporine. J. Am. Soc. Nephrol. 1992;2:1279-84.
  69. Lepage L., Dufour A.C., Doiron J., et al. Randomized clinical trial of sodium polystyrene sulfonate for the treatment of mild hyperkalemia in CKD. Clin. J. Am. Soc. Nephrol. 2015;10:2136-42. doi: 10.2215/CJN.03640415.
  70. Nasir K., Ahmad A. Treatment of hyperkalemia in patients with chronic kidney disease: A comparison of calcium polystyrene sulphonate and sodium polystyrene sulphonate. Journal of Ayub. Medical College, Abbottabad: JAMC. 2014;26:455-58.
  71. Gruy-Kapral C., Emmett M., Santa Ana C.A., Porter J.L., Fordtran J.S., Fine K.D. Effect of single dose resin-cathartic therapy on serum potassium concentration in patients with end-stage renal disease. J. Am.Soc. Nephrol. 1998;9:1924-30.
  72. Jing Wang, Meng-Meng Lv, Odeh Zach, et al. Calcium-Polystyrene Sulfonate Decreases Inter-Dialytic Hyperkalemia in Patients Undergoing Maintenance Hemodialysis: A Prospective, Randomized, Crossover Study. Ther. Apher. Dial. 2018;22(6):609-16. doi: 10.1111/1744-9987.12723.
  73. Шутов Е.В., Котлярова Г.В., Лысенко К.М., Федоров Д.В. Клиническое исследование применения кальция полистиролсульфоната для коррекции гиперкалемии у пациентов на программном гемодиализе. Клин. нефрология, 2019;1:22-7.
  74. Jadoul M., Karaboyas A., Goodkin D.A., et al. Potassiumbinding resins: associations with serum chemistries and interdialytic weight gain in hemodialysis patients. Am. J. Nephrol. 2014;39:252-59. doi: 10.1159/000360094.
  75. Weir M.R., Bakris G.L., Bushinsky D.A., et al. Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. N. Engl. J. Med. 2015;372:211-21. doi: 10.1056/NEJMoa1410853.
  76. Minford E.J., Hand T., Jones M.C. Constipation and colonic perforation complicating calcium resonium therapy. Postgrad. Med. J. 1992;68:302.
  77. Bakris G.L., Pitt B., Weir M.R., Freeman M.W., Mayo M.R., Garza D., Stasiv Y., Zawadzki R., Berman L., Bushinsky D.A.; AMETHYST-DN Investigators. Effect of patiromer on serum potassium level in patients with hyperkalemia and diabetic kidney disease: The AMETHYST-DN randomized clinical trial. JAMA. 2015;314:151-61. Doi:
  78. Pitt B., Anker S.D., Bushinsky D.A., et al. Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial. Eur. Heart J. 2011;32:820-28. doi: 10.1093/eurheartj/ehq502.
  79. Bushinsky D.A., Williams G., Pitt B., et al. Patiromer induces rapid and sustained potassium lowering in patients with chronic kidney disease and hyperkalemia.Kidney Int. 2015;88(6):1427-33.
  80. Packham D.K., Rasmussen H.S., Lavin P.T., El-Shahawy M.A., Roger S.D., Block G., Qunibi W., Pergola P., Singh B. Sodium zirconium cyclosilicate in hyperkalemia. N. Engl. J. Med. 2015;372:222-31. Doi: 10.1056/ NEJMoa1411487.
  81. Kosiborod M., Rasmussen H.S., Lavin P., Qunibi W.Y., Spinowitz B., Packham D., Roger S.D., Yang A., Lerma E., Singh B. Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: The HARMONIZE randomized clinical trial. JAMA. 2014;312:2223-33. doi: 10.1001/jama.2014.15688.
  82. Bushinsky D.A., Spiegel D.M., Gross C., Benton W.W., Fogli J., Hill Gallant K.M., Du Mond C., Block G.A., Weir M.R., Pitt B. Effect of patiromer on urinary ion excretion in healthy adults. Clin. J. Am. Soc. Nephrol. 2016;11:1769-76. doi: 10.2215/CJN.01170216.
  83. DeFronzo R.A. Hyperkalemia and hyporeninemic hypoaldosteronism. Kidney Int. 1980;17:118-34.
  84. Wiegand C.F., Davin T.D., Raij L., Kjellstrand C.M. Severe hypokalemia induced by hemodialysis. Arch. Intern. Med. 1981;141:167-70.
  85. Jadoul M., Thumma J., Fuller D.S., Tentori F., Li Y., Morgenstern H., Mendelssohn D., Tomo T., Ethier J., Port F., Robinson B.M. Modifiable practices associated with sudden death among hemodialysis patients in the Dialysis Outcomes and Practice Patterns study. Clin. J. Am. Soc. Nephrol. 2012;7:765-74. doi: 10.2215/CJN.08850811.
  86. Morrison G., Michel son E.L., Brown S., Morganroth J. Mechanism and prevention of cardiac arrhythmias in chronic hemodialysis patients. Kidney Int. 1980;17:811-19.
  87. Varallo F.R., Trombotto V., Lucchetta R.C., Mastroianni P. de C. Efficacy and safety of the pharmacotherapy used in the management of hyperkalemia: a systematic review.Pharm. Pract. (Granada) 2019;17(1):1361. Doi: 10.18549/ PharmPract.2019.1.1361.
  88. Harel Z., Harel S., Shah PS., Wald R., Perl J., Bell C.M. Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: A systematic review. Am. J. Med. 2013;126(3):264.e9-e24. Doi: 10.1016/j. amjmed.2012.08.016.
  89. Hagan A.E., Farrington C.A., Wall G.C., Belz M.M. Sodium polystyrene sulfonate for the treatment of acute hyperkalemia: a retrospective study. Clin. Nephrol. 2016;85(1):38-43. doi: 10.5414/CN108628.

Supplementary files

Supplementary Files
Action
1. JATS XML

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies